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aG �-_*• �'T'� '6EA6. Inter tek GS <br />Intertek InfertPk Intertek [""",k Intertek IntPfrek I1,rPrtPk <br />Project Authorization Form for Quote #500526566 <br />To initiate this project, please complete and return the entire quote to Anne Whitson at fax #608- 831 -9279 <br />or anne.whitson @intertek.com. By signing this proposal, you accept the terms and conditions within <br />and attached. <br />Quote issued to: <br />Company Legal Entity Name: <br />Authorized by (print name): <br />Signature: <br />Date Authorized: <br />Client Ready Date: <br />Enter the date when samples, documentation, and <br />prepayment (if required) will arrive at Intertek or will <br />be ready for on -site evaluation <br />Purchase Order # or Initials: <br />Please include a copy of your signed Purchase <br />Order with this form. If your company does not <br />require Purchase Orders for invoice payments, <br />please initial this line to confirm payment of invoices <br />will not be delayed due to the absence of a <br />Purchase Order. <br />Helen Gray <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />(Sunny Isles Beach, FL 33160 <br />Is this project request for an ETL /WH or Other TY ES ** No <br />Intertek Certification Listing? <br />* *If YES, please complete the attached client information sheet and return with this Project <br />Authorization Form if it is a: (1) New Certification Request, or (2) Revision to an Existing Intertek <br />Report involving a change to the Applicant or Manufacturer information. <br />Sample Return: Test samples not consumed during testing may be disposed of or returned after <br />completion of testing. Please choose and initial one option below: <br />Dispose of Sample(s) <br />Return Sample(s) <br />If required, sample disposal fees will be invoiced in <br />addition to quoted project fees; or, <br />'Return sample(s) instructions: <br />Shipping Method: <br />Charge to Account Number: <br />Insurance Value: <br />'Other Instructions: <br />Intertek Testing Services NA, Inc. 0500526566 <br />Page 7 of 8 <br />