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Work with Maintco, Inc.


    Company Information

    Attach Certificate of Insurance, General Liability Insurance, and Workers Compensation Insurance

    Insurance and Worker's Compensation Requirements

    Service provider agrees to defend and indemnify Maintco Corp. from liability associated with work
    performed as follows:

    1. Contactors providing service for Maintco Corp. are required to carry current General Liability
      Insurance at minimum $1,000,000 per occurrence and $2,000,000 aggregate

    2. Maintco Corp. must be named Additional Insured on the policy

      • Additional Insured must include language from CG 20 10, 11/85 edition or the equivalent.

    3. Service Providers agree to carry Worker's Compensationinsurance or sign a waiver if not applicable.

    4. Contractors shall supply Maintco Corp. a copy of all such insurance documents as they may be
      amended, modified, cancelled, terminated or replaced.

    Service Providers shall comply with all federal, state and locallaws relating to Worker's Compensation,
    Unemployment Compensation and Social Security withholding.

    Please submit a copy of your Certificate of Insurance, which clearly identifies the following:

    1. Insurance Company Name

    2. Expiration Date of the Policy

    3. Dollar Limits

    4. Maintco Corp, Inc. listed as additional Insured

    5. Maintco Corp, Inc. listed as a Certificate Holder

    Please Complete this section if Worker's Compensation is NOT applicable to your company.

    I certify that Iam the sole owner/operator of the company listed above and I do not have any employees. I
    will provide a certificate of Worker's Compensation Insurance to Maintco Corp. within 10 days of hiring
    any employees. Workers Compensation including employers' liability with minimum limits of $1,000,000 and
    include a waiver of subrogation in favor or Maintco Corporation.

    • Maintco Corp. Protection requires that all Service Providers have a current Contractor's or
      applicable license in the communities and trades in which they service.

    • A copy of your current license must be on file with Maintco Corp. and updated upon expiration I

    • Service Provider agrees not to accept any work assignments if insurance and/or license is not in
      effect or in good standing.

    Please fill out Facilities, Construction, or both

    Facility ServicesConstruction Services

    Facility Services Information

    Areas of Operation (List City and State)

    Air CompressorAir CurtainAsset TransferBoard TourBun Warmer EquipmentCanopyCappuccino EquipmentCeilingChili Cheese EquipmentClean upCoffee Brewer EquipmentCoffee EquipmentCounter InstallationDrive ThruElectricalExterior PaintingFan Repair/ReplacementFence RepairFire Extinguisher and SystemsFlooringFood Equipment SurveyGeneral RepairsGlass/Window/DoorGraffiti RemovalHandymanHealth Dept. /N.O.VHVACIce Brewer EquipmentIced Coffee/Bulk Creamer Eq.Iced Tea EquipmentInfusion Brewer EquipmentInterior PaintingLandscapingLicense/Permits/ViolationsLockMicrowave EquipmentMoney Order MachineNovelty Case InstallPaintingPastry Case InstallPlumbingPick Up/ DeliveryPaintingPost Mix/Fountain MachinePower WashingRefrigerationRoller Grill EquipmentRoofingSafeSanden Hot Food Display Eq.Seal Pest EntryService JobSign Repair/ReplacementSite PerformanceSlurpee EquipmentStore ChangeoverTemp Cooling UnitTurbo Chef EquipmentVault DoorWall RepairWater Filtration SystemWisco Hot Food Display Eq.

    (First hour = service call charge, including travel time and up to 60 minutes of diagnosis)




    Construction Information

    Areas of Operation (List City and State)

    Apartment ComplexesBCPCommercial High RiseCommercial IndustrialCommercial RetailCondo ComplexesDrive ThrusGround UpResidentialRoofingStore ChangeoverTI