Private Locate Information Step 1 of 3 33% State, County, Township* StateIllinoisIndianaKentuckyOhioMissouri County Township City* Subdivision Address Number* Numeric portion only!Street* Nearest Cross Street* Is the cross street within a 1/4 mile?*YesNoArea to be located* Meet Contact Onsite?*NoYesOnsite Contact?* Onsite Contact Phone Number*Is the Onsite Contact Name and Phone the same as the Requestor Name?* Yes No Requester Name* Requestor Phone Number*Requestor Email* Type of Work* Will GPR or Hand Concrete Scanner be needed?*GPRHand Concrete ScannerBothNoRequests are subject to schedule availability. You will be contacted by a Northern Lights representative to confirm your requested start date.Private Locate Start Date?* MM slash DD slash YYYY About what time would you like us to start?*5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pmStart times are subject to availability, you will be contacted by a Northern Lights employee if your selected time does not work.Do we need to confirm when private locate is finished?*YesNoIs this an emergency?*NoYesEmergency requests with less than 24 hour notice will be subject to a 25% premium in addition to normal rates. After Hour Emergency Requests (Monday – Friday from 6pm – 7am, Weekends and Holidays) will be subject to a 40% premium in addition to normal rates.Service Requested*Specify Private Utility Locating, Ground Penetrating Radar, Leak/Fault Detection, etc.Attachment Drop files here or Select files Accepted file types: pdf, jpg, jpeg, gif, png, dwg, kml, kmz, Max. file size: 10 MB, Max. files: 5. Please attach any copies of One-Call locates, prints, drawings, or other documents related to this request in pdf, jpg, jpeg, gif, png, or dwg format or via fax to 317-838-0925. Billing InformationJob or PO Number Company Name Contact Name* Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AP/Billing Email Address* Billing Contact Billing Phone Number*Please send my invoice by*EmailAddress aboveWould you like us to contact you after the locate is complete? No Yes Contact Name for Post Locate* Phone Number* Terms, Conditions and Pricing Service Needed Price Per Hour Minimum Hours Required Electromagnetic Locating (EM, Standard Locating) $180.00 One Hour Ground Penetrating Radar $250.00 One Hour Hand Concrete Scanner $275.00 One Hour Push Sewer Camera $250.00 One Hour Lateral Launch Camera System $315.00 Two Hours Single Technician Mobilization $85.00 One Hour For scheduling purposes, two business day notice is preferred. However, your business is important to us and we will make every effort to accommodate your needs when such notice is not possible. Additional fees may apply. I authorize NORTHERN LIGHTS LOCATING AND INSPECTION SERVICES, INC. (the "Company) to perform the work requested above. I agree to pay the Company for the work completed per the request above. Invoices are due on receipt. Failure to pay any balance due will result in the Customer liable for reasonable interest and shall be responsible for all costs of collection incurred by the Company including attorney fees, court costs and other costs of collection. Due to the nature of privately owned underground utilities, NORTHERN LIGHTS LOCATING AND INSPECTION SERVICES, INC. (the "Company") will not be held liable for any damaged facilities. The Customer is hereby advised that they are required to follow their state's One-Call law before beginning any excavation work. The Company will not guarantee the longevity of facility markings due to activities on site that may destroy or otherwise alter any markings placed on the ground by the Company. Customer shall provide notification of any existing or potential environmental hazards prior to the commencement of work. The Company reserves the right to postpone or decline scheduled work based on any hazards identified by the Customer or identified by the Company. The Company reserves the right to postpone and/or reschedule work based on weather conditions that may affect the accuracy of the work. The Customer will be advised of any weather related concerns and the Company will not be held liable should the work be performed in adverse weather under the direction of the Customer. The Customer releases and waives any liability or claim against the Company, it's agents and employees arising out of or in any way related to the services subject to this agreement. The Company will not be held liable for any damaged facilities at the address indicated on this request, whether or not located by the Company, caused by another contractor, builder or other person or firm. In which, the Customer agrees to assume, credit, release and satisfy that portion of the total amount of said damages that are determined in any trial or other disposition to have been caused by or to be the responsibility of the Company or its agents or employees. The Customer agrees to defend, indemnify and hold harmless the Company or its agents or employees: (i) for any claims or demands brought against them arising out of or related to the services subject to this agreement, including those founded upon the Company claimed negligence, and (ii) for any amounts they may be required to pay upon any judgments obtained against them for contribution and/or indemnification. The Customer hereby reserves its rights against all contractors, builders and other parties not hereby released.Check here to verify that you understand and acknowledge the above statements* I agree to these terms
