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<br />nom: rf\AmaKer <br /> <br />10: (:jU4LLL4~~~ <br /> <br />I-'age: 4/4 <br /> <br />Uate: {fj/'L.UU I 1: 14:04 I-'M <br /> <br />"Fa'cllity. Services KMART <br />Work Order Survey Form <br /> <br />Store #: KM003761 <br /> <br />STORE STAMP <br /> <br />Location: ZEPHYRHILLS <br /> <br />Contract / Work Order # : <br />Amount of Contract $: <br />Two hour minimum charge may apply <br />Contractor <br /> <br />East Coast Fire Protection <br /> <br />Date/Time Started <br /> <br />Date/Time Completed <br /> <br />Dated Awarded <br /> <br />N umber of people in crew <br /> <br />Project <br /> <br />The following service and/or work tickets by the contractor are associated with this project <br /> <br />The Store Manager MUST complete the following: <br />1, Did the contractor provide sufficient notice to the Store Manager prior to arrival at the store? <br />Yes _ No <br />2. Did the contractor survey the scope of the contract with the Store Manager prior to commencement? <br />Yes _ No <br />3. Were store operations disrupted? Yes No <br /> <br />4. Was the contractor made aware of the disruptions? Yes No <br />Did he do anything to alleviate the problem? Yes No_ <br />5. During the project, were any fixtures or merchandise damaged? Yes No <br />Was the contractor made aware of the damages? Yes No <br />6. If Yes, explain and provide estimate of damages. <br /> <br />7. Workmanship: <br /> <br />Above Average <br /> <br />Average <br /> <br />Below Average <br /> <br />8. Would you recommend using the firm again? Yes <br /> <br />No <br /> <br />9. Store Manager's comments (Print Legibly) <br /> <br />Store Manager's Signature <br /> <br />Date <br /> <br />Store Manager's Name (Print) <br /> <br />Contractor's Signature <br /> <br />Date <br /> <br />This Original Survey Form is to be returned with an Invoice, Waivers of Lien, Service Tickets, Etc. <br /> <br />This fax was sent with GFI FAXmaker fax seNer, For more information, visit: http://www,gfi,com <br />