Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Person Responsible for Bidding {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Alt Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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State of Incorporation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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W-9 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If Division/Subsidary Parent Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent Company Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address of Parent Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Equipment or other capabilities not listed above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Geography Serviced - States {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Geography Serviced - Counties {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Geography Serviced - Zip Codes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employees - Supervisors {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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UntitledEmployees - Floor Technicians {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employees - Cleaning professionals Full Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employees - Cleaning professionals Part Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Federal EIN # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Unemployment Insurance Acct# {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you carry General Liability Insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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General Liability Insurance Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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General Liability Insurance Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Company Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Policy Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Limit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Exp Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Company Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you carry Workers Compensation Insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Workers Compensation Insurance Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Workers Compensation Insurance Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Policy Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Limit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Insurance Company Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Janitorial Bond Coverage Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Janitorial Bond Coverage Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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To register the Service Provider/Vendor must fully complete this form and submit it to System4 Facility Services.
Approval or Rejection of Service Provider/Vendor Application
System4 reserves the right to approve or reject ANY application in its sole and absolute descretion. The Service Provider/Vendor will have no legal recourse against System4 for the rejection of the application.
Covanant Not to Compete and Non-solicitation
It is agreed that at no time during or for one year after the completion of any contract, billing or agreement with System4 will you engage in any business activity or solicitation which is competitive with System4 for work or contracts discussed, offered or dismissed by System4 including lost business.
Reasons for Rejection
Without limiting the right to reject any application for any reason whatsoever in the System4 absolute discretion, this application will be rejected if it is incomplete and or the applicant does not provide the required insurance and verifications as required by System4.
We declare that the above information is true, correct and complete and is given to induce System4 to accept my application as an authorized System4 Service Provider/ vendor.
Transaction Fee and Term Disclosure
System4 charges a 1% transaction fee for all billings on a monthly basis processed as a deduction from your monthly statement payment. System4 pays all service providers on a net60 term for services rendered to clients.
Name of Individual filling this form out {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Application {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I am authorized to submit this application and agree to the terms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I agree that by placing my name below it acts as my electronic signature for all purposes. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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