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CUSTOMER SERVICE AGREEMENT <br /> LIBRARY 228E**HEALTHCARE <br /> WASTV MANAGEMENT WMHS Knoxville * 9504 Diggs Gap Rd,TN 37754 US <br /> H1B althcatilre THIS OFFER IS VALID UNTIL: EFFECTIVE DATE: -/—/—/3 <br /> oksitions- CONTRACT NUMBER: TERM IN MONTHS: 12 <br /> SALES PERSON: 20-Brian Buerkett REASON CODE: NBG-New Business Greenfield <br /> Customer: Orange County Health Dept. Billing Name: SAME <br /> Hillsborough <br /> Service Address: 300 W Tryon St Billing Address SAME <br /> City: Hillsborough State: NC Zip: 27278 City: State: Zip: <br /> Phone No.: 919-245-2433 Fax: Phone No.: 919-245-2415 Fax: <br /> Contact: Marietta Fort Contact: Cathy Ferniany <br /> Email mforl:Oorangecountvnc.aov Email cfernianv@oranaecountvnc.aov <br /> County: In City Limits? County: In City Limits? <br /> N <br /> Quantity Container Size Waste Type Rate(lb/ea) Frequency o SUN MON TUE WED THUR FRI SA <br /> 2 30 RMW/Sharps 32.50 ea i Every 4 Wks <br /> E ° _ <br /> W C y <br /> aCo <br /> O <br /> Quantity Container size Waste Type Rate(lb/ea)/ea) Frequency 2 SUN MON TUE WED THUR FRI SA <br /> O <br /> L C O <br /> 0 <br /> 0 <br /> Sftecial Instructions <br /> Preferred Delivery Date:ASAP Quantity: Preferred First P/U <br /> Hours of Operation: Map Coordinates: <br /> Special Notes: <br /> Dollar Amount Svc Codes Service Description <br /> JDate of Increase Rate Restriction Base Rate Base Monthly Rate(non-OSHA/BBP) <br /> Z <br /> P.O.Number Bill to Acct# Stop Charge Med Waste Service Call <br /> W <br /> Sales Force# Parent Number $ 32.50 FAdditional Container Additional Container Charge <br /> Z Tax Code SIC Code $ 50.00 Additional Stop Additional Stop Charge <br /> W Price Grouo Minimum Fee Minimum RMW Fee(per stop) <br /> W Delivery Fee Delivery Fee <br /> � OSHA/BBP Service *First outline Rate Description <br /> Z Service Code Overweight Per Lb Overweight Per Lb <br /> WOSHA/BBP Monthly Rate A fuel surcharge and environmental cost recovery charge,calculated as a percentage of <br /> H the Charge(s), will be included on your invoice. Information about the Fuel/ <br /> W *Rate Environmental Charge can be found on our website at www.wm.com/fec under billing Description <br /> Q FRat 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 INDIVIDUAL ACKNOWLEDGES THAT HEISHE HAS READ AND UNDERSTANDS THE TERMS AND CONDITIONS OF THIS AGREEMENT SET FORTH ABOVE AND ATTACHED(WHICH 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 SERVICERMRKET AREA <br /> CUSTOMER: WM HEALTHCARE SOLUTIONS INC.: <br /> q <br /> AUTHORIZED SIGNATURE hQr" AUTHORIZED SIGNATURE <br /> J Brian Buerkett <br /> NAME,TITLE(PRINT OR TYPE) Y9/ NAME,TITLE(PRINT OR TYPE) <br /> DATE DATE <br /> (Please date and initial if more than one location) PAGE 7 OF 10 <br /> DATE INITIAL <br /> WM Healthcare Solutions Inc.• www.healthcare.wm.com•1001 Fannin Suite 4000•Houston,TX 77002• 866-931-6321 <br /> Co.lection template(111/15,11) <br />