New Contractor Qualification

New Contractor Qualification Form

Revision 2.6 01/11/12

Step 1 - INSTRUCTIONS1)READ these instructions in their entirety prior to entering any information. Crown, it's partners and affiliates treat this as your job application and resume.Errors and omissions will jeopardize your ability to work for these entities.

Step 2 - Questionnaire:

2)

-Read each question carefully and respond as completely as possible. -You must fill in every box and respond to every question on this sheet. -If you have duplicate answers, such as the addresses, you may use "Same as Above" as your answer. -If the question does not apply to your company, you may use "N/A" as your answer.

Step 3 - SOW:

3)

-Indicate all work you are capable of and/or certified to perform by selecting "Yes" from the drop down boxes. -If you are pursuing a Temporary contract for a single project, you still need to select which types of work you will be performing in addition to selecting the "TEMP" box. -You will only be qualified for work you indicate in this section.

Step 4 - COI / Step 4a - ENDORSEMENTS ****BE SURE TO SEND CROWN CASTLE INSURANCE REQUIREMENTS TO YOUR AGENT OR BROKER****

4)

-Once you have completed "Step 3 - SOW", your Certificate of Insurance (COI) will be populated with the coverages required to perform the work indicated for Crown Castle. -You can print or copy and send this form to your insurance carrier as the template for your COI. -If you do not carry the coverage requested, you cannot be qualified for the work you have indicated. You can either reduce the types of work on the SOW, or increase your coverage to become compliant. -Use the drop downs on the right to confirm that your COI matches the example. FAILURE TO ACCURATELY CONFIRM THAT YOUR CERTIFICATE AND ATTACHED ENDORSEMENTS ARE COMPLIANT MAY RESULT IN YOUR QUALIFICATION BEING SUSPENDED

Step 5 - Documents

5)

-Ensure all documents requested are compliant per instructions. -Confirm that all documents requested are attached to your submission. -Double Check the COI and attached endorsements meet all requirements. -Enter your Experience Modification Rating (EMR) or your Merit Rating and obtain loss runs if required.

Step 6 - Ethics

6)

-Read the Proper Business Practices and Ethics Policy carefully. -Check attached box if you agree to these terms, and indicate any exceptions. -If exceptions exist, attach separate document outlining each.

Step 7 - POC List

7)

-Select area where you intend to work and note the Point of Contact information for the Crown Castle Employee. -You may only send your qualification form and documents to ONE Point of Contact. -Your contact will be the Sponsor for your Vendor Qualification.

Step 8 - Crown Sponsor

8)

-This section must be filled out by a current Crown Castle employee. -You will need to obtain sponsorship and approval from a Crown Castle Employee in the area in which you intend to perform work primarily. -Crown Sponsor will determine whether or not there is a need within their area for the type of contractor pursuing qualification. -Crown Sponsor can also determine for which agreement types they wish the contractor to be qualified. Confirm agreement types using dropdown selections. -Approved packages will be sent to sponsors direct supervisor for approval, along with any detail about the qualifications requested. Supervisor will forward to Supply Chain for Processing. -Declined packages will be sent directly to Supply Chain from Sponsor with notation.

SCORECARDThis tab displays the completion level of your New Contractor Request for Crown Castle. The Total Sponsor and Contractor Response Compliance scores must be greater than 95%.

9)

CONTRACTOR - If your total Contractor Response Compliance is less than 95%, your information is incomplete, DO NOT SEND. SPONSOR - If your total Sponsor Response Compliance is less than 95%, your information is incomplete, DO NOT SEND. In either case above, please click on the link below your total percentage ("Click Here For Missing Items"). This will take you to the "Reasons" tab showing only the items still requiring attention.

New Contractor Qualification FormRevision 2.6 01/11/12

STEP 2 - Potential Contractor Questionnaire2.01 2.02 2.03 Legal Entity Name of Applicant: Is the Applicant presently doing business under a fictitious name, trade name, DBA or AKA? (state name) Is the Applicant presently a subsidiary of, or affiliated with, another firm? (state firm) Headquarters Address (no PO Boxes): 2.04

5965 Peachtree Corners East Suite C5, Norcross GA 30071

Remittance Mailing Address: 2.05


General Mailing Address: 2.06


2.07

Email to receive critical contractual announcements and Purchase Orders (Crown prefers you have a general email not one tied to a person): [email protected] Fax to receive Purchase Orders: Contact Name: Rosemarie McConnell Contact Title: CEO Contact Phone: 4043135065 Contact Fax: Contact E-mail: [email protected]

2.08 2.09 2.10 2.11 2.12 2.13 2.14

Contact Web address: www.Broadkey.com Applicant is a (Check only one box): Partner2.15 Corporation ship Choose Choose

Sole Proprietor-ship Choose

LLP Choose

LLC YES

Other Choose

### X

Applicant is able to work in the following countries: (Check all that apply) 2.16 USA YES 2.17 2.18 2.19 2.20 Puerto Rico Choose Canada YES

### ### ### ### ### 2 / 14

State of Organization Federal Tax ID # (EIN or SSAN): Number of Applicants Employees: Number of Vehicles owned by Applicant company:


STEP 2 - Potential Contractor Questionnaire2.21 Within the last three (3) years, has the Applicant or any of its principals or officers, filed bankruptcy or been forced into bankruptcy, receivership or other arrangements pursuant to which the officers or principals were not in control of the dayto-day business of the Applicant? If YES, fully explain on a separate sheet. Choose One

2.22

Are there presently any judgments, suits, sanctions, disbarments, or claims pending against, or contemplated by, the Applicant that could negatively impact its ability to perform any contract with Crown? If YES, explain on a separate sheet.

Choose One

2.23

Applicant represents and warrants, if it is approved for elevated work, that it will implement all procedures and take all measures necessary to ensure that only its and its Lower Tier Contractors employees or agents, who have been properly trained as qualified climbers in accordance with commonly recognized industry practices and applicable federal and state laws and regulations, including but not limited to 13 NCAC 07F.0600, shall perform any elevated work.

Choose One

2.24

Applicant represents and warrants that it is fully aware of and knowledgeable about the inherent dangers of working on or near wireless communication sites that are live, i.e. that are actively receiving and/or transmitting radio signals that may create Radio Frequency Radiation (RFR), hereinafter, Live Site, and will have its employees and Lower Tier Contractors trained accordingly.

Choose One

2.25

The information contained herein is true, complete and correct to the best of the undersigneds knowledge and belief. It is understood that any misleading and/or false information or statements contained herein may disqualify the Applicant and/or be sufficient cause for termination of any contract, agreement or work assignment awarded by Crown and/or its authorized agents.

Yes

3 / 14


Step 3 - SOW***IMPORTANT******Indicate all work you are capable and/or certified to perform by selecting "Yes" from the drop down boxes***JDE Search Type VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ VQ1 VQ VQ1

Work Descriptions Tower Erection Tower Lighting Install Antenna Hardware (Frames, Mounts, Coax, Fasteners) Customer Antenna Installation Sweep tests Access Road Civil Work (Clear, Grub, Grade, Stone & Matting) Fence & Gate Generator / Fuel Pad Foundation Grounding / Meggar Tests Set Equipment Shelters Set Generator / Fuel Tank Shelter / Equipment Foundations Shelter / Room Build Out Telco / Electrical Work Tower Foundations Utilities (PVC Conduit Install) Utility Center (Meterboard with Electrical Equipment) Construction Management (Making decisions on behalf of Crown) Installation (HVAC / Generators) Maintenance, Climbing (Tower Painting, Lighting, Roof Repairs, etc) Landscaping / Grounds Care Maintenance, Ground level (general carpentry, painting, etc.) Site Acquisition Services and SA-Project Management (Advising / consulting) Title Search Zoning Design & Drawings (Construction/ Foundation/Zoning) Structural & Foundation Analysis & Tower Reinforcement Geo-Technical Testing and Reporting Tower Mapping Inspection Services Regulatory Survey (1-A or 2-C) NSD (National Site Development) / DAS (Distributed Antenna Systems) Turnkey Vendor DAS (Distributed Antenna Systems)

Cost Code 32280 32300 32310 38210 38220 32120 32110 32330 32200 32220 32160 32210 32150 32180 32270 32140 32230 32240 33110 32190 6122 32130 6122 30100 30110 30180 30190 32350 30150 30130 33110 30130 All All

Contract Type

Requested

Elevated

G G G G G G G G G G G G G G G G G G G G M M M S S S A A A A A C TK DAS

-

Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

VQ VQ VQ VQ

-

-

Note 1: Engineering Approval Required

INSR LTR

TYPE OF INSURANCE GENERAL LIABILITY

ADD'L SUBR INSRD WVD

POLICY NUMBER

POLICY EFF POLICY EXP (MM/DD/YYYY)(MM/DD/YYYY) EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person)

LIMITS $1,000,000

X -

COMMERCIAL GENERAL LIABILITY CLAIMS MADE

X

OCCUR

X

X

PERSONAL & ADV INJURY

$1,000,000 $2,000,000 $2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: PROPOLICY LOC JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS _ HIRED AUTOS X NON-OWNED AUTOS X

X

X

GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE

DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETARY/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below INSTALLATION FLOATER *includes transit -

A R DX XX -

T F

Y P O C

GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC. AUTO ONLY: AGG. EACH OCCURRENCE AGGREGATE

$1,000,000

$5,000,000 $5,000,000

WC STATUTORY LIMITS E.L. EACH ACCIDENT E.L. DISEASE- EA EMPLOYEE E.L. DISEASE - POLICY LIMIT MAX DEDUCTIBLE -

OTHER $100,000 $100,000 $500,000 $$$$-

PRINT THIS PAGE ALONG WITH THE COI EXAMPLE AND FORWARD TO YOUR INSURANCE CARRIER.Copies of the following Endorsements must be submitted with the qualification package. :Additional Insured: General Liability, Auto Liability, and Excess Liability policies must be endorsed to include Crown Castle USA Inc. and its

parent, joint ventures, subsidiaries and affiliates as Additional Insured. Coverage must include ongoing & completed operations. If you have separate policies for each coverage and the endorsement cannot follow form, you must have a seperate endorsement for each policy.

Waiver of Subrogation: All policies must be endorsed to include a Waiver of Subrogation in favor of Crown Castle USA Inc., and its parent, jointventures, subsidiaries and affiliates. If you have separate policies for each coverage and the endorsement cannot follow form, you must have a seperate endorsement for each policy.

Thirty (30) day notice of Termination, Cancellation or Material Change of any policy: All policies must be endorsed to provide a thirty(30) day notice. The endorsement must be clear that the notice will be : a.) Delivered to the Certificate Holder or Additional Insured and b.) Must outline who is responsible. If you have separate policies for each coverage and the endorsement cannot follow form, you must have a seperate endorsement for each policy.

Click Here if you are unable to comply with, or do not understand an endorsement requirement. Be specific ab


Revision 2.6 01/11/12

STEP 5 - DocumentsCertificate of Insurance (COI) and Endorsements 5.01Must match example from "Step 4 - COI" exactly. Endorsements provided per "Step 4a - Endorsements".

Attached?

CHOOSE

BY SELECTING "YES, ATTACHED" I AM AFFIRMING CROWN CASTLE INSURANCE REQUIREMENTS HAVE BEEN REVIEWED AND MET BY MY AGENT OR BROKER.

W9 - Signed and Dated 5.02Tax ID and Contractor name must match info given in "Step 2 - Questionnaire"

CHOOSERATING

Experience Modification / Merit Rating Worksheet 5.03Current Workers Compensation Experience Rating or Merit Rating Worksheet. ***Rating (EMR) must be 1.00 or lower or Merit must be 100% or lower*** -

CHOOSE9/1/2010

1.90

Last Audited Financial Statement and Current Balance Sheet

5.04

Minimum documents required: Income Statement and Balance Sheet. -

CHOOSE9/1/2010

CROWN CASTLE USA INC. ITS AFFILIATES AND SUBSIDIARIES PROPER BUSINESS PRACTICES AND ETHICS POLICY1.0 Statement of PolicyIt is a fundamental policy of Crown Castle USA Inc. and its affiliates (collectively, CCUSA) to conduct its business with honesty and integrity in accordance with the highest legal and ethical standards. CCUSA and its employees and representatives shall comply with all applicable legal requirements of the United States, Canada, Puerto Rico and every other country in which CCUSA conducts or may conduct business.

2.0

Questionable or Improper Payments or Use of CCUSA's Assets2.1 2.2 The use of any funds or assets of CCUSA for any unlawful or improper purpose is prohibited. No payments or gifts from CCUSA's funds or assets shall be made to or for the benefit of a representative of any domestic or foreign government (or subdivision thereof), labor union, or any current or prospective customer or supplier for the purpose of improperly obtaining a desired government action, or any sale, purchase, contract or other commercial benefit. Notwithstanding the foregoing, commercial business entertainment and transportation which is reasonable in nature, frequency and cost is permitted. Reasonable business entertainment or transportation includes, without limitation, a lunch, dinner, or occasional athletic or cultural event; gifts of nominal value (approximately $100 or less); entertainment at CCUSA's facilities or other authorized facilities; or authorized and reasonable transportation in CCUSA's vehicles or aircraft. In addition, reasonable business entertainment covers traditional promotional events sponsored by CCUSA. This prohibition applies to direct or indirect payments made through third parties and employees as well as is intended to prevent bribes, kickbacks or any other form of payoff.

2.3 2.4

Employees of CCUSA shall not accept payments or gifts of the kinds generally described in this Section. All arrangements with third parties such as distributors or agents should be evidenced or memorialized in a written contract, order, or other document which describes the goods or services that are in fact to be performed or provided and for reasonable fees or costs.

2.5

CCUSA's assets are not maintained for use by employees for non-business related purposes. An employee's occasional personal use of items such as stationery, supplies, copying facilities or telephone, when the cost to CCUSA is insignificant, is permissible. Employees in shall abide by CCUSA's guidelines concerning the use of CCUSA's automobiles as those guidelines may be communicated to them from time to time.

3.0

Conflicts of Interests3.1 A conflict of interest is deemed to exist whenever, as a result of the nature or responsibilities of his or her employment with CCUSA, an employee is in a position to further any personal financial interest or the financial interest of any member of the employee's family. The following situations probably involve conflicts of interests:

a.

An employee's interest in, or holding a position with, any supplier, customer or competitor of CCUSA, except generally for an investment in publicly traded securities.

b.

An employee's acceptance of, or giving permission for a member of the employee's immediate family to accept gifts or favors of more than nominal value from an actual or prospective customer, supplier or competitor of CCUSA, or any governmental official or employee. This does not preclude an employee's acceptance of reasonable business entertainment, such as a lunch or dinner, or events involving normal sales promotion, advertising or publicity.

c.

An employee's disclosure or use of confidential information gained by reason of employment by CCUSA for profit or advantage for the employee or anyone else.

d.

An employee's competition with CCUSA in the provision of services, acquisition or disposition of rights or property.

I have read and understand CCUSA's Proper Business Practices and Ethics Policy (the Policy). I agree that I will comply with the letter and spirit of the Policy during my tenure as a qualified vendor of CCUSA. I further agree to give promptly a written report to the Director of Supply Chain Management describing any circumstances in which: I have reasonable basis for belief that a violation of the Policy by any employee or representative of CCUSA or its affiliates has occurred; I have, or any member of my business has, or may have engaged in any activity which violates the letter or the spirit of the Policy;

To the best of my knowledge and belief, neither I nor any member of my business has any interest or affiliation or has engaged in any activity, which might conflict with CCUSAs Policy, except as noted on a separate attachment. (If no exceptions are noted, please select "I Agree, No Exception" from the drop down menu below)

Choose One

New Contra

STEP 7 - Crown Point of Contact (POC) List

(updated 11/02/2011)

East AreaName of District New England / Upstate NY Eric Pogoda New York State Northeast Metro Delaware Maryland Virginia East Carolina West Carolina Craig Bottrill Sean Booth Anthony Queen Jonathan Dyer Brian Pilkington Dennis Sobecki Dan Popp(or delegate)

Midwest Area(or delegate)

South Area(or delegate)

WestHouston James Voigts Austin

District Manager

Tower Operations Name of District Manager

District Manager

Tower Operations Name of District Manager North Florida South Florida Tennessee Brandy Bowlin

District Manager

Tower Operations Name of District Manager

Cynthia Qualtire Stephen Jastermsky Monica Mosesso Amy Parker Ron McIntosh Raul Figueroa Vic Palmer Jimmy Lafontaine

Pittsburgh

Jeffrey Parsons

Eric Stewart

Indianapolis

Dan Wolfgang Christopher Gladstone Aaron Knight Mike Hamrick

Phoenix Kath Green Los Angeles San Francisco Seattle

Louisville

Georgia

Chicago

Alabama Puerto Rico

St. Louis

Robert Bruce

Program Managers National Site Development (NSD)Bill Gorgone Patrick Doyle Scott Davidson

Daryl

Site Acquisition Directors Alternative Site Development (ASD)Kevin Conroy Type of Work Tower Reinforcements/Antenna Installations Tower Lighting and Maintenance New Site Builds TBD Contact District Manager Tower Operations Mgr. Program Manager David Markum

Christop

For email address use first name then a "p name followed by @crowncastl


ontact (POC) List

(updated 11/02/2011)

West Area(or delegate)

District Manager John Landry

Tower Operations Manager

Chad Thibodeaux

Rob Zanoni Connie Walters Scott Crisler Angela Castellano Steven Sanford Paul Schmitz

Matt Dunham

ram Managers e Development (NSD)Daryl Teed

quisition Directors ite Development (ASD)Christopher Elliot

For email address use first name then a "period" then last name followed by @crowncastle.com


CONTRACTOR LEGAL NAME:0

STEP 8 - Crown Sponsor Questionnaire8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT 8.09 INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT INCOMPLETE PACKAGE - DO NOT SUBMIT

VENDOR QUALIFICATIONS REQUESTEDG M S General Construction - Ground Level Maintenance - Ground Level Services - Site Acquisition -

CONFIRMED?Yes Yes or No Yes Yes Yes Yes Yes or or or or or No No No No No

Sponsor: Confirm your request to qualify contractor for agreement type(s) listed above.

Documents Attached?5.01 5.02 5.03 5.04 Certificate of Insurance (COI) and Endorsements W9 - Signed and Dated Yes or No Yes or No Yes or No Yes or No 20% Err:508

8.10

INCOMPLETE PACKAGE - DO NOT SUBMIT

-

Total Contractor Response Compliance Total Sponsor Response Compliance


Revision 2.6 01/11/12

SCORECARD% Percent Complete

Step 2 - Questionnaire Step 3 - SOW Step 4 - COI Step 5 - Documents Step 6 - Ethics Step 8 - Crown Sponsor

0.000%

100.000%

0.000%

0.000%

0.000% Err:508

Total Contractor Response Compliance Total Sponsor Response Compliance

20.000% Err:508Err:508

CLICK HERE FOR MISSING ITEMS

VENDOR QUALIFICATIONS REQUESTEDG M S General Construction - Ground Level Maintenance - Ground Level Services - Site Acquisition -

c t o New Contractor Qualification Form r Revision 2.601/11/12

SCORECARDSTEP STEP STEP STEP STEP 2 Contractor Questionnaire Incomplete (See Below) 4 Contractor must indicate if COI matches Example 5 Contractor must confirm compliant documents attached (See Below) 7 Contractor must confirm understanding of Crown Castle Ethics Policy 8 Please complete Crown Sponsor Questionnaire (See Below)

m u s t a t t a c h C u r r e n t W o r k e r s C o m p e n s a t i o n E x p e r i e n c e o r M e r i t R a t i n g

Step 2 - Contractor Questionnaire2.01 2.02 2.03 2.08 2.12 2.17 2.18 2.19 2.20 Please Please Please Please Please Please Please Please Please indicate Legal Name indicate whether operating under fictitious/trade name or dba (If not, indicate "N/A") indicate whether a subsidiary or affiliated with another firm (If not, indicate "N/A")

indicate Fax for Purchase Orders

indicate Contact Fax

indicate indicate indicate indicate

State of Organization Federal Tax ID (must match W-9) # of Applicants Employees # of Vehicles Owned by Company

2.21

You have either failed to indicate or have indicated "Yes" regarding bankruptcy or other similar arrangements. Answering "Yes" will require full description approval from your Area contact to proceed with qualification. You have either failed to indicate or have indicated "Yes" regarding judgments/suits or other similar arrangements. Answering "Yes" will require full description and approval from your Area contact to proceed with qualification. You have either failed to indicate or have indicated "No" regarding Elevated Work procedures. If you have indicated on the SOW that you intend to perform Elevated work, you MUST have proper procedures/training. You have either failed to indicate or have indicated "No" regarding RF Safety procedures. You must have this knowledge and these procedures in place to perform work. -

2.22

2.23 2.24 -

Step 3 - Scope Of Work (SOW)-

-

-

Step 4 - COICOI You must confirm that all items on your COI match the example.

Step 5 - Documents5.01 5.02 5.03 5.04 Contractor must attach Certificate of Insurance and confirm it matches example in "Step 4 - COI" exactly. Contractor must attach W9 and ensure the name and Tax ID match information given in "Step 2 - Questionnaire". Contractor must attach Current Workers Compensation Experience or Merit Rating worksheet. ***Rating (EMR) must be 1.0 or lower or Merit Rating must be 100% or lower*** Contractor must attach last audited Financial Statement and current Balance Sheet.

Step 6 - EthicsEthics Contractor must choose a selection and agree to Ethical Business Practices

w o r k s h e If Contr e Contrac t . If Contr * * * R a t i n g ( E M

Step 8 - Crown Sponsor8.01 8.02 8.03 8.04 8.05 8.06 Please indicate Sponsors Name Please indicate Sponsors Title Please indicate Sponsors Area Please indicate Sponsors District Please indicate when Contractor will be needed to start work Please indicate if this is a Request to Reinstate a Contractor 13/14


SCORECARD8.08 8.12 Please indicate if this is a Customer Request (Crown To Pay Contractor) Please indicate if this Contractor will be providing services for the DAS program

14/14