⚠️ Single-Use Form — Please Read Before Starting
This form cannot be saved and returned to later. Once you begin, you must complete and submit it in one session.
Closing or refreshing this page will clear your progress.
Have all of the following files ready to upload before you start:
W-9 form, government-issued ID, and your Certificate of Insurance (COI).
You will need two separate COIs — one for each of
the entities below. Each COI must name that entity as an Additional
Insured. They cannot be combined onto a single certificate.
COI #1 — Additional Insured:
City Wide Facility Solutions – Mt. Diablo
2001 Clayton Road, Suite 200
Concord, CA 94520
COI #2 — Additional Insured:
City Wide Franchise Company Enterprises, LLC
15230 W. 105th Terrace
Lenexa, Kansas 66219
Please provide both addresses to your insurance agent before completing this form so both COIs are ready to upload.
Thank you for your interest in partnering with City Wide Facility Solutions – Mt. Diablo.
Please complete all sections of this application. Required fields are marked with a *.
Upload your supporting documents at the bottom. Once submitted, our
team will review your application and be in touch shortly.
Questions? Contact us at dfawkes@gocitywide.com |
Address: 2001 Clayton Road, Suite 200, Concord, CA 94520