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Home My WebLink AboutAgreement_General_01/17/2013 (2) cur is Im 1520 N Powerline Road Company: Pompano Beach, FL 33069 CSM Acct: PJCT #: P. 954 - 984 -4282 / F. 954 - 984 -4284 Site Address / Building: Phone #: DATE: E -Mail: ALARM MONITORING OPTIONS AGREEMENT CODE DESCRIPTION RATE (PER MONTH) v ( 1000 Local Digital Base Rate (Required for all) $25.00 1002 Test Daily (panel will send signal every 24 hours) $15.00 1005 Test Weekly (panel will send a signal weekly) $10.00 1600 GMS (cellular Back -Up Only)(required if back -up radio is present) $15.00 TC IGSM Plus Total Connect (Cellular Back -Up + Web Access) $35.00 ❑ 1008 Open / Close Unsupervised (panel reports Arming / Disarming of alarm $20.00 system events and keeps a log in history of account) ❑ 1006 Open / Close Supervised (panel reports Arming / Disarming of alarm system $35.00 — Schedule is provided by alarm company if events happen out of scheduled hours or events don't report action is taken on whatever action dealer defines) CSM Supervised Schedule Instructions (only available with Code 1006) N/C OPEN BY: AM/PM CLOSE BY: AM/PM SEC TOTAL MONTHLY AMOUNT (DOES NOT INCLUDE APPLICABLE SALES TAX) $ TO BE BILLED: []MONTHLY ❑QUARTERLY ❑YEARLY I am an authorized representative or individual for the company and /or location that is listed above. I have selected, reviewed and agree to pay the total monthly amount shown above plus any applicable taxes, for all selected /required options above. I understand it is necessary, in addition to this agreement, to complete and sign a Data Information Sheet before services will be effective. I am aware that in the event of Non - Payment over 60 days, Security 101 reserves the right to suspend and /or terminate any and all services provided above. If any service option changes need to be made, a new Alarm Monitoring Options Agreement will need to be completed, signed and put into effect the 1 of the following month. A fee may apply if an option change or termination is made. Rates and plans are subject to change after renewal date (1 year from date shown on the top of this form). I have read and understand this agreement. SIGNATURE: � DATE: (Customer) �, p PRINT NAME: �'' "l i��'IGfL� (;' L{ zZ 0 TITLE: SIGNATURE: DATE: (Security 101 Programmer) Rev. A (12- 15 -11) Page 1 of 1 �.. 1520 N Powerline Road Company: �c. �/,��o� a-� �,�� Pompano Beach,FL 33069 CSM Acct:�L��p��_P1CT#: P.954-984-4282/F.954-984-4284 Site Address/Building: iA1�r- !,.�..,L��- �jl�C d�� ./�.'�r:r_ �/k,��„�� L .�'�� Phone#: � -"7 S� -4yy DATE: /� / E-Maii: ALARM MONITORING OPTIONS AGREEMENT CODE DESCR/PT/ON RATE PER MONTH 1000 Local Digital Base Rate(Required for all) $25.00 : 1002 Test Daily(panel will send signal every 24 hours) $15.00 _: 1005 Test W (panel will send a signal weekly) $10.00 _' 1600 GMS(celtular Back-Up Only)(required if back-up radio is present) $15.00 -� TC IGSM Plus Total Connect(Cellular Back-Up+Web Access) $35.00 � 1008 Open/Close Unsupervised(panel reports Arming/Disarming of alarm $20.00 system events and keeps a log in history of account) � 1006 Open/Close Supervised(panel reports Arming/Disarming of alarm system $35.00 -Schedule is provided by alarm company if events happen out of scheduled hours or events don't report action is taken on whatever action dealer defines) CSM Supervised Schedule Instructions(only available with Code 1006) N/C OPEN BY: `-AM/PM CLOSE BY: .`" AM/PM SEC TOTAL MONTHLY AMOUNT(DOES NOT INCLUDE APPUCABLE SALES TAX) $�:��C�� TO BE BILLED OMONTHLY ARTERLY �:YEARLY I am an authorized representative or individual for the company and/or location that is listed above. I have selected, reviewed and agree to pay the total monthly amount shown above plus any applicable taxes,for all selected/required options above. I understand it is necessary,in addition to this agreement,to complete and sign a Data Information Sheet before servites will be effective. I am aware that in the event of Non-Payment over 60 days,Security 101 reserves the right to suspend and/or terminate any and all services provided above. If any service option changes need to be made,a new Alarm Monitoring Options Agreement will need to be completed,signed and put into effed the is`of the following month. A fee may apply if an option change or termination is made. Rates and plans are subject to change after renewal date(1 year from date shown on the top of this form). I have read and understand this agreement. SiGNATURE: � DATE: �''j 7"�� {Customer) • PRINTNAME:�C�'ll(1�° L LQU ZZD nT(.E: 1/lL(�!9-GE /�lF�NA�J�� SIGNATURE: (�(.1 ..._ ��l �,, DATE: 2 I� I (Security 101 Pro�rammer) Rev.A(12-15-11� Page 1 of 1 �MS Data Information Sheet c�rr�conn . , . ,r t Dealer Information � �Security 101 2/18/13 Dealer Number Dealer Name Date Subscriber Information Residential ✓ ommercial ❑Commercial Fire ❑Two-Way ❑Medical Only ❑UL Fire FLB56463 VILLAGE OF TEQUESTA WATER TREATMENT PLANT Account Number Secondary Account Number Subscriber Name 901 OLD DIXIE HWY TEQUESTA FL 33469 Address(no P.O.Box) Apt#. Ciry State Zip Code Premises Phone Number Second Premises Phone Number Cross Sheet Subdivision Ma Grid Authorities 24 Hour Emergency Number(not 9l 1) Pertait Number PD FD MD Guazd Test Frequency If no test received notify Dealer via: Canmunications None ❑ Event History Standard Zone Template Panel Panel Phone# Fortnat � Daily ❑ Fax � Weekly � Email � Monthly ❑ Telephone Two-Way Panel Audible? Yes� No Time Zone ECV LEnhanced Call V�ification) ❑ Atlantic ❑ Yes Manual Reset of Cut off in Minutes OEastern ❑ No ❑ Cenval Passcode(ma�c of 10 characters Verbal Duress Code(mau of 10 characters) s'In ECV areas,all premises number ❑ Mountain and ihe first contact will be called ❑ Pacific prior to dispatch on all Burglary and Tamper signals`• ❑ Hawaii-Aleutian Contact I.ist Name Telephone Number Time Frame Subscnber Email Type• User# Passcode I. 2. 3. 4. 'For"1'ype"above,please note which alartn event types the contact shouid be notified on. The choices are�Burglary,fire,Trouble,Open/Close,Medical and PanicMoldup• Zone Ala�m Type Description PR PT PD FD MD CL AL LOG Disoatch Order• PR-Call Premises PT-Call Guard/Security/Patrol PD-Dispatc6 Police FD-Dispatch Fire MD-Dispatch Medical CL-Norify Cali List AL-Notify Alazm Co. Log Only-Log to History only no other actions Deleyed Events-Delayed Events will automancally apply to Residential Low Battery and Trouble events for(60)minutes and Commerical A/C Fait and Low Battery events for(30) minutes while awaiting Restore. If restore is received,no action will be taken. If restore is not received,acriou will be taken. a Do Not Apply Delayed Even[s Special►nswctions: ❑ Supervised Opening and Closing Schedule ouHined on attached Ope�i/Close Schedule Fortn