Eastern Sign Tech, LLC. SUBCONTRACTOR QUALIFICATION QUESTIONAIRE

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1 Company Name: Date: DBA: Website: Mailing Address: Main Office Main Contact: A/P Contact: Emergency Contact: Cell: Type of Licenses Held: Area Licensed: SERVICE / INSTALLATION CAPABILITIES: # Service / Installation Crews: Service Turnaround Time: Erection and Service Equipment Please specify size where applicable Lifting Capacity Maximum Height 1 Person 2 Person 3 Person Crane Service Truck Scaffolding Auger & Dump Truck Back-hoe & Dump Truck Cherry Picker / Manlift Other (Describe) Total number of shop employees: Union Represented: (List Unions & # Men From Each Union) Inside Storage Space: Outside Fenced: 1

2 Service / Installation Personnel Rates Apprentice: Mechanic: Shop Helper: Other: Permit Procurement: Project Management: Design: Other: Please indicate the number of people required per crew (if applicable): Do you do primary wiring? Do you drill or dig footing holes or do you subcontract? If yes, what size auger is available? Indicate mark-up percentages you charge on cost of: Overhead: Material: Sub-contract Labor: Shop Capabilities Support Steel Fabrication: Custom Cabinet Fabrication: Steel & Sheet Metal Fabrication: Formed (Embossed) Plastic ID Faces: Lexan? In House Painting Capabilities: Advertising Copy Layout Capabilities: Digital Printing Capabilities: Do you fabricate sign cabinets from Extrusion? Do you fabricate signs from Angle Iron & Sheet Metal? Do you have shop and field certified welders? Aluminum? Do you fabricate to U.L. standards? Do you have (or have access to) a registered professional structural engineer? List state(s) registered in: Do you have (or have access to) a registered professional electrical engineer? List state(s) registered in: 2

3 Minority Business Enterprise: yes no Woman Business Enterprise: yes no Disadvantaged Business Enterprise: yes no Year Company Started: D&B #: Tax Exempt (if yes, attach certificate): Federal Tax ID #: Type of Business: (Sole Proprietor, Corporation; Partnership; Other) Bank Reference Bank Name: Address: Contact: Account #: Insurance Name of Insurance Co: Address: Agent Name: Please attach or forward, under a separate cover, a copy of your insurance certificate. Bonding Capabilities Name of Bonding Co: Agent Name: Present Bonding Capacity: Aggregate: 3

4 Has your organization ever failed to complete a construction contract? (If yes, describe): Does your firm have any current or pending litigation or arbitration w/ past or present clients or subcontractors? Within the past (5) years, has any officer or principal of your organization ever been an officer or principal of another corporation when it failed to complete a construction contract? Has your company or any of its principals ever petitioned for bankruptcy, failed in business defaulted or terminated on a contracted awarded to you? ATTACH A LISTING OF AT LEAST (5) PAST CLIENTS. These will be used as references, so please include a eferred that the contacts be people who worked closely with your firm on a day-to-day basis. ATTACH A LISTING OF AT LEAST (5) VENDORS & SUBCONTRACTORS. The information required is identical to that in the request above. 4

5 NON-COMPETE AGREEMENT This agreement is made as of the date of the last signature below by and between Eastern Sign Tech, LLC. (:EST"), having principal offices at 1899 Route 38, Southampton, NJ 08088, and. ("Subcontractor"), having its address at. Per this agreement Subcontractor agrees that for so long as Subcontractor shall remain engaged by EST as a subcontractor for a period of (5) years after termination of engagement with EST for any reason (to be known as the "Non-Compete Period"), Subcontractor shall not directly or indirectly solicit the business of servicing or supporting EST signs / products from an EST customer or client, nor engage in (as an employee, principal, shareholder or partner, consultant or any other capacity) any enterprise conducting business activities directly or indirectly with a EST's customer or client to the extent that said business activities are related to servicing or supporting EST equipment, nor directly or indirectly solicit EST employees for employment. Engagement is at will for both parties and may be terminated by either party upon written notification to the other party. IN WITNESS WHEREOF, the parties herto agree: Eastern Sign Tech, LLC. (Subcontractor) Robert Convery Vice President (Signature) (Printed Name) (Title) (Signature) (Printed Name) (Title) (Date) (Date) PLEASE RETURN THIS FORM AND ALL REQUIRED DOCUMENTS TO: EASTERN SIGN TECH, LLC ROUTE 38 SOUTHAMPTON, NJ ATTN: MARIANNE DUNPHY PHONE: / FAX: MUST BE SIGNED BEFORE WORK IS RELEASED EST Officer Approval Date Payment Terms 5