REQUESTOR NAME
Enter name of requestor / DATE SUBMITTED
Enter date submitted / DATE COMPLETED [FOR INTERNAL USE ONLY]
SUPPLIER NUMBER [FOR INTERNAL USE ONLY] / ☐ADD☐CHANGE☐REPLACE Enter vendor # to be deleted
TO BE COMPLETED BY SUPPLIER
AM/NS Calvert Standard Payment Terms are Net 60
SUPPLIER NAME
Enter supplier name – should match legal name on W-9 / FEDERAL TAXPAYER ID NUMBER
Enter Tax ID Number here
CORPORATE HEADQUARTER’S STREET ADDRESS (NO PO BOX)
Enter corporate street address / CITY
Enter City
STATE
Enter state / ZIP CODE
Enter Zip Code / COUNTRY
Enter Country
PAYMENT TERMS
Payment Terms / SCAC
Enter SCAC / WEBSITE
Enter website
ORDERING INFORMATION [Attach a signed W-9(domestic) or W-8BEN-E(foreign)]
STREET ADDRESS (NO PO BOX)
Enter ordering address here / CITY
Enter City
STATE
Enter state. / ZIP CODE
Enter Zip Code / COUNTRY
Enter Country
CONTACT NAME (PRIMARY)
Enter name of primary contact / PHONE
Enter phone no. / FAX
Enter Fax no. / E-MAIL (POs)
Enter primary email address
E-MAIL (RFQs)
Enter primary email address
CONTACT NAME (ALTERNATE)
Enter name of alternate contact / PHONE
Enter phone no. / FAX
Enter Fax no. / E-Mail (POs)
Enter alternate email address
E-MAIL (RFQs)
Enter alternate email address
REMITTANCE INFORMATION[Attach signed EFT Agreement, bank letter, voided check, or remit instructions]
REMIT TO STREET ADDRESS
Enter remit to street address / REMIT TO PO BOX
Enter PO Box / REMIT TO CITY
Enter city
REMIT TO STATE
Enter state / REMIT TO ZIP CODE
Enter zip code / REMIT TO COUNTRY
Enter country
CONTACT NAME
Enter contact name / PHONE NUMBER
Enter phone no. / FAX NUMBER
Enter Fax No.
NOTE: All foreign vendors must provide a bank letter with instructions for receiving USD wires to bank accounts outside the U.S.
CERTIFICATIONS [Attach a copy of all named certificates]
QUALITY CERTIFICATIONS
☐ISO 9001: current edition☐ISO TS 16949: current edition☐Other – Explain
☐ISO 14001: current edition☐Lab-ISO/IEC 17025 or equiv: current edition
MINORITY/WOMEN/VETERAN BUSINESS ENTERPRISE CERTIFICATIONS
☐MBE – Minority Business EnterpriseCertificate Type:Choose an item.
☐WBE – Women Business EnterpriseCertificate Type:Choose an item.
☐VOB – Veteran Owned BusinessCertificate Type:Choose an item.
Certifying Agency: / ☐NMSDC / ☐WBENC
INSURANCE CERTIFICATE / Insurance Group: Select Insurance Group
- Review Insurance Requirements matrix attached and identify your insurance group, minimum coverage levels, and declaration requirement.
- Attach a Certificate of Liability meeting these requirements on an ACORD Form;
- Certificates not meeting the specified insurance requirements will be discarded.
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SUPPLIER PROFILEBUSINESS TYPE:
Choose an item.Choose an item. / PRODUCTS / SERVICE OFFERED:
Enter products / service offered
NO. OF EMPLOYEES: Enter no. of employees / ESTIMATED ANNUAL SALES: Enter estimated annual sales
UNION AFFILIATIONS:Enter union affiliations / NATIONAL MAINTENANCE AGREEMENT SIGNATORY:Y or N
Will work be performed on our site by your employees or sub-contractors?Y or N
Will sales calls be made at our plant?Y or N
How will deliveries be made? ☐Supplier’s Truck☐Third Party Carrier
☐Other Enter shipping/delivery method here
RELATIVE OR FORMER EMPLOYEE DISCLOSURE
Is anyone in the company an Ex AM/NS Calvert or ArcelorMittal employee?* (former companies, subsidiaries, etc.) / Y or N / Enter name of former employee
Enter name of former employee
Is anyone in the company a relative of a current AM/NS Calvert or ArcelorMittal employee? / Y or N / Enter name of individual
Enter name of individual
A “Current or Former Employee or Relative” means any person who is currently or was within the past three (3) years a salaried, non-represented employee of any ArcelorMittal company (a “Current or Former Employee”) and any person who is a parent, child or sibling of a Current or Former Employee.
SUPPLY CHAIN SECURITY
- Is your company solely a service provider?
N= Go to Question 2
- Will goods be shipped to ArcelorMittal or AM/NS Calvert from outside the USA?
N=Please continue to Terms & Conditions
- Is the company CTPAT certified?
N= Attached completed Supply Chain Security Survey
IMPORTER SECURITY FILING (ISF) REQUIREMENTS
☐ By marking this checkbox, you acknowledge that you have read and understand the US Customs Importer Security Filing (ISF) Reporting Requirements below, applicable for all shipments excluding DDP (Incoterms 2010).
NO LATER THAN 48 HOURS PRIOR TO LADEN ON BOARD SELLER MUST REPORT/FORWARD THE FOLLOWING CARGO RELATED INFORMATION TO .
1. Full name and physical address of seller related information
2. Full name and physical address of buyer related information
3. Importer of record number identification number
4. Consignee number(s)
5. Full name and physical address of manufacturer (or supplier) of good(s)
6. Full name and physical address of ship to party
7. Country of Origin
8. The six digit commodity tariff classification as sourced from Harmonized Tariff Schedule of the United States
9. Full name and physical address of the container stuffing location
10. Full name and address of the consolidator
11. The Bill of Lading number and
12. Commercial invoice, pro-forma or customs invoice.
FAILURE TO FILE: US Customs and Border Protection (CBP) shall withhold the release or transfer of the cargo until CBP receives the required ISF information and has had the opportunity to review the documentation and conduct any necessary examination. CBP has the authority to limit the permit to unlade so as to not permit unlading of merchandise for which no ISF has been filed. Further, if such cargo is unladen without permission, it may be subject to seizure. Liquidated Damages: CBP may assess a claim for liquidated damages as follows: Late filing: $ 5,000.00; Inaccurate filing: $ 5,000.00; Inaccurate update: $ 5,000.00; Withdrawal: $ 5,000.00 per transaction. Vendor agrees to hold ArcelorMittal harmless from or reimburse ArcelorMittal for any US Customs fines, penalties, direct damages and/or costs of seizure arising out of vendor’s failure to timely provide accurate ISF information.
TERMS AND CONDITIONS
Identify your Terms & Conditions Agreement from the table below. Go to the AM/NS Calvert website to print a copy. Attach a signed copy to the completed supplier application.
T&C Agreement No. / Agreement Type / Examples
AMUSA-100 / General Terms – Purchase Order / Purchases of goods and incidental services
AMUSA-101 / Construction Contract / On site stand-alone contract for construction project
AMUSA-102 / MRO Services / On site construction or industrial services (All on site contractors)
AMUSA-103 / Environmental Services / On site environmental contractor or consulting
AMUSA-106 / Engineering Services / Engineering services
AMUSA-107 / Consulting Services / IT and other consulting services (not covered by another agreement ) on or off-site
Enter agreement no / Previously executed agreement / Agreements previously executed with AM/NS Calvert
If none of the Terms and Conditions above are applicable or you are covered by the AMUSA-100 or another executed agreement, please sign below indicating that you accept and will abide by ArcelorMittal USA LLC Terms & Conditions as referenced on the website below. Attach a copy of the signed Terms and Conditions to the completed application.
Signature of Supplier Representative:
Printed Name: / Enter printed name here / DATE: Enter date of signature
Title: / Enter title here /
GENERAL INFORMATION
Quote Policy: To maintain fair and equitable treatment of all suppliers, all commercial information (including pricing) is to be provided ONLY to the AM/NS Calvert LLC Purchasing Department. Technical information may be provided to non-Purchasing employees.
Gifts and Gratuities: To ensure that all suppliers receive fair treatment, your full support of our “Conflict of Interest” policy is essential. Team members of AM/NS Calvert are not permitted to accept any gifts, dinner invitations, and invitations for other types of entertainment from vendors, customers, or other business partners unless pre-approved by senior management.
Authority: Only the Purchasing Department of AM/NS Calvert is authorized to negotiate / issue a purchase order on behalf of AM/NS Calvert. Actionsby other departments or individuals are unauthorized and will not bind AM/NS Calvert LLC. All goods and services delivered require a published AM/NS Calvert purchase order – no exceptions. Direct all commercial inquiries to your Purchasing contact.
Environmental / SDS: All suppliers must provide Safety Data Sheets (SDSs) for each line item number per PO. Each SDS must reference the Purchase order / release number AM/NS Calvert part number and direct delivery location. These sheets must be forwarded to the plant environmental department Attn: Hazard Communication Coordinator within 48 hours of receipt of product. Failure to comply with this requirement entitles the buyer to demand immediate removal of the product from plant site at the seller’s expense and full reimbursement for the purchase price of the product.
SUPPLIER APPLICATION DOCUMENT CHECKLIST
Please submit the following:
- Completed Supplier Application Form
- Signed W-9 or W-8BEN-E (signed by hand)
- Voided check or remittance instructions on company letterhead must be attached for US suppliers; Bank letter is required for all foreign suppliers
- Certification of Insurance as required
- T&C Agreement (signed by hand)
- Quality / Minority and Women Business Enterprise Certifications (if applicable)
- EFT Agreement (must be signed by hand)
- Complete page 1 for each additional ordering address
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Electronic Funds Transfer Agreement
ATTACH SIGNED COPY TO COMPLETEDSUPPLIER APPLICATION
The undersigned (“Payee”) authorizes AM/NS Calvert LLC ("Calvert") to make payment for goods and services covered by any purchase order or agreement, now or hereinafter in effect, through electronic fund transfer.
In connection with electronic fund transfers, the Payee agrees as follows:
1)Payee will use reasonable efforts to verify and ensure that the Depository Institution selected by Payee is able to receive electronic fund transfers from Calvert's originating bank directly, or from a correspondent bank or through an automated clearing house or any other electronic payment network designated or approved by Calvert from time to time.
2)Payee may, at least 30 days prior to the effective date of the next electronic fund payment by Calvert, change any portion of the information provided in this document by submitting to Calvert an amended payment authorization in a form acceptable to Calvert. The Payee is responsible for any loss which may arise by reason of any error, mistake, or fraud regarding the information provided to Calvert, included but not limited to return fees charged by Calvert's or the Payee's bank for any returned payments, or the Payee's failure to follow the procedure set forth in this document.
3)The payment terms specified in the applicable purchase order or agreement are modified by adding four calendar days to the time period for payment. For example, for payment terms of "net 60 days", the electronic funds transfer will occur on the 64th day. If the payment date is a non-banking day, the electronic funds transfer will occur the following day on which both Calvert's originating bank and the Payee's Depository Institution are available to transmit and receive electronic funds transfers.
4)Electronic fund transfers will be deemed to have been made when the Payee’s Depository Institution receives or has control of the payment. Any loss of payment following the point at which the Payee's Depository Institution receives or has control of the payment will be borne by the Payee.
5)In the event of duplicate payment, overpayment, fraudulent payment or payment made in error, Payee will promptly cause the return of funds to Calvert at its designated originating bank.
6)In the event that payment has not been received by Payee, Payee shall notify Calvert immediately in writing and Calvert will have a reasonable period in which to make the payment, and until the expiration of that period, Payee agrees that it will not have or pursue any rights or remedies against Calvert for any failure to make payment including, without limitation, actual, incidental, or consequential damages.
Company Name: / Enter company name / Contact Name: / Enter contact name /Remit Address: / Enter remit to address / Phone Number: / Enter phone no. /
E-Mail Address: / Enter email address of person signing this form /
E-mail Address*: / Enter email address for remittance advices /
*(For receipt of remittance information; this will be the only remittance information Payee will receive)
Beneficiary Bank Information
Account Name: / Enter account name / Bank Name: / Enter bank name /Account Number: / Enter account no. / Bank Address: / Enter bank address /
ABA/Routing No: / Enter ABA/Routing No. / Bank Contact: / Enter Bank Contact /
IBAN: / Enter IBAN / Bank Phone No.: / Enter bank phone no. /
Swift/UK Sort Code: / Enter Swift Code /
The Payee accepts the terms of this agreement executed on this Choose an item.day ofChoose an item. ,Choose an item..
Payee Authorized Signature:Printed Name: / Enter printed name / Title: Enter title
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INSURANCE REQUIREMENTS- Identify your insurance group, minimum coverage levels, and declaration requirements in the chart below.
- Attach a Certificate of Liability meeting these requirements on an ACORD form to the complete Supplier Application.
- Send a copy of Certificate of Liability meeting these requirements on an ACORD form to:
- Mail: Address below under Certificate HolderFAX: (847) 592-8691E-Mail:
Certificates Not Meeting the following requirements will be discarded:
1)Meets General Liability / Umbrella dollar coverage per category assigned by AM/NS Calvert
2)ArcelorMittal USA Holdings LLC named as an Additional Insured
3)Certificate Holder declared as ArcelorMittal USA Holdings LLC / 4)Workers Comp Waiver of Subrogation declared (Group A-C)
5)Auto Liability minimum met
6)Worker Comp box checked and minimum set
Certificate Holder
ArcelorMittal USA Holdings LLC
c/o Certificate Management Solutions
8725 West Higgins Road, Suite 110
Chicago, IL 60631
Group A / Group B / Group C / Group D / Group E / Group F / Group G
Supplier Type: / High Risk Contractors, Environmental Services / Moderate Risk Contractors, High Risk Services / Lower Risk Contractors, Lower Risk Services, Professional Services, Special Projects / Delivery Only/ No on-site work / Ship to Only/ No on-site work / On-site Consultants / Trucking/Transportation
Examples: / Electrical, General Contractors, Demolition, Steel Erectors, Elevator Installation, Drilling Landfills, UST Removal, Asbestos Abatement, Waste Haulers, Construction Over Railroads / Plumbing, Masonry, Carpentry, Concrete Work, Snow Removal, Elevator Maintenance, HVAC Repair / Drywall Installer, Light Carpentry, Painters, Janitorial, Landscaping, Food Service, Architects, Engineers, Surveyors, Designers, Lawyers, Medical, Outside Processors, Equipment Lessors, Purchased Steel / Trucking/Transportation Vendors
General Liability
Minimum Acceptable Levels / Each Occurrence / $5,000,000 / $2,000,000 / $1,000,000 / $1,000,000 / $1,000,000 / $500,000 / $1,000,000
General Aggregate / $5,000,000 / $2,000,000 / $1,000,000 / $1,000,000 / $1,000,000 / N/A / $1,000,000
Product/Comp Operations Aggregate / $5,000,000 / $2,000,000 / $1,000,000 / $1,000,000 / N/A / $1,000,000
Workers Compensation (At Statutory Limits)
-Employers Liability / Each Accident / $5,000,000 / $2,000,000 / $500,000 / N/A / N/A / N/A / $500,000
Disease / $5,000,000 / $2,000,000 / $500,000 / N/A / N/A / N/A / $500,000
Disease Each Employee / $5,000,000 / $2,000,000 / $500,000 / N/A / N/A / N/A / $500,000
Certificates must include a Waiver of Subrogation in favor of ArcelorMittal USA Holdings LLC / Yes / Yes / Yes / No / No / No / Yes
Automobile Liability (Including Hired and
Non-Owned Vehicles) - Per Accident or Loss / $5,000,000 / $2,000,000 / $1,000,000 / $1,000,000 / N/A / $500,000 / $1,000,000
Motor Truck Cargo / $50,000
All Insurance Certificates must show ArcelorMittal USA Holdings LLC as an Additional Insured, in respect to all work performed for, or on the premises of ArcelorMittal USA Holdings LLC any subsidiary and affiliated companies as required and agreed.
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