2148 Pomona Blvd. Pomona,CA 91768 Phone: 909-397-800 Fax: 909-397-8001

Installation Verification Form Customer Information Customer Name

Chep USA

Project Address

2883 Brighton Henrietta Town Line Rd Rochester, NY Ryan Infield

Contact Names

585 360 3864

Contact Phone #

Project Information Location

Fixture Type-Description

# of Fixtures Quoted

Task lighting

4' Four Lamp T5HO vapor

13

# of Fixtures Installed (Customer Count)

Complete Y/N

Customer Initials

Additional Notes

Installation and Product Warranty Please refer to Monterey Energy, Inc., Limited Warranty Statement and Contractor Warranty for clarification on installation and manufacture warranties.

Customer Acknowledgement and Verification By signing this form customer verifies that the fixture types and quantities listed above were installed per the signed agreement and hereby considers the job substantially complete. By signing this the customer gives the permission to be invoiced and to remit contractor for payment as substantial completion of the project has been achieved. All work that is pending or open will be listed on the Project Completion Punch List. All work referenced on the Project Completion Punch List will be the responsibility of Monterey Energy, Inc. to rectify.

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Date

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Date

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Contact Signature:

Contractor Name: Contractor Signature: