Work Authorization Form - Floor Tek printable pdf download

Work Authorization Form - Floor Tek

FLOORTEK 2016

OCTOBER 18-20, 2016

DALTON! CONVENTION CENTER

WORK AUTHORIZATION FORM

DEADLINE: July 27, 2016

We have contracted with the following firm to erect and/or dismantle our exhibit display:

Service Company:

___________________________________________________________

Address:

___________________________________________________________

City/St./Zip:

___________________________________________________________

Telephone:

‰

______________________ Contact: ____________________________

It is understood that the above contractor will service and maintain insurance coverage as follows:

a) Workmen’s compensation insurance in the minimum amounts required by the laws of the STATE

OF GEORGIA.

b) Comprehensive General Liability insurance with minimum combined single limits of liability of

$1,000,000.00 for bodily injury and/or property damage in any one occurrence.

Such insurance shall be maintained in full force during the period when the contractor is working on

my display at FloorTek Expo 2016.

The independent contractor will furnish Show Management with a Certificate of Insurance attesting to

these coverages. Deadline for receipt of this certificate of insurance is August 28, 2016.

Booth Number:

___________________________________________________________

Exhibiting Company:

___________________________________________________________

Address:

___________________________________________________________

City/St,/Zip:

___________________________________________________________

Authorized Signature:

_______________________________________Date: _______________

Print Name:

______________________________ Title:________________________

Work Authorization Form - Floor Tek