Vendor Application

Company Street Address ^*

Other (please specify)

Describe the work being done ^*

Preferred Payment Type ^*

• If you have chosen ACH, a voided check and your bank information/routing number is required to set up electronic payment for checking accounts.
• You may email your ACH information to - accounting@modugo.com and CC carol@modugo.com

• Invoice Processing:

  • Please send all invoices to: ModuGo Accounts Payable
  • E-mail: ap@modugo.com

After completion of this form, a Vendor Agreement will be sent to you for e-signature.

Once ALL paperwork is completed and received by ModuGo at vendors@modugo.com, an email will be sent to you asking you to register online with myCOI. It is critical that you provide ModuGo with an accurate email address. Part of the registration process includes providing contact information for your insurance agent(s). You will also need this information available to you at the time of registration. Once you have registered and entered the email address for your insurance agent(s), an email will be sent to the insurance agent(s) requesting them to upload your Certificate of Insurance (COI) directly into the myCOI website. Certificates of Insurance cannot be mailed, emailed, or faxed to ModuGo. You will not be allowed to begin work and no payments will be made to you until registration is completed and a compliant COI is received from your agent(s).

Applicant must provide an Acord Certificate evidencing the following minimum limits:

Certificate Holder: ModuGo, LLC.

General Liability:

• $1,000,000 Each Occurrence
• $2,000,000 Aggregate
• $2,000,000
• Products-completed Operations Hazard
• *ModuGo, LLC must be listed as Additional Insured on policy
• *Certificate must show Vendor’s insurance is primary and ModuGo, LLC is non-contributory.

Automobile Liability:

• $1,000,000 Bodily Injury
• $1,000,000 Property Damage

Umbrella Insurance:

• $1,000.000

Workers Compensation/ Employers Liability:

If the services/work to be performed in a monopolistic state, current proof of Workers Compensation coverage from that State must be provided.

$500,000 Each Accident

$500,000 Disease – Each Employee

$500,000 Disease – Policy Limit

*Must include a Waiver of Subrogation in favor of ModuGo, LLC.

*If you are a Sole Proprietor/Individual without employees and are not required by law to carry Workers Compensation insurance, a Worker’s Comp Waiver form must be filled out and uploaded into the myCOI portal upon registration.

Cargo: (Freight Vendors Only)

$5,000 Per Unit ModuGo, LLC must be listed as Loss Payee on policy

Professional Liability (for Professional Services):

$1,000,000 Each Occurrence/$2,000,000 Aggregate

**Copies of Additional Insured, Waiver of Subrogation and Primary/Non-Contributory endorsements must be received by ModuGo, LLC within 30 days after COI.

Comments, Payment Terms, etc.

Required Documentation

The following documents must be submitted along with this application:

• 1. A completed W9 form
• 2. Certificate(s) of Insurance & Endorsements meeting all requirements outlined above (to be uploaded into myCOI portal upon registration)
• 3. For Sole Proprietors/ Individuals, a Workers Comp Waiver form must be filled out and sent to ModuGo at vendors@modugo.com.

If you need a blank Worker’s Comp Waiver form: Click here

If you need a Blank W9 Form: Click here

Attach Certificate of Insurance with Requirements Outlined Above

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