Vendors

Company Name*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Are you insured?*

Yes
No

Do you have General Liability insurance?*

Yes
No

Do you have Workers Compensation?*

Yes
No

Do you have a State of Michigan Exclusion Form?*

Yes
No

Location(s) in which you work:*

What is your specialty?*

What types of repairs do you NOT do?*

Costing per hour:*

Costing per job:*

Costing per service call:*

Number of Fleet Vehicles:*

Do you provide/contract inspections for large scale jobs completed by your company?*

Yes
No

References

Name

First Last

Phone

Type of Work Completed:

Name

First Last

Phone

Type of Work Completed:

Name

First Last

Phone

Type of Work Completed:

Insurance Requirements

Workers’ Compensation Insurance and Employers Liability Insurance
Workers Compensation	Statutory
Employers Liability	$500,000 Each Accident $500,000 Each Employee $500,000 Policy Limit
Comprehensive General Liability Insurance
Bodily Injury / Property Damage	$1,000,000 Per Occurrence $2,000,000 Aggregate
Products and Completed Operations	$2,000,000 Aggregate
Comprehensive General Liability Insurance
Bodily Injury/Property Damage	$1,000,000 Combined Single Limit

Upload documents

Drop files here or

Accepted file types: doc, docx, jpg, xls, xlsx, png, Max. file size: 100 MB.

Please upload the following required forms: General Liability Insurance, Workers Compensation Insurance, W-9 Form, and Contractor License

Are you a Sole Proprietor?*

Yes
No

Please complete the Independent Contractor Worksheet and send it to our office.

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References

Insurance Requirements

Call us:(248) 652-8221

Call us:
(248) 652-8221