CONTRACTORS QUALIFICATION STATEMENT

Info provided will be used to select vendors that may be used to service our Commercial/Retail clients.
Please return this form via e-mail to service@jonnafs.com or fax to 248-566-6701.
Should you have any questions contact (248) 341-9696 ext. 702.
Trade: _____________________ Service Area: ________________ Date of Response: _________
Company Name: _______________________________________________
Street Address: ________________________________________________
City: _______________________State: _________________ Zip: _______
Mailing Address__________________________________________ (if different from above)
City: _____________________________________ State: __________________ Zip: ________
Phone: ______________Fax: ______________Website: _______________________________
Contact Name: ________________________ Email Address: ________________________________
Please list the trade(s)/bid package(s) your Company is interested in bidding:
_________________________________________________________________________
Year Company Started: ________ Hourly Rate_______ Trip Charge_____Type of Company: (Circle)
Corporation,

Partnership,

Proprietorship,

LLC,

Sub S. Corp.

Contractors License Number: ___________________ State: ______ Expiration: ___________

Type of Labor: Direct Staff or Subcontracted________________ Number of employees______
Ability to provide Required Documentation: W-9 form, Certificate of Insurance including below
information. Proper Additional Insureds and Limits of Liability are mandatory:
Facility Manager: Jonna Facility Services, LLC 2953 Industrial Row Suite 200 Troy, MI 48084
Owner: Client Name, Client Address
GENERAL LIABILITY - $1,000,000 Combined Single Limit per Occurrence$2,000,000 Annual Aggregate
for Bodily Injury and Property Damage including Premise and Operations,
AUTOMOBILE LIABILITY - $1,000,000 Combined Single Limit Per Occurrence for Bodily Injury and
Property Damage
WORKERS COMPENSATION (NO EXCEPTIONS) - Statutory State Requirements or Owner/Operator
waiver
1

References:
A.Company: ____________________________________________________________________
Address: _____________________________________________________________________
Phone: _____________________________ Fax: ________________________________
Contact: ______________________________________________________________________
B.Company: ____________________________________________________________________
Address: _____________________________________________________________________
Phone: _____________________________ Fax: ________________________________
Contact: ____________________________________________________________________
C.

Company: ____________________________________________________________________
Address: _____________________________________________________________________
Phone: _____________________________ Fax: ________________________________
Contact: ______________________________________________________________________