Profile of Insurance Company

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					INSURANCE REQUIREMENTS – EXHIBIT A



Please complete the Document Pages 1 through 5 attached, and please read the requirements
below.
       It is the policy of Dualite Sales & Service that all contractors who offer Installation
services meet the following insurance requirements prior to beginning any project:

CERTIFICATE HOLDER:                   Dualite Sales & Service
                                      1 Dualite Lane
                                      Williamsburg, Ohio 45176


                         $2,000,000 – RECOMMENDED COVERAGE

ABSOLUTE MINIMUM REQUIREMENTS ARE:
 $1,000,000 - GENERAL LIABILITY
($500,000 if Maintenance/Service only contractor)
Include PRODUCTS LIABILITY, COMPLETED OPERATIONS, CONTRACTUAL
LIABILITY, and BROAD FORM, PROPERTY DAMAGE.

 $1,000,000 - AUTO LIABILITY
($500,000 if Maintenance/Service only contractor)
Include OWNED, HIRED, and NON-OWNED AUTOS.

 $500,000 - WORKER’S COMPENSATION & EMPLOYER’S LIABILITY
(STATUTORY or Minimum State Requirement)

                     Cancellation clause must provide for a 30 day written notice of the
                       Certificate Holder.
                     Contractors with $500,000 maintenance coverage must increase their
                       General and Auto coverage to $1,000,000 in order to be eligible for
                       installation projects.

NOTE:

The biggest oversight we have experienced in the past is the insurance agent failing to list
Dualite Sales & Service not only as the “Certificate Holder”, but also as “Additional Insured”.
We have found that faxing this form directly to them saves time and avoids confusion. Also,
in the future, any certificates for Dualite Sales & Service should only be sent to address listed
above. Any other addresses that your insurance agent may have on file for us should be
removed.
                    COMPANY PROFILE – EXHIBIT A
                                       Document Page 1 of 5

Company Name:
Street Address:
City:                                             ST:         Zip Code(9-igit):
Company Owner(s) Name:
Shipping Address (if Different)
Street:
  City:                                  ST:       Zip Code(9-digit):
Remittance Address (if different)
Street:
  City:                                  ST:       Zip Code(9-digit):
Mailing Address (if different)
Street:
  City:                                  ST:       Zip Code(9-digit):
Federal Express Address (if different than Shipping address)
Street:
  City:                                  ST:       Zip Code(9-digit):
Customer Service Contact:
Accounting Email Address:
Service Email address:
Digital Capabilities: Yes         No       Explain:

        ****** DUALITE REQUIRES DIGITAL PHOTOS ON ALL JOBS ******


Accounting Contact:
Telephone Number:
Fax Number:
Other Phone Numbers (Pager, etc.):                                 :
24 Hour Emergency Number:
                     COMPANY PROFILE – EXHIBIT B
                                      Document Page 2 of 5


Indicate with a P, S, or N whether your company provides Primary (P), Secondary (S), or
None (N) of the following services:

Manufacturing:             Installation:           Service:        Electrical:


Please check Yes or No for the following items:
Unionized? Yes             No                           Incorporated?       Yes     No
Licensed?     Yes          No                           Bonded?             Yes     No
WBE (Women’s Business Enterprise)?          Yes            No
DBE (Disadvantaged Business Enterprise)?    Yes            No
MBE (Minority Business Enterprise)?         Yes            No


In business since:                            Federal ID Number:        -

NOTE: Please provide a W9 Form with your Federal ID Number and provide a new form
should your ID number be changed in the future.

Hours:    Installation:                    Delivery:                Operation:

Number of employees:                       Number of Crews:

Operating Area and Radius:




Trucks: 35ft              55ft             100ft          130 ft            Other


Maximum Reach Capabilities (other than renting crane):




Insurance Company Name/Address:
                         RATE SHEET - EXHIBIT C
                                   Document Page 3 of 5

PLEASE CHECK THE SIGN SERVICES THAT YOUR COMPANY OFFERS:

INSTALL                          SERVICE                          MANUFACTURING
    Surveys                          Emergency Response               Wholesale
    Neon Signs and Wiring            48-hour response for             Formed Faces
    Pylon Signs over 50 ft.         non-emergency service             Box Signs
    High-rise (over 5 stories        Cleaning                         Neon (in house)
    Rappelling                       Electrical Troubleshooting       Flex Faces
    Primary Electric                 Electronic Repair                Channel Letters
    Foundations/footings             Pressure Washing                 UL Approved
    Electronics                      Fluorescent Repairs              Crating/Shipping
    Other, please note:              Parking Lot Lighting             Other, please note:
                                     Pylon/Monument Signs
                                     over 50 ft.
                                     Painting
                                     Neon
                                     L.E.D. Repairs

                                           RATES:
             Survey                                      Obtain Permits
            $                                           $
             Two men and a crane                         Neon units
            $             Per Hour                      $                 Per Hour
             One man and a crane                         Fabrication rate
            $             Per Hour                      $                 Per Hour
             One man and a service truck                 One man with pickup/van
            $             Per Hour                       for electrical or lamping
             Journeyman Electrician                     $                 Per Hour
            $             Per Hour                       Apprentice Electrician
                                                        $                 Per Hour

                  **Actual time traveled not to exceed 1 hour at base labor rate**

MATERIAL & EQUIPMENT PRICING:
          Ballast - - List less 50 %
          Transformer - - List less 50 %
          Lamp Prices - - List less 50 %
          Misc. Materials & Electronic Ballasts at Cost - - Plus 20 %
          Staging, Lifting at Cost - - Plus 15 %

Dualite Sales & Service
                   Completed By:                                      Date :
                              SAFETY – EXHIBIT D
                                    Document Page 4 of 5


Does your company have a safety program?                    Yes         No



How often are safety meetings conducted?


Are daily inspections made of all crane and/or trucks
and are the inspections documented?                         Yes         No


Does your company abide by all local, county, state,
and Federal OSHA and regulatory agencies?                   Yes         No


Are you a DOT company?                                      Yes         No


Indicate the number of Federal OSHA citations or
complaints in the past three years:


Are your cranes required to be certified?                   Yes         No


How often?



Dualite Sales & Service requires that:


OSHA:
      All work shall be performed in accordance with all applicable laws and       regulations
regarding employee health and safety. It is the contractor’s responsibility to determine if the
state has an OSHA approved state plan for the work being performed, and to determine which
portions of the state plan apply.


ENVIRONMENTAL:
      All materials provided and work furnished shall be In compliance with all federal, state,
and local laws and regulations regarding the environment, including but not limited to the
Federal Clean Air Act, Clean Water Act, Resource Conservation and Recovery Act, Toxic
Substances Control Act, and the Safe Drinking Water Act.
                     PAYMENT TERMS – EXHIBIT E
                                   Document Page 5 of 5

Please select from one of the available payment terms:




                      STANDARD - No discount, paid 30 days after invoice date

                                     *When all documentation and photos, as outlined      on
                                     our purchase order, has been sent with your invoice.


                      2 % DISCOUNT - Paid 10 days after invoice date
                                 PLEASE MARK INVOICE WITH 2% DISCOUNT
                                 *When all documentation and photos, as outlined      on
                                 our purchase order, has been sent with your invoice.




*** You, the contractor are required to sign all purchase orders
from Dualite Sales & Service as an agreement for each specific
job. That acceptance is to be faxed to 513-724-6437.

Contractor:

Company                                            Dualite Sales & Service


Name & Title                                       Signature


Signature                                          Date


Date

				
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