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EQ 09.12.07 Dealer Program Guide Underwritten and Administered by:

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Page 1: Dealer Program Guide Program Guide - Canada.p… · determined call rate (travel/diagnostic time), ... Please take a moment to complete the Dealer Enrolment Form and get started today

EQ 09.12.07

Dealer Program Guide

Underwritten and Administered by:

Page 2: Dealer Program Guide Program Guide - Canada.p… · determined call rate (travel/diagnostic time), ... Please take a moment to complete the Dealer Enrolment Form and get started today

Welcome to Home Climate Protection Plus, a simple and worry-free risk management plan. You will realize all of the benefits of a comprehensive plan without the hassles that can be associated with a conventional program. Here’s how the plan works for residential products. Each service call starts with a pre-determined call rate (travel/diagnostic time), then a pre-determined repair fee and a parts mark-up allowance to cover the cost of handling parts covered by the extended service agreement as well as parts not covered by the extended service agreement. There are labour-only plans as well as parts and labour plans available. Depending upon the reimbursement schedule that best fits your business model, you can choose from three (3) levels of reimbursement. Dealer Benefits include:

• Profits on the initial sale. • Possibility of customer retention for future revenue. • Improved customer satisfaction. • Provides value added offering preferred by consumers. • Simple Home Climate Protection Plus reimbursement for no hassle claims.

Equiguard is North America’s largest provider of risk management programs for the HVAC/R industry and has developed an extended service agreement program for certain products that are manufactured and/or sold by Whirlpool. This program offers a unique, user-friendly opportunity to take your business to the next level. This program is underwritten and administered by Equiguard. Through Home Climate Protection Plus you may be able to increase profits and retain customers while increasing the value of your business. Please take a moment to complete the Dealer Enrolment Form and get started today. Equiguard is available to discuss any questions you may have. Please mail the completed Dealer Enrolment Form to your local distributor for processing.

Underwritten and Administered by:

Welcome

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For assistance, contact Equiguard’s Customer Service Department.

Equiguard, Inc. P.O. Box 3368 Oak Brook, IL 60522-3368 (USA) TEL: (800) 886-9363 / FAX: (630) 325-7126 Email: [email protected]

ContactDirectory

Underwritten and Administered by:

Page 4: Dealer Program Guide Program Guide - Canada.p… · determined call rate (travel/diagnostic time), ... Please take a moment to complete the Dealer Enrolment Form and get started today

Home Climate Protection Plus Program

Welcome to Home Climate Protection Plus

Contact Directory for Home Climate Protection Plus

Program Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Dealer Enrolment Process Flowchart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Dealer Enrolment Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Dealer Enrolment Terms and Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6

Extended Service Agreement Billing Flowchart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Claim Repair Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Claim Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Residential Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-12

Residential Claims Process Flow Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Residential Overview of Coverages and Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Residential Claims Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Residential Claims Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Commercial Section

Commercial Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Commercial Claims Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Commercial Claims Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-24

Sample Extended Service Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-26

Underwritten and Administered by:

Residential Index

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• No labour rate tables to look up for residential plans • No parts mark-up tables to look up for residential plans • Simple claim forms • Reimbursement schedules to meet your needs • Electronic deposit reimbursement option for claims • Two (2), Five (5), and Ten (10) year plans available

Program Benefits

Underwritten and Administered by:

1

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DEALER ENROLMENT PROCESS

Dealer sends completed and signed Dealer Enrolment Form to

local Distributor

Distributor adds Distributor Number to the form and forwards

it to Equiguard

Equiguard sends enrolment package to Dealer that includes dealer number, order forms and

claim forms

Dealer Enrolment Process Flow Chart

Underwritten and Administered by:

Equiguard reviews Dealer Enrolment Form and Dealer

information and enters information into system

2

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If you will be utilizing electronic/automatic deposit for service claim reimbursement, you will need to send your “VOIDED” check to Equiguard, P.O. Box 3368 Oak Brook IL 60522-3368 (USA) to set-up this process with your bank. Accounts Payable Contact Extension Service Manager Contact Extension

Number of Employees Number of Service Technicians

Hours of Operation After Hours Answering Yes No

Pager System Yes No Cellular Phone System Yes No Pager No. Cellular No. Geographical Coverage Area (by County / municipality(s) or Mileage Area / Kilometer Radius)

If you are already enroled with Equiguard, simply provide us your contractor number and update your information if necessary i.e. Labour rates, addresses, telephone number. Equiguard reserves the right to re-enroll any contractor under the newest or most current Contractor Enrolment Form at our discretion. Please mail or fax this Contractor Enrolment Form to your local distributor to acknowledge your Enrolment. Company Name Date

Address

City State/Province Zip/Postal Code

Tel Fax E-mail We do not sell, trade or rent your personal information to any third party. The information is collected primarily to ensure that we are able to fulfill your requirements. GST/HST/PST Number:____________________________

These are necessary to process your claims. INSURANCE: Prior to becoming an authorized Equiguard contractor, contractor must provide Equiguard with a copy of its current Certificate of Insurance, which shows workers compensation and general liability insurance of no less than $500,000.00 (USD) / $750,000.00 (CAD). If you are part of our dispatch service network, workers compensation and general liability insurance must be no less than $1,500,000 (USD). Distributor Name Distributor Number City State/Province Tel Which applies to your company? Sales Service Both Manufacturers Brand(s) Sold Manufacturers Brand(s) Serviced

Dealer Enrolment Form

Equiguard Office Use Only

Customer Number

Contractor Number

Processor

3

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Circle the following that apply to your business

HVAC Yes No Refrigeration Service Yes No Commercial HVAC Yes No Industrial HVAC Yes No Chiller Service Yes No Control System Service Yes No

Please review the accompanying terms and conditions. “I certify that the information contained in this Contractor Enrolment Form is true and complete to the best of my knowledge and that I have read the accompanying terms and conditions that apply to this Enrolment form.” Owner / Manager Signature

Print Name

Title

Equiguard Signature

Title

Date

PLEASE FAX OR MAIL TO YOUR LOCAL DISTRIBUTOR

The Equiguard Program can offer you an optional service to assist you in retaining equipment owners for additional years of service. Through the Renewal Program, Equiguard will automatically notify your equipment owners that have 2 to 5 year agreements, of their opportunity to renew their services with you. When they renew, you will be listed as the service provider for the additional years, with opportunities to provide other services such as preventative maintenance, add-on accessories and replacement equipment. Equiguard will then provide you with a commission for each renewal for either an air conditioner or furnace or a complete system or package unit.

If you would like to participate in this program, please sign here: _________________________ Date:_______________

4

Page 9: Dealer Program Guide Program Guide - Canada.p… · determined call rate (travel/diagnostic time), ... Please take a moment to complete the Dealer Enrolment Form and get started today

CONTRACTOR ENROLMENT TERMS AND CONDITIONS

AUTHORIZATION TO SELL EQUIGUARD EXTENDED SERVICE AGREEMENTS

The parties agree that, upon the execution of the Contractor Enrolment Form (“Enrolment Agreement”) by Equiguard, Inc. (“Equiguard”), Contractor shall be authorized to offer the Equiguard Extended Service Agreement (“Service Agreement”) for sale to its customers subject to the following terms and conditions:

LIMITED AGENCY RELATIONSHIP Contractor may act as Equiguard’s agent only pursuant to the express terms of this Enrolment Agreement and only with regard to the marketing, selling and servicing of Service Agreements. Any act taken by the Contractor and/or its agents that is outside the scope of this Enrolment Agreement shall not be authorized, and shall be deemed a breach of this Enrolment Agreement. Contractor shall be liable to Equiguard for all damages, costs and fees arising out of Contractor’s acts outside the scope of its authority.

WARRANTIES AND REPRESENTATIONS Contractor hereby represents and warrants to Equiguard as follows:

Upon each sale by Contractor of a Service Agreement, Contractor shall promptly pay Equiguard in full all amounts due Equiguard on such sale. Contractor shall inform each holder of a Service Agreement that the Service Agreement shall not be valid unless and until Contractor pays Equiguard in full all amounts due Equiguard;

Contractor shall promptly notify Equiguard in writing of each sale of a Service Agreement by Contractor; Contractor shall promptly provide Equiguard with such information as is necessary for Equiguard to register each

Service Agreement sold by Contractor and to identify the holder of such Service Agreement; and Each and every claim submitted by Contractor to Equiguard shall be true, genuine and authentic, shall represent

services actually performed by Contractor on the equipment identified on the claim and parts actually used for the benefit of the holder of the Service Agreement as set forth in the claim, and shall be covered under the Service Agreement. Claims made for parts and labour which were not a result of an equipment failure will not be paid by Equiguard.

Contractor agrees that it shall not initiate any repair(s) for the Service Agreement holder without checking the date and terms of the respective Service Agreement. During the respective Service Agreement period, Contractor shall give Equiguard any factory warranty or warranties on all new products and new parts.

CLAIMS Contractor shall have the right to refuse any service work or service calls. Contractor shall be paid at normal straight time rates only, with no overtime or holiday pay or as otherwise agreed to in writing by Equiguard. Only one (1) person per job hour is authorized. Contractor shall guarantee labour for ninety (90) days on all repairs or replacements made within the term of the Service Agreement. Equiguard shall pay a claim within thirty (30) days from receipt of said claim in its claims department. Equiguard’s program rates are based on it receiving Contractor’s “best” hourly labour rates or flat rate pricing. Therefore, Equiguard requires that Contractor use its “best preferred customer” rates when submitting claims under a Service Agreement.

OWNERSHIP OF INTELLECTUAL PROPERTY Equiguard is the sole owner of any and all copyrights, service marks, trademarks, trade names, trade dress, patents and all other intellectual property (collectively referred to as the “Intellectual Property”) used by Equiguard in its business, including, but not limited to, the “Equiguard®” trademark and all associated trademarks and service marks. All Intellectual Property is, and shall remain, the sole and exclusive property of Equiguard, and nothing in this Enrolment Agreement shall grant or convey to Contractor any rights to, or licenses in, the Intellectual Property except as expressly provided for herein.

5

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USE OF EQUIGUARD NAME Thirty (30) days prior to implementing any sales, marketing or customer solicitation program (e.g., direct mailing, brochure describing services or Service Agreement, advertisements, etc.) which, in any manner, uses or otherwise exploits the “Equiguard” name or trademark, or any other Intellectual Property, Contractor must notify Equiguard’s marketing division at 1-800-986-9363 of said program, and must obtain Equiguard’s written approval of said program and use or other exploitation of the “Equiguard” name, trademark or other Intellectual Property. Equiguard shall have the sole and exclusive right to reject any such program or campaign for any reason whatsoever. In the event Contractor fails to notify Equiguard as set forth above, or fails to obtain the required approval of the program, Contractor shall have no right to use or otherwise exploit the “Equiguard” name or trademark, or any other Intellectual Property, in said program in any manner whatsoever.

TERMINATION Subject to the terms of this paragraph, either party may terminate this Enrolment Agreement at any time, with or without cause, upon thirty (30) days prior written notice to the other party. In the event Equiguard discovers evidence of a Contractor’s (or its agent’s) material fraud, misrepresentation or breach of this Enrolment Agreement, Equiguard shall promptly notify Contractor, in writing, of its evidence and findings. Upon such an event and prior written notice to Contractor, Equiguard may take such action as it deems reasonable and necessary, including but not limited to (i) requiring the Contractor to immediately terminate any agent(s) or employee(s) found to have engaged in material fraud, misrepresentation or breach, (ii) conducting an accounting and review of Contractor’s books and records, (iii) requiring Contractor to implement certain internal procedures to reduce the incidence of such fraud, misrepresentation or breach, or (iv) terminating this Enrolment Agreement; provided, however, that termination shall only be upon a good faith finding that Contractor has engaged in a pattern and practice of material fraud, misrepresentation and breach, or has failed to take reasonable and necessary measures to prevent such fraud, misrepresentation or breach by its agent(s) or employee(s) after being put on notice of the same. Upon such termination, Contractor shall have no further right to sell, market or deal in Service Agreements, or any Equiguard product, in any manner or on behalf of any party, and Contractor shall have no further right to, directly or indirectly, submit any claim or claims, regardless of their nature and timing, under or pursuant to said Service Agreements.

CANCELLATION In the event of a cancellation of a Service Agreement, Equiguard agrees to promptly refund through distribution (Equiguard to Distributor to Contractor to Consumer) the Equiguard pro-rata portion of the monies received from the sale of the original Service Agreement. Contractor hereby represents and warrants that it shall promptly return all said monies to the respective holder of the Service Agreement. For details on cancellation of a Service Agreement, please refer to the Equiguard Terms and Conditions.

ENFORCEMENT Notwithstanding anything else contained herein, Equiguard may seek a temporary restraining order, preliminary injunction and/or a permanent injunction in order to prevent the Contractor from continuing to sell, offering or marketing Service Agreements or from continuing to represent itself as an authorized contractor, agent or representative of Equiguard. Subject to the above, if either Equiguard or the Contractor seeks enforcement of, damages under or construction of this Enrolment Agreement, such matter shall be submitted to binding arbitration pursuant to the rules of the American Arbitration Association. Each party shall select an arbitrator, and those arbitrators shall chose a third arbitrator. Each party shall submit its case to the arbitrator within thirty (30) days of the appointment of the final arbitrator. Within thirty (30) days of the parties’ submission, the arbitrators shall determine whether termination, or such other remedy, is appropriate. The expense of the arbitration shall be borne by Contractor. The arbitration shall take place in Chicago, Illinois.

ATTORNEYS FEES In the event of litigation between the parties for any matter arising out of, related to or connected with this Enrolment Agreement or the Service Agreement(s), or the breach or non-performance hereof, if Equiguard is the prevailing party in such litigation, Equiguard shall be entitled to recover against Contractor reasonable attorneys’ fees, expenses and court costs at all levels.

GOVERNING LAW Illinois law, including its laws governing the conflicts of laws, shall govern this Enrolment Agreement and any and all disputes arising hereunder or related hereto. ANY MODIFICATIONS IN THE ABOVE TERMS AND CONDITIONS SHALL NOT BE EFFECTIVE OR ACCEPTED WITHOUT A PRIOR WRITTEN CONSENT SIGNED BY AN OFFICER OF EQUIGUARD.

6

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EXTENDED SERVICE AGREEMENT BILLING FLOW CHART

Dealer completes Residential Application Order Form

Underwritten and Administered by:

Extended Service Agreement Billing Flow Chart

Equiguard invoices Dealer

Equiguard records information and mails one copy to Customer

and one copy to Dealer

Dealer remits payment to Equiguard

Dealer forwards the application to Equiguard for processing

7

Page 12: Dealer Program Guide Program Guide - Canada.p… · determined call rate (travel/diagnostic time), ... Please take a moment to complete the Dealer Enrolment Form and get started today

A Replace Circuit Board A Replace Fan Limit B Replace Fuel PumpA Replace Fan Relay / Time Delay B Replace Oil Burner MotorA Replace Fan Center Control A Replace Oil Pump CouplingA Replace Limit Snap Disk / Fixed / Fusible / Rollout A Replace Primary with Accustat

E Replace Compressor A Replace Door Switch C Replace Oil Burner AssemblyA Replace Crankcase Heater (If factory supplied) A Replace ElectrodesA Repair Terminal A Replace Oil Ignition TransformerA Replace Start Assist Assembly A Replace Protector Relay

Clean or Replace A Replace Stack SwitchReplace Sound Blanket A Replace Stack ControlAdd Sound Blanket A Replace Auto Shut-Off Valve

C Reline Oil BurnerReplace Flue Cap or ElbowClean Obstruction Replace Fuel Filter Cartridge

E Replace Condenser Coil Replace Fuel Oil Filter AssemblyE Leak Repair Replace Oil Nozzle

CleaningClean Condenser Coil B Replace Single Stage Gas ValveStraighten Fins B Replace Two Stage Gas Valve

CoveredConversion Kit Standing Pilot to Spark Ignition C Replace Threaded Hi / Lo Pressure Switch With ShraderAdjust Gas Pressure D Replace Hi / Lo Pressure Switch

E Replace Accumulator or Muffler A Replace Condenser Fan Blade Replace Gas Shut Off / Union / Gas FlexB Replace Condenser MotorB Replace Condenser Fan Blade and Motor

D Replace Reversing ValveB Replace Blower Motor E Replace Heat Exchanger A Replace Electrical CoilC Replace Variable Speed Blower Motor D Replacing both at the same time C Replace Variable Speed Module A Replace Contactor Clean Heat ExchangerB Replace Blower Motor and Wheel A Replace Two Speed Contactor Simple Carbon Monoxide TestC Replace Variable Speed Blow Motor and Wheel B Replace Blower Wheel A Thermostat

Capacitors are included if changed with a motor A Programmable ThermostatA Replace Circuit Board / Timer A Replace Current Sensing Relay A Deluxe Programmable Thermostat

Pull and Clean Blower Wheel A Replace Two Speed Circuit Board A Replace Orifice A Heat Pump ThermostatAdjust Blower Wheel A Replace Relay A Replace Humidistat A Programmable Heat Pump Thermostat

A Replace Thermostat A Replace Saddle Valve A Deluxe Programmable Heat Pump ThermostatA Replace Solenoid Valve

Clean and Adjust Light Pilot Assembly Replace Thermostat Wire (One Man - up to 50 ft) External WiringB Replace Triple Aqua Stats Clean Flame Sensor Replace Humidifier Pad Calibrate ThermostatC Replace Circulators Adjust Heat AnticipatorA Replace Zone Valves - Power HeadC Replace Zone Valves - CompleteC Replace Expansion Tanks D Replace Filter Drier (No parts process fee cost only) A Replace Hot Surface Igniter / Flame SensorA Replace Solenoiod Valves A Replace Thermocouple A Replace Circuit Board / BallastD Replace Firebox A Replace Standing Pilot AssemblyE Replace Blast Tubes Replace Bulb C Replace Diffuser Cones A Replace Air Pressure SwitchA Replace Multiple zone control B Replace CellsA Replace Switching relays A Replace Cell Handle A Replace Motor Assembly and WheelNot Covered A Replace Current Sensing Relay A Replace Wheel D Replace Drain Pan

Feed Water Regulators A Replace Ionizing Wire A Replace Motor A Replace Condensate PumpFlow Checks A Replace Power Pack A Replace Pressure SwitchAnti-Scald Valves for HW From Tankless Coil A Replace Sail Switch Replace Auxiliary Drain Float SwitchBackflow Preventers Clean Cells and Pre Filters Replace Auxiliary Drain Pan

Replace Pre Filter Clean and Adjust Inducer Clean / Blowout DrainReplace Condensate Drain

A Replace Circuit Breaker- Internal OnlyA Replace Low Voltage Fuse- Internal Only A Replace Fusible LinkA Replace High Voltage Fuse-Internal Only A Replace High Limit A Replace Low Voltage Fuse

B Heater Package Reset & Test / Tighten A Replace Sequencer / Heat Relay A Replace Transformer Minor Repair Locate ShortReplace 30 / 60 Amp Disconnect A Replace Fuse- Internal Only Replace Thermostat Wire

Replace Thermostat Wire (One Man--up to 50 Ft) External WiringN/A

D Simple Leak RepairE Replace Evaporator Coil

C Replace Burner A *** Replace Low Ambient Kit / Freeze StatCleaning D Replace TXV B *** Repair Gas Leak Inside Unit Only - factory fittings only

Pull and Clean Burner C Replace SchraderD Replace Service Valve Recovery Minor Repair Tape or Reattach DuctworkD Replace Access Valve Overnight Shipping Fee

A Replace Fan BeltA Replace Single Capacitor Clean Piston Blockage *** Covered repairs listed in the above miscellaneous section A Replace Dual Capacitor Maintenance Schrader Caps are valid, provided the equipment is listed on the agreement.

Not Covered

Covered

Covered

Not Covered

METERING DEVICE

OIL FURNACE

CoveredREVERSING VALVE

PRESSURE SWITCH (refrigeration)

Not Covered

Covered

THERMOSTAT

ULTRAVIOLET

WATER LEAK

WIRING

Covered

Not Covered

Covered

Covered

Covered

Not Covered

Covered

Not Covered

DRIER

Covered

DEFROSTCovered

LOW VOLTAGE

HUMIDIFIER

ELECTRONIC AIR CLEANER

LEAK SEARCH

INDUCER

Not Covered

Covered

Covered

Not Covered

CoveredCOMPRESSOR

Not Covered

Not Covered

Not Covered

Claim Repair Codes

HEAT EXCHANGER

Covered

Not Covered

CONDENSER FAN

CONDENSER COILCovered

Not Covered

BLOWER MOTOR & WHEEL

ACCUMULATOR

Not Covered

CAPACITOR (only repair)Covered

EVAPORATOR (coil leak)

BURNERCovered

Not Covered

CIRCUIT BOARD

Covered

Covered

Covered

Not Covered

Covered

ELECTRIC HEAT

Covered

Not Covered

Not Covered

CoveredCONTACTOR

CoveredBREAKERS

BOILERSCovered

Not Covered

Covered

Not Covered

Not Covered

FAN BELTNot Covered

CoveredMISCELLANEOUS

Covered (if the cause of repair)

FAN & LIMITS

GAS VALVE

FILTERS

FLUE

Covered

Not Covered

CoveredCovered (Included in repair cost of C, D & E)

Covered

IGNITION

8

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Residential Claim Reimbursement

Plan II Plan III$60.00 $70.00 $40.00 $40.00

Repair Code

A $79.00 $90.00

B $123.00 $140.00

C $158.00 $180.00

D $245.00 $280.00

E $385.00 $440.00

Examples:

Repair Code B Repair Code BFailure – Condenser Fan Motor In Warranty out-of-warranty Failure – Condenser Fan

Motor In Warranty out-of-warranty

Service call $50.00 $50.00 Service call $60.00 $60.00

Motor replacement $105.00 $105.00 Motor replacement $123.00 $123.00

Parts process allowance $30.00 $30.00 Parts process allowance $40.00 $40.00

Parts cost* $0.00 $45.00 Parts cost* $0.00 $45.00

Repair Code D Repair Code D

Failure – TXV In Warranty out-of-warranty Failure –TXV In Warranty out-of-warranty

Service call $50.00 $50.00 Service call $60.00 $60.00

TXV replacement $210.00 $210.00 TXV replacement $245.00 $245.00

Parts process allowance $30.00 $30.00 Parts process allowance $40.00 $40.00

Parts cost* $0.00 $55.00 Parts cost* $0.00 $55.00

Repair Code E Repair Code E

Failure – Compressor In Warranty out-of-warranty Failure – Compressor In Warranty out-of-warranty

Service call $50.00 $50.00 Service call $60.00 $60.00

Compressor replacement $330.00 $330.00 Compressor replacement $385.00 $385.00

Parts process allowance $30.00 $30.00 Parts process allowance $40.00 $40.00

Parts cost* $0.00 $350.00 Parts cost* $0.00 $350.00

* Example parts cost. Actual cost may vary

Plan I (Parts & Labor) Plan II (Parts & Labor)

Process Allowance $30.00 Type of Repair Repair Rate

Replacement of electrical or mechanical components such as all circuit boards, relays, water relief valve, thermocouple, thermostat, condenser fan

blade, fan limit switch, door switch, control transformer.$68.00

Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, ignition transformer, oil

burner motor.

$105.00

Note: Parts in-warranty - process allowance (Plan II & III only), Parts out-of-warranty - cost of part plus process allowance

Parts & Labor - Each service call includes a call/diagnostic rate and a parts process allowance in addition to the amount from the specific repair code. (see specific coverage)

Plan ICall/ Diagnostic Rate $50.00

Labor Only - Each service call includes a call/diagnostic rate in addition to the amount from the specific repair code.

Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor,

variable speed module.$135.00

Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes

leak search, refrigerant recovery time, refrigerant replacement, and dryer)$210.00

Major repairs to sealed system such as heat exchanger, compressor, condenser/evaporator coil replacement, accumulator or muffler. (Repair

code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer)

$330.00

Total $185.00 $230.00

Total $290.00 $345.00

Total $410.00 $760.00 $485.00

Total

Total

Total $835.00

$400.00 $345.00

$268.00 $223.00

SelecRate

9

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CRCSWSRI-02L CRCSWSRII-02L CRCSWSRIII-02L CRCSWSRI-10L CRCSWSRII-10L CRCSWSRIII-10L

CRHPWSRI-02L CRHPWSRII-02L CRHPWSRIII-02L CRHPWSRI-10L CRHPWSRII-10L CRHPWSRIII-10L

CRPUCWSRI-02L CRPUCWSRII-02L CRPUCWSRIII-02L CRPUCWSRI-10L CRPUCWSRII-10L CRPUCWSRIII-10L

CRPUHPWSRI-02L CRPUHPWSRII-02L CRPUHPWSRIII-02L CRPUHPWSRI-10L CRPUHPWSRII-10L CRPUHPWSRIII-10L

CRPUGWSRI-02L CRPUGWSRII-02L CRPUGWSRIII-02L CRPUGWSRI-10L CRPUGWSRII-10L CRPUGWSRIII-10L

CRCUWSRI-02L CRCUWSRII-02L CRCUWSRIII-02L CRCUWSRI-10L CRCUWSRII-10L CRCUWSRIII-10L

CRHPCWSRI-02L CRHPCWSRII-02L CRHPCWSRIII-02L CRHPCWSRI-10L CRHPCWSRII-10L CRHPCWSRIII-10L

CRFAWSRI-02L CRFAWSRII-02L CRFAWSRIII-02L CRFAWSRI-10L CRFAWSRII-10L CRFAWSRIII-10L

CRAHWSRI-02L CRAHWSRII-02L CRAHWSRIII-02L CRAHWSRI-10L CRAHWSRII-10L CRAHWSRIII-10L

* Includes Thermostat, Does not Include Thermidistat or HumidistatNOTE: All Coverage Inclusive of OEM Warranty, includes diagnostic/service call

$145.59 $171.21 $196.66 Air Handler With or Without Strip Heat* $26.94 $31.70 $36.41

PLAN OPTIONS (Check appropriate box)

2 Year TermPlan I

2 Year TermPlan II

2Year TermPlan III

10 Year TermPlan I

10 Year TermPlan II

10 Year TermPlan III

Equipment Type: RESIDENTIAL

61st Day – 2nd Year Labour Only

31st Day – 2nd Year Labour Only

31st Day – 2nd Year Labour Only

61st Day – 10th Year Labour Only

31st Day – 10th Year Labour Only

31st Day – 10th Year Labour Only

Complete System - A/C*(Condensing Unit, Coil, & Furnace) $87.66 $103.06 $118.38 $338.69 $398.16 $457.21Complete System - HP*(Condensing Unit, Coil, & Air Handler) $98.95 $116.25 $133.46 $510.48 $599.58 $688.26

Package Unit - Cooling Only*$87.66 $103.06 $118.38 $338.69 $398.16 $457.21

Package Unit - Heat Pump*(With or Without Strip Heat) $98.95 $116.25 $133.46 $510.48 $599.58 $688.26

Package Unit - Gas/Electric*$87.66 $103.06 $118.38 $338.69 $398.16 $457.21

A/C Condensing Unit and Coil*$59.72 $70.08 $80.41 $226.36 $265.60 $304.71

Heat Pump Condensing Unit and Coil* $79.63 $93.46 $107.23 $391.00 $458.75 $526.31

$174.71 $205.13 $236.50 Furnace - Gas Fired or Electric*

$39.71 $46.76 $53.78

SELECRATE ORDER FORM Equipment Less Than 12 Months Old

TOTAL PRICE: $___________________

PO # __________________________________________

CONTRACTOR NAME ___________________________________________________________ EQ CONTRACTOR # _____________________

EQUIPMENT OWNER ____________________________________________________________ PHONE # (_________) ____________________

MAILING ADDRESS __________________________________________________________________________________________________________

CITY _____________________________________________________PROVINCE ________________POSTAL CODE _________________________

EQUIPMENT LOCATION (if different) __________________________________________________________________________________________

CITY _____________________________________________________PROVINCE ________________POSTAL CODE _________________________

Date Sold: ________/________/________

**Date Installed:________/________/________

*Agreement Charge: ___________________

**INSTALL DATE IS REQUIRED FOR PROCESSING

*Agreement Charge is required in all provinces. This is the price the customer paid.

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Fax this form to 630-986-863310

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CRCSWSRI-05 CRCSWSRII-05 CRCSWSRIII-05 CRCSWSRI-10 CRCSWSRII-10 CRCSWSRIII-10

CRHPWSRI-05 CRHPWSRII-05 CRHPWSRIII-05 CRHPWSRI-10 CRHPWSRII-10 CRHPWSRIII-10

CRPUCWSRI-05 CRPUCWSRII-05 CRPUCWSRIII-05 CRPUCWSRI-10 CRPUCWSRII-10 CRPUCWSRIII-10

CRPUHPWSRI-05 CRPUHPWSRII-05 CRPUHPWSRIII-05 CRPUHPWSRI-10 CRPUHPWSRII-10 CRPUHPWSRIII-10

CRPUGWSRI-05 CRPUGWSRII-05 CRPUGWSRIII-05 CRPUGWSRI-10 CRPUGWSRII-10 CRPUGWSRIII-10

CRCUWSRI-05 CRCUWSRII-05 CRCUWSRIII-05 CRCUWSRI-10 CRCUWSRII-10 CRCUWSRIII-10

CRHPCWSRI-05 CRHPCWSRII-05 CRHPCWSRIII-05 CRHPCWSRI-10 CRHPCWSRII-10 CRHPCWSRIII-10

CRFAWSRI-05 CRFAWSRII-05 CRFAWSRIII-05 CRFAWSRI-10 CRFAWSRII-10 CRFAWSRIII-10

CRAHWSRI-05 CRAHWSRII-05 CRAHWSRIII-05 CRAHWSRI-10 CRAHWSRII-10 CRAHWSRIII-10

* Includes Thermostat, Does not Include Thermidistat or HumidistatNOTE: All Coverage Inclusive of OEM Warranty, includes diagnostic/service call

$188.88 $242.06 $267.53 Air Handler*(With or Without Strip Heat) $68.33 $99.24 $111.20

PLAN OPTIONS (Check appropriate box)

5 Year TermPlan I

5 Year TermPlan II

5 Year TermPlan III

10 Year TermPlan I

10 Year TermPlan II

10 Year TermPlan III

Equipment Type: RESIDENTIAL

61st Day – 5th Year Labour ONLY

31st Day – 5th Year Labour and Parts Process Allowance

LESS Compressor

31st Day – 5th Year Labour and Parts Process Allowance

LESS Compressor

61st Day – 10th Year Labour,6th - 10th Year Parts and Parts Process Allowance

INCLUDING Compressor

31st Day – 10th Year Labour and Parts Process Allowance

LESS Compressor,6th - 10th Year Parts

INCLUDING Compressor

31st Day – 10th Year Labour and Parts Process Allowance

LESS Compressor,6th - 10th Year Parts

INCLUDING Compressor

Complete System - A/C*(Condensing Unit, Ciol, & Furnace) $185.34 $267.46 $299.80 $439.75 $552.35 $611.39Complete System - HP*(Condensing Unit, Ciol, & Air Handler) $209.34 $293.15 $329.54 $656.91 $816.85 $905.55

Package Unit - Cooling Only*(With or Without Strip Heat) $185.34 $267.46 $299.80 $439.75 $552.35 $611.39

Package Unit - Heat Pump*$209.34 $293.15 $329.54 $656.91 $816.85 $905.55

Package unit - Gas/Electric*$185.34 $267.46 $299.80 $439.75 $552.35 $611.39

A/C Condensing Unit AND Coil*$121.43 $165.14 $186.14 $283.50 $348.69 $387.95

HP Condensing Unit AND Coil*$182.13 $247.70 $279.20 $489.93 $602.53 $670.08

$233.55 $301.59 $332.36 Furnace - Gas Fired or Electric*

$86.19 $129.85 $145.04

SELECRATE ORDER FORM Equipment Less Than 12 Months Old

TOTAL PRICE: $___________________

PO # __________________________________________

CONTRACTOR NAME __________________________________________________________ EQ CONTRACTOR # ______________________

EQUIPMENT OWNER ___________________________________________________________ PHONE # (__________) ____________________

MAILING ADDRESS _________________________________________________________________________________________________________

CITY ________________________________________________________PROVINCE _______________POSTAL CODE _______________________

EQUIPMENT LOCATION (if different) __________________________________________________________________________________________

CITY ________________________________________________________PROVINCE _______________POSTAL CODE _______________________

Date Sold: ________/________/________

**Date Installed:________/________/________

*Agreement Charge: ___________________

**INSTALL DATE IS REQUIRED FOR PROCESSING

*Agreement Charge is required in all provinces. This is the price the customer paid.

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Fax this form to 630-986-863311

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RCSWSRI-12 RCSWSRII-12 RCSWSRIII-12

RHPWSRI-12 RHPWSRII-12 RHPWSRIII-12

RPUCWSRI-12 RPUCWSRII-12 RPUCWSRIII-12

RPUHPWSRI-12 RPUHPWSRII-12 RPUHPWSRIII-12

RPUGWSRI-12 RPUGWSRII-12 RPUGWSRIII-12

RCUWSRI-12 RCUWSRII-12 RCUWSRIII-12

RHPCWSRI-12 RHPCWSRII-12 RHPCWSRIII-12

RFAWSRI-12 RFAWSRII-12 RFAWSRIII-12

RAHWSRI-12 RAHWSRII-12 RAHWSRIII-12

* Includes Thermostat, Does not Include Thermidistat or HumidistatNOTE: All Coverage Inclusive of OEM Warranty, includes diagnostic/service call

$263.94 $331.06 $365.01 Air Handler*(With or Without Strip Heat)

PLAN OPTIONS (Check appropriate box)

12 Year Plan I

12 Year Plan II

12 Year Plan III

31st Day - 12th Year Labor & Parts Process Allowance,

6th - 12th Year Parts

31st Day - 12th Year Labor & Parts Process Allowance,

6th - 12th Year Parts

31st Day - 12th Year Labor & Parts Process Allowance,

6th - 12th Year Parts

Complete System - A/C*(Condensing Unit, Coil, & Furnace) $603.05 $742.31 $819.73

Equipment Type: RESIDENTIAL

$892.08 $1,088.95 $1,204.25

Package Unit - Cooling Only*(With or Without Strip Heat) $603.05 $742.31 $819.73

Complete System - HP*(Condensing Unit, Coil, & AH or Furnace)

$892.08 $1,088.95 $1,204.25

Package unit - Gas/Electric*$603.05 $742.31 $819.73

Package Unit - Heat Pump*

$388.75 $470.58 $522.36

HP Condensing Unit With Coil*$670.65 $811.75 $900.63

A/C Condensing Unit With Coil*

$318.91 $401.59 $441.60 Furnace - Gas Fired or Electric*

SELECRATE ORDER FORMEquipment Less Than 12 Months Old

TOTAL PRICE: $___________________

PO # __________________________________________

CONTRACTOR NAME ____________________________________ EQ CONTRACTOR # __________________

EQUIPMENT OWNER _____________________________________ PHONE # (_______) __________________

MAILING ADDRESS ______________________________________________________________________________

CITY ________________________________________STATE _________________ZIP _________________________

EQUIPMENT LOCATION (if different) ______________________________________________________________

CITY _________________________________________STATE _________________ZIP ________________________

Date Sold: ________/________/________

**Date Installed:________/________/________

*Agreement Charge: ___________________

**INSTALL DATE IS REQUIRED FOR PROCESSING

*Agreement Charge is required in certain states. This is the price the customer paid.

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

9/10/07 Fax this form to 630-986-863312

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CLAIMS PROCESS

RESIDENTIAL PROGRAM, the Dealer completes a claim form for Residential Home

Climate Protection Plus and sends it to Equiguard along with the original service ticket.

Equiguard processes the claim and ensures all necessary documentation is included with the claim.

Equiguard sends a check or makes a direct deposit into the dealer’s account for the approved amount

Residential Claims Flow Chart

Underwritten and Administered by:

13

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Overview: This overview is only a guide. Please refer to Equiguard’s terms and conditions located on the Equiguard Extended Service Agreement for complete listing of all conditions. Covered Repairs Included

• Mechanical failures of covered equipment during normal operation. • Accessories (humidifiers, zoning controls, thermostats, economizers, power

exhaust, electronic/ultraviolet light, air cleaner and evaporator coil), provided additional coverage is purchased.

Exclusions

• Repairs as a result of installation error. • Maintenance or repairs resulting in a lack of proper maintenance. • Acts of God, war or terrorism, earthquake, lightning, flood, hurricane, etc.

What defines a “Residential” application?

• Single family dwelling/apartments/condominium and • Equipment less than or equal to 5 tons

NOTE: A single family dwelling is intended to be occupied by one family where business is not conducted. When multiple repairs are made, the highest repair code will be first, the second repair will be at ¾ of the following highest code and the third and final code will be at ½.

Residential Overview of Coverage and

Exclusions

Underwritten and Administered by:

14

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Residential Claims Procedure

Underwritten and Administered by:

Coverage is limited to the equipment itself, i.e., no ductwork, field piping, etc., and does not include nuisance calls or normal maintenance. See the specifics concerning exclusions listed on the back of the actual service agreement. To File A Claim: Pre-approval is not required except in the case of full equipment replacement. Please include the following:

• Home Climate Protection Plus Completed Claim Form o Home Climate Protection Plus Agreement Number o Model and Serial Number of Equipment

• Original Service Ticket o Customer Signature

• Any Required Parts Receipts

This may be mailed or faxed to Equiguard, Inc.

Equiguard, Inc. Attn: Claims Department P.O. Box 3368 Oak Brook, IL 60522-3368 USA Fax: (630) 214-1823

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Claim Form - HVAC

Equipment Owner Agreement Number

Address

City

Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City

Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $68 $105 $135 $210 $330 Plan II $79 $123 $158 $245 $385 Plan III $90 $140 $180 $280 $440

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

Invoice Number___________________________________ Service Call ($50 or $60 or $70) $

Failure Date______________________________________ Parts Process Allowance ($30 or $40) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

16

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Commercial

Section

17

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CCPSWSRI-056-5 CCPSWSRII-056-5 CCPSWSRIII-056-5 CCPSWSRI-106-5 CCPSWSRII-106-5 CCPSWSRIII-106-5

CCPSWSRI-056-7 CCPSWSRII-056-7 CCPSWSRIII-056-7 CCPSWSRI-106-7 CCPSWSRII-106-7 CCPSWSRIII-106-7

CCPSWSRI-056-12 CCPSWSRII-056-12 CCPSWSRIII-056-12 CCPSWSRI-106-12 CCPSWSRII-106-12 CCPSWSRIII-106-12

CCPSWSRI-056-17 CCPSWSRII-056-17 CCPSWSRIII-056-17 CCPSWSRI-106-17 CCPSWSRII-106-17 CCPSWSRIII-106-17

CCPSWSRI-056-20 CCPSWSRII-056-20 CCPSWSRIII-056-20 CCPSWSRI-106-20 CCPSWSRII-106-20 CCPSWSRIII-106-20

NOTE: All Coverage Inclusive of OEM Warranty.

$2,955.59 $3,429.34 $3,746.01

Package Unit - Gas/Electric - Heat Pump w/wo EconomizerSplit System - Furnace Gas/Electric OR Air Handler, Heat Pump, Condensing Unit and Evaporator Coil<= 20 Tons

$1,380.55 $1,599.58 $1,710.56

PLAN OPTIONS (Check appropriate box)

5 Year TermPlan I

5 Year TermPlan II

5 Year TermPlan III

10 Year TermPlan I

10 Year TermPlan II

10 Year TermPlan III

Equipment Type: COMMERCIAL

61st Day – 5th Year Labour and Parts Process Allowance,

2nd - 5th Year Parts

61st Day – 5th Year Labour and Parts Process Allowance,

2nd - 5th Year Parts

61st Day – 5th Year Labour and Parts Process Allowance,

2nd - 5th Year Parts

61st Day – 10th Year Labour and Parts Process Allowance,

2nd - 10th Year Parts

61st Day – 10th Year Labour and Parts Process Allowance,

2nd - 10th Year Parts

61st Day – 10th Year Labour and Parts Process Allowance,

2nd - 10th Year Parts

Package Unit - Gas/Electric - Heat Pump w/wo EconomizerSplit System - Furnace Gas/Electric OR Air Handler, Heat Pump, Condensing Unit and Evaporator Coil<= 5 Tons

$483.34 $583.71 $631.78 $1,039.24 $1,257.83 $1,360.38

Package Unit - Gas/Electric - Heat Pump w/wo EconomizerSplit System - Furnace Gas/Electric OR Air Handler, Heat Pump, Condensing Unit and Evaporator Coil<= 7.5 Tons

$611.61 $731.05 $788.71 $1,305.88 $1,564.14 $1,748.96

Package Unit - Gas/Electric - Heat Pump w/wo EconomizerSplit System - Furnace Gas/Electric OR Air Handler, Heat Pump, Condensing Unit and Evaporator Coil<= 12 Tons

$732.13 $864.93 $926.54 $1,567.43 $1,855.31 $2,048.61

$2,255.65 $2,621.33 $2,865.38

Package Unit - Gas/Electric - Heat Pump w/wo EconomizerSplit System - Furnace Gas/Electric OR Air Handler, Heat Pump, Condensing Unit and Evaporator Coil<= 17 Tons

$1,047.44 $1,215.24 $1,295.74

SELECRATE ORDER FORM Commercial Equipment Less Than 12 Months Old

TOTAL PRICE: $________________________

PO # __________________________________________

CONTRACTOR NAME ___________________________________________________________ EQ CONTRACTOR # __________________________

EQUIPMENT OWNER _________________________________________________________ PHONE # (____________) ________________________

MAILING ADDRESS ______________________________________________________________________________________________________________

CITY _____________________________________________________________PROVINCE _____________POTAL CODE _________________________

EQUIPMENT LOCATION (if different) ______________________________________________________________________________________________

CITY _____________________________________________________________PROVINCE _____________POSTAL CODE ________________________

Date Sold: ________/________/________

**Date Installed:________/________/________

*Agreement Charge: ___________________

**INSTALL DATE IS REQUIRED FOR PROCESSING

*Agreement Charge is required in all provinces. This is the price the customer paid.

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Equipment Type/Make __________________________________

Model # _____________________________________________

Serial # _____________________________________________

Fax this form to 630-986-863318

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Plan II Plan III$80.00 $90.00 $50.00 $50.00

Repair Code

A $128.00 $144.00

B $160.00 $180.00

C $180.00 $203.00

D $340.00 $383.00

E $640.00 $720.00

Examples:

Repair Code B Repair Code BFailure – Condenser Fan Motor In Warranty out-of-warranty Failure – Condenser Fan

Motor In Warranty out-of-warranty

Service call $65.00 $65.00 Service call $80.00 $80.00

Motor replacement $130.00 $130.00 Motor replacement $160.00 $160.00

Parts process allowance $30.00 $30.00 Parts process allowance $50.00 $50.00

Parts cost* $0.00 $45.00 Parts cost* $0.00 $45.00

Repair Code D Repair Code D

Failure – TXV In Warranty out-of-warranty Failure –TXV In Warranty out-of-warranty

Service call $65.00 $65.00 Service call $80.00 $80.00

TXV replacement $276.00 $276.00 TXV replacement $340.00 $340.00

Parts process allowance $30.00 $30.00 Parts process allowance $50.00 $50.00

Parts cost* $0.00 $55.00 Parts cost* $0.00 $55.00

Repair Code E Repair Code E

Failure – Compressor In Warranty out-of-warranty Failure – Compressor In Warranty out-of-warranty

Service call $65.00 $65.00 Service call $80.00 $80.00

Compressor replacement $520.00 $520.00 Compressor replacement $640.00 $640.00

Parts process allowance $30.00 $30.00 Parts process allowance $50.00 $50.00

Parts cost* $0.00 $350.00 Parts cost* $0.00 $350.00

* Example parts cost. Actual cost may vary

Commercial Claim ReimbursementEquipment Up To 5 Tons

Total

Total

Total $1,120.00

$525.00 $470.00

$335.00 $290.00

Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor,

variable speed module.

Total $615.00 $965.00 $770.00

Total $225.00 $270.00

Total $371.00 $426.00

$146.00

Note: Parts in-warranty - process allowance, Parts out-of-warranty - cost of part plus process allowance

Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes

leak search, refrigerant recovery time, refrigerant replacement, and dryer)$276.00

Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair

code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under

compressor capacity not system size)

$520.00

Each service call includes a call/diagnostic rate and a parts process allowance in addition to the amount from the specific repair code.

Plan ICall/ Diagnostic Rate $65.00

Plan I Plan II

Process Allowance $30.00 Type of Repair Repair Rate

Replacement of electrical or mechanical components such as all circuit boards, relays, water relief valve, thermocouple, thermostat, condenser fan

blade, fan limit switch, door switch, control transformer.$104.00

Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, ignition transformer, oil

burner motor.

$130.00

SelecRate

19

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Claim Form – Commercial HVAC Equipment Up To 5 Tons

Equipment Owner Agreement Number

Address

City

Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City

Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $104 $130 $146 $276 $520 Plan II $128 $160 $180 $340 $640 Plan III $144 $180 $203 $383 $720

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under compressor capacity not system size) $

Invoice Number___________________________________ Service Call ($65 or $80 or $90) $

Failure Date______________________________________ Parts Process Allowance ($30 or $50) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

20

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Claim Form – Commercial HVAC Equipment Over 5 Tons Up To 7.5 Tons

Equipment Owner Agreement Number

Address

City

Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City

Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $104 $130 $146 $276 $585 Plan II $128 $160 $180 $340 $720 Plan III $144 $180 $203 $383 $810

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under compressor capacity not system size) $

Invoice Number___________________________________ Service Call ($65 or $80 or $90) $

Failure Date______________________________________ Parts Process Allowance ($30 or $50) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

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Claim Form – Commercial HVAC Equipment Over 7.5 Tons Up To 12 Tons

Equipment Owner Agreement Number

Address

City

Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City

Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $111 $138 $163 $309 $650 Plan II $136 $170 $200 $380 $800 Plan III $153 $192 $225 $428 $900

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under compressor capacity not system size) $

Invoice Number___________________________________ Service Call ($65 or $80 or $90) $

Failure Date______________________________________ Parts Process Allowance ($50 or $75) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

22

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Claim Form – Commercial HVAC Equipment Over 12 Tons Up To 17.5 Tons

Equipment Owner Agreement Number

Address

City Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $130 $163 $195 $325 $845 Plan II $160 $200 $240 $400 $1,040 Plan III $180 $225 $270 $450 $1,170

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under compressor capacity not system size) $

Invoice Number___________________________________ Service Call ($65 or $80 or $90) $

Failure Date______________________________________ Parts Process Allowance ($50 or $75) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

23

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Claim Form – Commercial HVAC Equipment Over 17.5 Tons Up To 20 Tons

Equipment Owner Agreement Number

Address

City

Province Postal Code

Phone

Fax

Email

Contractor Equiguard Contractor Number

Address

City

Province Postal Code

Phone

Fax

Email

Repair Code A B C D E Plan I $163 $195 $260 $455 $1,105 Plan II $200 $240 $320 $560 $1,360 Plan III $225 $270 $360 $630 $1,530

REPAIR DESCRIPTION

REPAIR CODE “A” Replacement of electrical or mechanical components such as all circuit boards, all relays, water relief valve, thermocouple, thermostat, condenser fan blade, fan limit switch, door switch, control transformer.

$

REPAIR CODE “B” Replacement of electrical or mechanical components such as blower motor, blower wheel, condenser fan motor, condenser fan blade & motor, heater package and heat strips, gas valve, fuel pump, burner ignition transformer, oil burner motor.

$

REPAIR CODE “C” Replacement of electrical or mechanical components such as shaft and bearings, gas burners, blower motor assembly, variable speed blower motor, variable speed module.

$

REPAIR CODE “D” Minor repairs to sealed system such as TXV, reversing valve, factory joint leaks, refrigeration pressure switch, service valve. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) $

REPAIR CODE “E” Major repairs to sealed system such as heat exchanger, compressor*, condenser/evaporator coil replacement, accumulator or muffler. (Repair code includes leak search, refrigerant recovery time, refrigerant replacement, and dryer) (*Compressors are to be claimed under compressor capacity not system size) $

Invoice Number___________________________________ Service Call ($65 or $80 or $90) $

Failure Date______________________________________ Parts Process Allowance ($50 or $75) $

Model Number ___________________________________ Cost of Parts Out of Warranty $

Serial Number____________________________________ If Applicable, Sales Tax at % $

TOTAL DUE $

IMPORTANT NOTICE: PLEASE ENCLOSE A COPY OF THE CUSTOMER WORK ORDER AND RECEIPT FOR PARTS.

SelecRate

Mail or Fax to: P.O Box 3368 ♦ Oak Brook, IL 60522-3368 (USA) Tel (800) 886-9363 ♦ Fax (630) 214-1823 www.equiguard.com

Underwritten and Administered by:

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AMERICAN HOME ASSURANCE COMPANY

EXTENDED SERVICE AGREEMENT

DECLARATIONS

SECTION

SERVICE CONTRACT PRICE GST QST TOTAL OWNER INFORMATION

OWNER’S NAME TELEPHONE NUMBER

ADDRESS

CITY PROVINCE POSTAL CODE

DEALER INFORMATION THE ITINERANT MERCHANT’S PERMIT NUMBER: DEALER CODE NUMBER

DEALER’S NAME TELEPHONE NUMBER

ADDRESS FAX EMAIL

CITY PROVINCE POSTAL CODE

EQUIPMENT DESCRIPTION NOTE: The equipment listed below MUST match the equipment description stated. Equipment may not be moved from the original installation site and remain under coverage.

MANUFACTURER EQUIPMENT TYPE

MODEL NUMBER SERIAL NUMBER UNIT SIZE DATE OF FABRICATION

* PRICE OF EQUIPMENT

Installation date MUST be within one (1) year of coverage start date (for contracts of five (5) or ten (10) years extended warranty agreement), except for specific Contracts on equipment up to five (5)

years old. COVERAGE START DATE IS BASED ON THE EQUIPMENT INSTALLATION DATE OR AGREEMENT PURCHASE DATE, WHICHEVER OCCURS LAST. This service agreement, hereinafter referred to as “Agreement”, is inclusive of the manufacturer’s limited warranty and is only for the coverages listed herein. The warranty for labor is effective on the (31st) day following the in service date in force in the event of a new installation. This agreement is between American Home Assurance Company (We, Us, Our) and owner (YOU and YOUR). It applies only to the equipment described herein. Any manufacturers’ recall and/or repair labor allowance program becomes part of this agreement. During the term of this agreement WE, at OUR sole discretion, will arrange through an authorized service facility, to either repair, replace, or reimburse YOU for authorized repairs/replacement to covered equipment, if required due to mechanical or electrical breakdown, subject to the terms and conditions stated herein. Such repair, replacement or reimbursement will be performed by US or other authorized service facility. A mechanical or electrical breakdown is defined as the inability of a covered part to perform a routine function, for which it was designed, when properly cleaned and serviced, due to a defect in material and/or faulty workmanship as supplied by the manufacturer. Replacement of parts may be a duplicate part of like kind and quality. A mechanical or electrical breakdown does NOT include a reduction in operating energy efficiency. This agreement must be registered within six (6) months after purchase date or equipment start date. EQUIPMENT CONDITION. All covered equipment must have been inspected and been in good working order on date of installation. WE do not guarantee that the material or workmanship supplied by the manufacturer is free of defect or will satisfy specific requirements for a specific period of time. Coverage includes equipment (installed and used in accordance with the manufacturer’s specifications) as supplied by the manufacturer, which fail through normal operation during the term of this agreement. TERM. New equipment is considered new within one (1) year of installation date. The term commences on the date of installation. LIMIT OF LIABILITY. OUR liability is limited to the replacement cost of like and kind equipment during the term of this Agreement. Single part coverage agreements, such as water heaters, compressors, motors, pumps, etc., are limited to ONE (1) replacement during the term of the agreement. KILOMETERS: This agreement covers the distance in kilometers from the authorized dealer up to fifty (50) kilometers when the equipment is returned, at a rate of 0.60$ “Canadian currency” for each

kilometer, outside the usual covered area (which is within a radius of fifty (50) kilometers from the service contractor or the office). Travel time and time required to obtain parts and supplies are excluded. YOUR RESPONSIBILITY In order to keep this agreement valid, YOU must have the equipment serviced as recommended by the manufacturer. YOU must keep maintenance records validated by the servicing facility, or keep receipts and work orders showing dates and service performed. If YOU perform the maintenance, keep receipts sufficient to document performance. TRANSFER This agreement may be transferred to subsequent owners if the maintenance has been performed as required by the manufacturer. Assignment is effective upon inspection and payment of a thirty-five dollar ($35) transfer fee. Requests must be submitted in writing thirty (30) days of change of ownership. CANCELLATION YOU may cancel this agreement for any reason during the first ten (10) days after it is

issued and obtain a full refund of the purchase price. After the first ten (10) days, YOU may cancel this agreement and receive a prorated refund based on the time remaining on your plan, less an administrative fee not to exceed ten percent (10%) of the price of this agreement or twenty-five dollars

($25) whichever is less and less the value of any services or claims that have been provided or paid.

WE may not cancel this agreement except for fraud, material misrepresentation or non-payment of premium by YOU. If WE cancel this agreement after the first sixty (60) days, YOU will receive a pro-rated refund of one hundred percent (100%) of the purchase price of YOUR agreement based on the time remaining on YOUR plan less any services provided or claims paid. CLAIMS SUBMISSION

1. First call your service contractor whose number appears under information of your extended warranty contract agreement to determine the problem and the cause of the failure and make the repair. If your service contractor is not available call our administrator’s claim service center for instructions at (800) 886-9363 or

(630) 986-9363, who will appoint a service/repair facility that will do the inspection and diagnose the problem

2. Keep defective parts as they must be available to send to OUR claims administrator, if

requested, at time of claim. Submit invoice for any replacement parts for which charges are being made, invoice must show serial number if applicable and dealer cost.

3. Acknowledge the service facility’s invoice by signing it upon completion of the repair.

YOU or the service facility must forward the invoice to OUR claims administrator within thirty (30) days of date of repair or replacement. Service facility to send invoice, copy of work order and receipts for parts (or factory warranty claim form if replaced part is covered under OEM warranty) to the administrator for processing and payment.

• LABOR ONLY COVERAGE Pays labor only for one (1) person to repair or replace the covered

part which fails due to a mechanical or electrical breakdown.

• PARTS ONLY COVERAGE Pays for the part only at dealer’s cost, no mark-up, not to exceed any published rate for a covered part which fails due to a mechanical or electrical breakdown.

• PARTS AND LABOR COVERAGE Pays labor for one (1) person and parts at dealer’s cost plus mark-up, not to exceed any published rate for a covered part which fails due to a mechanical or electrical breakdown.

ADDITIONAL STATMENTS, COVERAGES, EXCLUSIONS and PROCEDURES ARE LOCATED ON THE REVERSE SIDE

EQ_TC_CDN_V2.0406

COVERAGE START DATE

COVERAGE END DATE

AGREEMENT NUMBR

DISTRIBUTOR NUMBR

PART NUMBER

* This is the retail price of the equipment only and includes no other charges such as ductwork, plumbing, etc. Nor does this determine the limit of liability for this contract.

Administered By

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COVERAGE: For electronic air cleaners, boilers, water heaters, exhaust/ventilation fans, heat pumps and thermostats: all internal functioning parts supplied by the manufacturer: For compressors/condensing units: all internal functioning parts supplied by the manufacturer. Leaks in evaporator, condensor coils and metering device as received from the manufacturer are covered for sixty (60) days from equipment installation; any factory warranty must first be applied before this coverage is in effect. Loose service valves and connections are excluded. Refrigerant leaks do not include interconnecting fittings or field piping. Only one (1) leak is covered for the term of the agreement. WE will not pay for refrigerant loss in system beyond internal charge of the unit, or changeover from CFC to non-CFC refrigerants, including changes in oils, due to governmental regulations. For evaporator coils: all internal parts as received from the manufacturer. A. New evaporator coils covered when sold as part of a complete system. B. Existing coils: YOU will certify that coils are clean and not defective on the installation date of replacement Condensing Unit(s). Condensate pan melting and/or corrosion are not covered. For furnace and air handler, electric, butane, gas, oil, propane: all internal functioning parts supplied by the manufacturer, heat modules and controls supplied as part of the unit by the manufacturer. For humidifiers: all internally installed parts as supplied by the manufacturer. Coverage does not include pads, media material, filters, etc. Cleaning is not covered. EXCLUSIONS. EXCLUDED FROM COVERAGE: • Incidental / Consequential Damage. This agreement DOES NOT extend to damages for personal

injury, property damage, pecuniary loss, consequential or incidental damages resulting in any action of the manufacturer, the service facility or US.

• Improper installation, modification, abuse, negligence, misuse of equipment or unit. Equipment

listed must be used for its sole purpose (i.e. water heater to heat water, furnace to heat air, etc.) • Appearance features, esthetics, paint and cabinet parts, knobs and buttons. • Charges for diagnostic, truck, shipping, freight, taxes, kilometers (outside of fifty (50) kilometers)

overtime and/or holiday rates and/or charges, labor charges for obtaining replacement parts and/or supplies at supply house, rigging and/or crane services, special tooling or inflated pricing, equipment rental or usage fees (i.e. refrigerant reclaimers (or reclaiming), leak detectors or temporary services).

• Damages, consequential or otherwise caused by rust, brownouts, environmental conditions outside

of manufacturer’s specifications, oxidation, corrosion, water, freezing, fire or other natural acts. • Loss of performance due to normal wear and tear, overrated capacities, modifications to original

system, insufficient water or poor water conditions. • Consumable products such as nitrogen, torch, solder, carbon dioxide, process fluids, lubricants,

glycol, additives, batteries, etc. • Wiring/electrical: Low or high voltage wiring external of unit (i.e. humidifier, thermostat, condenser

or other controls mounted external of the unit), fuses, breakers (unless part of unit by the OEM). • Miscellaneous: registers, grills, key valves, duct work, routine maintenance, plumbing, venting. • Accessories or add-ons: Hard start capacitors, motor controllers, isolation relays, time delays,

zone valves (unless otherwise noted on front under “Equipment Description”) etc.

CLAUSE REQUIRED UNDER THE CONSUMER PROTECTION ACT. (Contract entered into by an itinerant merchant) 1. The consumer may cancel this contract within 10 days following that on which he comes into

possession of his duplicate of the contract. 2. The merchant may not receive any payment before the expiry of the 10 day period provided

for the above for cancellation, except if the consumer has already received the goods that form the object of the contract.

3. A consumer who cancels the contract within the 10 day period must do so in one of the

following 3 ways: a. by returning the goods to the merchant or his representative; b. by returning, to the merchant or his representative, after completing and signing it,

the form entitled “cancellation form” which must be attached to the duplicate of the contract; or

c. by forwarding to the merchant or his representative a notice in writing indicating his intention to cancel the contract.

1. The contract is canceled, without further formality, as soon as the consumer returns the goods

or forwards the form or notice. 2. Within 10 days following the cancellation, the consumer and the merchant must restore what

they have received from one another. The merchant shall assume the costs of restitution. 3. The merchant shall assume the risk of loss or deterioration, even by fortuitous event, of the

goods forming the object of the contract, until the expiry of the 10 day period provided for above for the restitution of the goods.

4. The consumer shall not cancel his contract if, as a result of an act or a fault for which he is

liable, he is unable to restore the goods to the merchant in the condition in which he received them.

It is the consumer’s interest to refer to sections 58 to 65 of the Consumer Protection Act (R.S.Q.,

c. P-40.1) and, where necessary, to communicate with the “Office Of Consumer Protection”. WHAT YOU MUST DO IN THE EVENT OF A CLAIM. 1. Use all reasonable means to protect YOUR equipment from further damage resulting from

continued operation. 2. First call your service contractor who’s number appear’s under information of your extended

warranty contract agreement to determine the problem and the cause of the failure and make the repair. If your service contractor is not available call OUR administrator’s claims service center for instructions at (800) 886-9363.

If a claim is not paid by the administrator within sixty (60) days of reporting, it can be submitted to the following address: American Home Assurance Company 2000 McGill College Avenue, suite 1200, Montreal (Quebec) Canada H3A 3H3. IMPORTANT INFORMATION: Provincial and federal laws that protect your interest as a consumer vary. If YOU cannot resolve a problem with US or OUR administrator, YOU may have other rights and remedies.

For customer service call (800) 886-9363 or write: Equiguard, Inc. • P.O. Box 3368 • Oak Brook, IL 60522-3368 USA

Executed in four (4) copies this day of : 20 month at , Province of _________________ address city Signature of seller: per:

(full business or corporate name, if not an individual) Signature of buyer: Schedule 1 CANCELLATION FORM (CONSUMER PROTECTION ACT.S. 58) TO:

(name of itinerant merchant or his representative)

(address of itinerant merchant or his representative) Date:

(date of sending of this form)

By virtue of section 59 of the Consumer Protection Act, I cancel this contract

Made

to

(number of the contract if indicated)

(date when the contract was made) (place where the contract was made) (name of consumer) (signature of consumer) (address of consumer)

Administered by: Equiguard, Inc. P.O. Box 3368 Oak Brook, IL 60522-3368 USA Phone (800) 886-9363 Fax (630) 325-7126 (630) 986-9363

EQ_TC_CDN_V2.0406

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