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Ave a 71-/7 <br /> CUSTOMER SERVICE AGREEMENT <br /> LIBRARY 22SE**HEALTHCARE <br /> WAST16 MANAGEMENT WMHS Knoxville * 9504 Diggs Gap Rd,TN 37754 US <br /> 1140althealra THIS OFFER IS VALID UNTIL: EFFECTIVE DATE: q-1-1-;,, <br /> Solutions, CONTRACT NUMBER: TERM IN MONTHS: 12 <br /> SALES PERSON: 20-Brian Buterkett REASON CODE: NBG-New Business Greenfield <br /> Customer: Orange County Health Dept. Billing Name: SAME <br /> Chapell Hill <br /> Service Address: 2501 Homestead Rd Billing Address 300 W Tryon St <br /> City: Chapel Hill State: NC Zip: 27516 City: Hillsborough state: NC Zip: 27278 <br /> Phone No.: 919-245-2473 Fax: Phone No.: 919-245-2415 Fax: <br /> Contact: Denise Shaver Contact: Cathy Ferniany <br /> Email dshaver0orangggggfljync.goV Email cferniany0orangecountyaQ.ggy <br /> County: In City Limits? County: In City Limits? <br /> Quantity Container Size Waste Type Rate(lb ea) Frequency SUN MON TUE WED THUR FRI SAT <br /> N 2 30 RMW Sharps 32.50 ea 1 Every 4 Wks LLL <br /> C 0 <br /> 76 0 <br /> L--- — <br /> 0 <br /> 76 <br /> CL <br /> W 0 CU <br /> 0 Quantity Container Size Waste Type Rate lb I ea Frequency 0 2 SUN MON TUE WED THUR FRI SATI <br /> 2 :2' <br /> .2 <br /> L <br /> DCL <br /> 10 . <br /> Special InstnUctions, <br /> Preferred Delivery Date:ASAP Quantity:_ Preferred First PIU <br /> Hours of Operation: Map Coordinates: <br /> Special Notes: <br /> Dollar Amount Svc Codes Service Description <br /> >' Date of Increasel I Rate Restrictioni I Base Rate Base Monthly Rate(non-OSHAIBBP) <br /> J - <br /> Z <br /> 0 P.O.Number Bill to Acct#F- Stop Charge Mod Waste Service Call <br /> LU <br /> Sales Force# Parent Number $ 32.50 Additional Container lAdditional Container Charge <br /> ---- <br /> F- Tax Code SIC Code $ 50.00 Additional Stop <br /> TAdditional Stop Charge <br /> z <br /> U.1 Minimum Fee IN Price Group Minimum RM Fee(per stop) <br /> 2 F7 i <br /> LU <br /> OSHA BBP Service *First outline Rate Desoription Delivery Fee Delivery Fee <br /> Z Service Codel Overweight Per Lb 1Overweight Per Lb <br /> W OSHA/BBP Monthly Rate A fuel surcharge and environmental cost recovery charge,calculated as a percentage of <br /> the Charge(s), will be included on your invoice. Information about the Fuel/ <br /> U) *Rate Environmental Charge can be found on our website at www.wm.com/fec under billing <br /> < Description Rate is in addition to per container billing inquiry.State and local taxes,if applicable,will also be added to the Charges. <br /> THIS IS A LEGALLY BINDING CONTRACT,EACH UNDERSIGNED INUVOUAL ACKNOWLEDGES THAT HE/SHE HAS READ AND UNDERSTANDS THE TERMS AND CONDITIONS OF INS AGREEMENT SET FORTH ABOVE AND ATTACHED MHC14 ARE INCORPORATED <br /> HEREIN)AND THAT HE/SHE HAS THE AUTHORITY TO SIGN.ALL DELIVERY AND PICK UP DATES ARE SUBJECT To CHANGE DEPENDING ON ROUTE SERVICE IN THE PARTICULAR SERVICEA"KET AREA. <br /> CUSTOMER: WM HEALTHCARE SOLUTIONS INC.: <br /> AUTHORIZED SIGNATURE Ir AUTHORIZED SIGNATURE <br /> Brian 2 r ett e./G '�✓'1 -. <br /> NAME,TITLE(PRINT OR TYPE) NAME,TITLE(PRINT OR TYPE) <br /> DATE DATE yy <br /> (Please date and initial if more than one location) PAGE J OF (0 <br /> DATE INITIAL <br /> WM Healthcare Solutions Inc.• www.healthcare.wm.com•1001 Fannin Suite 4000•Houston,TX 77002• 866-931-6321 <br /> Collection template(1111511) <br />