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Request for flagging services <br /> Southern Region <br /> '10: CN Date submitted: <br /> Attn: Mare Ellen Carmody,Audit Officer <br /> 2800 Livernois,Suite 2211 <br /> Troy,Michigan 48083 <br /> (248)740-6227 <br /> (248)740-6036 fax <br /> marycllcn.carmody(g)cn.ca <br /> FROM: <br /> (Name) <br /> I am requesting a flagman for the following project. All blanks below must be completely- filled <br /> in before any flagman request will be honored. Proof of Insurance must accompany this form. Flagman <br /> will be provided within five (5) business days, at your cost,depending on availability. Direct your calls <br /> concerning availability and problems to(248)740-6227. <br /> Project Location: <br /> RR milepost,Street,etc. <br /> Company: <br /> Billing Address: <br /> Citv: State: Zip: <br /> CompnnN Phone: _ Comp"Im. rax: <br /> **A,geenient or Authorization No.: Dated: <br /> With: <br /> Contractor's Contact Person: Phone: <br /> Date(s) Flagging needed: <br /> Starting time: },nding'Dime: <br /> Location for flaFanan to report: <br /> Prepayment for WEEKDAY flagman protection is required,and must be submitted by over-night delivery to <br /> the address shown at the top of this page. The prepayment amount will be based on the number of weekdays a <br /> flagman is required,at the base rate of$1000.00 per weekday(1-8 hour continuous period). Prepayment for <br /> WEEKEND flagman protection will be at the rate of$150.00 per hour, with an eight hour (8) minimum of <br /> $1,200.00. Any hours in excess of eight(8)continuous hours per flagman on either WEEKDAY or WEEKEND <br /> days are to be prepaid at the rate of$150.00 per hour. Hours of flagman protection provided in excess of <br /> prepayment amounts will be billed at the proper rate and will be promptly paid by over-night delivery. <br /> If project will run longer than originally anticipated, MaryEllen Carmody must he contacted in advance,and <br /> an additional check for the overrun submitted by over-night delivery. <br /> Cost for a railroad S&C cable locate is$250.00,and is to be prepaid by over-night delivery. <br /> ** )"ou must have an agreement with CA'railroad subsidiary, such as a Right of Entry,Permit,Formal <br /> Agreement or Slate, Cormh, Cil( Pr c jecl Number and proof of insurance before You can enter the property. <br /> Description of work to be perlbrmed: <br /> Will you receive State or Federal Funds as reimbursement for this project? Yes No <br /> — <br /> I agree to pay for flagging services as requested: <br /> ,41tach map or other location info ane!feu completed form with cover letter on Your company's lenei-he ad and <br /> proof of insurance to MaryEllen Carmody(248) 740-6036. <br /> Illinois Central Railroad Company - Original <br />