COVID-19 Transportation Interest Form

Transportation services will be available to residents of the City of Detroit who do not have their own means of transportation for the purpose of COVID-19 testing. All trip requests will be centrally scheduled and not by calling the transportation provider directly. If you are interested in serving as a transportation provider for this operation, please complete the fields below and we will contact you. If you have any questions, please contact Mark de la Vergne at DLVergneM@detroitmi.gov.

Company Name*

Contact Person*

Phone*

E-mail

Fleet Size

Fleet Details

Types of vehicles in your fleet and number of each vehicle size

Number of vehicles available

How many vehicles are available for this service?

Number of vehicles with glass partition

Glass partition between driver and rider

Other Information

Any other information you’d like to share about your fleet or company

General Liability Insurance

Please confirm that you have General Liability Insurance: To include Premises/Completed Operations, Contractual, Personal Injury, Contractual, Personal Injury and Independent Providers with a minimum limit of $1,000,000 per occurrence and $2,000,000 Aggregate. Check the box to confirm.

Automobile Liability Insurance

Please confirm that you have Automobile Liability Insurance: To include “any auto” or all Owned, Non-Owned and Hired Auto, to cover all vehicles operated by Provider under this contract, with a minimum combined single limit of $1,000,000 per accident for bodily injury and property damage. Check the box to confirm.

Certificate of Insurance, W9, Sample Invoice

Please upload copies of the following documents: 1. Certificate of Insurance 2. W9 3. Sample invoice

Drag and drop files here or

Next Steps

We will reach out to you for more information. Thank you!

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