SECTION 1: Work Order Site Details
RULER FOODS 408
Service Location:
Phone Information:
Site Contact is:
(314) 869-7884
ST LOUIS, MO 63137
10009 BELLEFONTAINE
PO Information:
Schedule Date/Time:
/
RWO: 12827 August Requested By:
Scheduled With:
Monitoring Acct:
AM / PM
Fire Extinguisher Inspection-Annual
<If unable to complete the full scope of work, OR scope of work changes OR additional work is required tech must contact KFM Account Manager for instruction>
Special Instructions AND Scope of Work
6 - 10LB ABC FIRE EXTINGUISHERS ONSITE
Annual fire extinguisher inspection OK to due six year maintenance, 12 year HT, and recharges. If any need replaced or some added store manager must approve. MAKE
SURE YOU CHECK MOTOR OR ELECTRICAL ROOMS IF LOCKED GET WITH THE STORE MANAGER. IF THERE IS A LITTLE CLINIC IN THE STORE MAKE SURE
YOU INSPECT THIER EXTINGUISHER ALSO IF THEY HAVE FUEL STATIONS OR LIQUOR STORS. ANY NEW CLEAN AGENT OR SPECIALTY EXTINGUISHERS
MUST BE QUOTED OR APPROVED BY CORPORATE -- beginning this Friday 4/24 you are now required to wear a facial mask while working in or visiting a store. The
masks or coverings that are to be worn can be surgical or an associate may bring their own cloth mask as long as they are clean and appropriate.
Location Equipment Information
SECTION 2: TECHNICIAN REQUIRED FIELDS
Arrival Time: AM / PM
Departure Time: AM / PM
Phone Information: ( )
Time Off-Test: AM / PM Operator#
<If unable to complete the full scope of work, OR scope of work changes OR additional work is required tech must contact KFM Account Manager for instruction>
Part# Quantity Description Technician(s) Full Name Labor Hours
* Review ALL paperwork to confirm complete and accurate before invoicing KFM - please submit ALL invoice paperwork within 14 business days of completion
* Invoiced paperwork submitted to KFM that does not include the completed customers required paperwork (where applicable), and the KFM issued work order with description of work performed to
* Invoicing not submitted or awaiting additional information over 30 days will be subject to a NO PAY status unless approved by KFM
SECTION 3: OFFICE REQUIRED BILLING INSTRUCTIONS:
** Technician will complete KFM WO page 2 titled "Deficiency/Recommendation Technician Report" for ALL unapproved services needed and/or being recommended **
Please review the work performed with site contact to include status of system at time of collecting signature(s)
Technician Print Name: ___________________________
Technician Signed Name: _________________________ Customer Signed Name: __________________________
Customer Print Name: ____________________________
STORE STAMP (WHERE REQUIRED)
Materials Used (Contact KFM Account Manager for Approval if NOT in Scope of Work)
Monitoring Company:
Time On-Test: AM / PM Operator#
Summary of Work Performed
* Please email ALL reviewed and completed invoiced paperwork to KFMinvoices@KoorsenFM.com
include ALL applicable inspection reports with technician(s) and customer signatures will NOT be processed for payment.
Date: _________________________________________ Date: __________________________________________
Due Date:
8/25/2021
Issue Date:
Priority Level:Normal
Office: (317) 616-1614Toll Free: (888) 256-5515
Indianapolis, IN 46219
2801 N Catherwood Avenue
Koorsen Facilities Management
Fire Extinguisher Inspection-Annual
7/26/2021
KFM Account:
Jim McHugh
(317) 285-0891
Direct:
KFM Account Manager:
Marmic Fire & Safety (4.0)
KFM Work Order:
Amy Reese
WO Added By:
KFM Service Provider:
80JAY1004
82204
