Rep Info

Rep Name

Request Date

Rep Agency

Distributor

Opportunity General Info

Opportunity Name

Electrical Contractor

Opportunity Address

City

Google Earth Coordinates

State

Facility Type

Contact Info

Contact Name

Affiliation

Primary Phone #

Email Address

Opportunity Info/Questions

Opportunity Originated From

If Other

State Purchasing Co-Op

Bid Date

Going out for Bid or Bid Direct

Known Competitors

Approved Supplier

10 Day Prior Date

Approval Submittal Supplied

SLG to Provide Spec

Specifications Provided?

Plans Provided?

Approval Submittal Supplied

BONDING INFO (*5-7 Day Turnaround Time)

*Bid Bond Required?

Certificate of Insurance Required?

*P & P Bond Required?

Prevailing Wages Required?

SOLUTION REQUIREMENTS

Material Only

Turnkey Installation

Partial Installation

Design Details

Field(s) Type

Fixture Series

Field(s) Dimensions

Fixture Wattage

Footcandle Requirements

Fixture Wattage

Egress Requirements

Egress Fixture Type

Spill Requirements

Construction Type

New Construction

Combo

Retrofit

Construction Type

Pole Type

Other

Special Pole Features

Pole Mounting Height

Retrofit

Existing Pole Heights

Retrofit X-arm Method

Existing Fixture Counts

Existing System Photos Provided

Additional Proposal Requirements/Details

Control System

Warranty

Adder(s)

Additional Notes/Comments

COMPLETION OF THIS FORM IS MANDATORY FOR ALL OPPORTUNITIES / PROJECTS