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r-rom: r-Ax.maKer 10: bU4LLL4j8j fJage: L/4 Uate: Ir.3/'2UU/1:14:bj fJM FMG Work Order#: Customer Name: Location ID: 0030146550 KMART - 3761 07/03/2007 Date of Dispatch: KM003761 r-- c= c= ~ ~ ') Provider Information Provider Name: East Coast Fire Protection Phone Number: (800) 252-5069 Fax Number: (804) 222-4393 (. .> -~ ~ '-, Scope of Work 1. Upon arrival call FMG IVR line at 800-306-4122 to check in. 2. Install ciJ'cuits, conduit, wire and new manual fh'e alarm pull station at gal'den center exits. ! And at receiving at the new door. Tie new devices and circuits to existing Simplex 4002 Fire I Alarm system. '0 o ,0 o 3. Upon departure call FMG IVR line at 800-306-4122 to check out. Scheduling Service (must be at least 24 hours prior to date of service) 07/13/2007 Required Completion: ~ , .,j ;.~ ~ ~ -- '" First name of manager at the location: I Last name of manager at the location: I Date customer location called to schedule service: I I Time customer location called to schedule service: I I Performing Service FMG Original Authorized Hours: Provi d er La bor Ra te: FMG Original Authorized Material/Equipment Amount: 24.00 85.00 976.48 FMG Increased Authorized Hours (with FMG authorization code only): I I FMG Authorized Code (if additional hours or material is approved): I I FMG Increased Authorized Material/Equipment Amount (with FMG authorization code only): I I FMG Work Completion/Survey Form All Services performed and parts used listed on the FMG Work Completion/Survey Form' (If it is not on the FMG Work Completion/Survey Form we ca nnot pay you for it) DYes DNa DYes oNo Did you call FMG at 800-306-4122 to confirm your arrival at the location' Did the location ma nager sign the FMG Work Completion/Survey Form? Did you call the FMG Service Department at 800- 306-4122 to verify that the job is done' Did the location manager stamp the FMG Work Completion/Survey Form? (If there is no stamp, did you get a business card or register tape with the location number and address on it?) DYes o No Is the time in and time out noted on the FMG Work Completion/Survey Form? Payment Requirements (FMG Invoice Fax Line 480-753-5481) labor Hours: Is the invoice detailed with breakdown of labor, materials and tax' Material Cost: Are all labor hours and materials on the invoice within the authorized amounts' Tax: Are all labor hours and materials on the invoice clearly noted on the FMG work completion/survey form? Total: Have you faxed FMG at 480-753-5481 the completed invoice, FMG Service Authorization Form and FMG Work Completion/Survey Form? (Mailed invoices will not be accepted) This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www,gfi,com Provider ID: EA S005 DYes DNa DYes DNa DYes DNa DYes DNa DYes DNa DYes o No DYes DNa