International Paint Limited, 2007

This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

J anuary 2007
Chartek Epoxy Fireproofing
Application Contractor Qualification Form

NAME:
ADDRESS:


TELEPHONE NO:
PRINCIPAL CONTACT:

1. EXPERIENCE WITH MASTIC COATINGS YES NO
Materials Used


Process(es)


Surface preparation required YES NO
Type of surface coated


Number of jobs:
Numbers of years experience:





International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

J anuary 2007

2. EQUIPMENT EXPERIENCE
Abrasive blasting


Rigging


Priming



3.
APPROXIMATE ANNUAL SALES
(, US$ or local currency, please state):
Other

4. EMPLOYMENT LEVEL:
Number full time
Number part time

5. FIRE PROTECTION PROJECT EXPERIENCE
(Please provide name, location, type of job, products applied, approximate m
2

protected)
Offshore fabrication, new construction












International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

J anuary 2007
Offshore maintenance






Refineries and petrochemical








Other industrial








Commercial and general buildings/structures, new
construction













International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

J anuary 2007











Commercial and general buildings/structures,
maintenance and retrofit








Other commercial and general














International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

J anuary 2007

7. REFERENCES
(Preferably Three Related to Above Experience)
1. COMPANY NAME:
ADDRESS:



TELEPHONE NO.:
CONTACT NAME:

2. COMPANY NAME:
ADDRESS:



TELEPHONE NO.:
CONTACT NAME:

3. COMPANY NAME:
ADDRESS:



TELEPHONE NO.:
CONTACT NAME:







International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission of International Paint Limited.
All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

6

SUPPLEMENTARY INFORMATION

I. Please list all your present employees who have attended a formal ChartekEpoxy
Fireproofing Applicator Training School:

Employee Name Date of School Location
























International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission of International Paint Limited.
All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.

7

II. Please fill in the name of contacts at your company for the following purposes:
Management:
(Whom do we contact for matters relating to formal Applicator Agreements etc?)
Sales:
(To whom do we refer clients for bids or quotes?)
Commercial/Purchasing:
(Who is the contact for purchasing responsible for ordering materials from us?)
Health & Safety:
(To whom do we send information regarding health and safety questions?)
Quality:
(Who is the company contact on quality assurance matters?)







International Paint Limited, 2007
This document and its contents are the copyright of International Paint Limited and may not be reproduced in whole or in part without the express permission
of International Paint Limited. All products supplied and technical advice or recommendations given are subject to our standard Conditions of Sale.


8
III. If you possess spray equipment approved for Chartek epoxy
fireproofing, please list:










IV. Do you possess plural spray equipment for other epoxy fireproofing
materials? If so, please list.