EyeQ — EWP Partner Application

Section 1

Points of Contact

Provide contact details for each role. EyeQ will route communications based on these assignments.

ℹ️

Required roles

Primary Partner Contact and After-Hours Emergency Contact are required. All others are strongly recommended.

Role	Name	Phone	Email
Primary Partner Contact *
Dispatch / Scheduling
Billing / Accounts Receivable
After-Hours Emergency *
Executive Escalation

Section 3

Licensing & Insurance

List all active licenses and current insurance coverage. Copies must be emailed with your application.

State Contractor Licenses

⚠️

Attach copies

Attach a copy of each license when submitting this application. Expired licenses will disqualify your application.

State	License Type	License Number	Expiration Date	Qualifier Name

Insurance Coverage

Coverage Type	Carrier Name	Policy Number	Limit	Expiry Date
General Liability *
Workers' Compensation *
Commercial Auto
Umbrella / Excess

Additional Insured

Can EyeQ be named as Additional Insured on your GL policy? *

Yes — within 48 hours Need to confirm with carrier No

Do you carry Errors & Omissions (E&O) insurance?

Yes No

Section 4

Technical Capability

Describe your field workforce, certifications, systems experience, and equipment inventory.

Field Workforce

W2 Field Technicians *

Approved 1099 / Contract Techs

Techs with Low Voltage Cert.

Techs with Security / Alarm Cert.

Industry Certifications

Certifications held (list all — NICET, ESA, manufacturer certs, etc.)

Equipment & Vehicles

Dedicated Service Vehicles

Dedicated Install Vehicles

GPS Tracking on Vehicles

All vehicles Some vehicles No GPS tracking

OSHA / Safety Program

OSHA 30 Trained OSHA 10 Trained Basic in-house program No formal program

Section 5

Coverage Zone Selection

Click counties on the map to select the zones you are applying to cover. You must hold an active license and have certified technicians in each selected zone.

Zones selected

0

States covered

0

Regions covered

0

Available zones

3,143

Selected Zones (0)

No zones selected yet. Click counties on the map above.

Selected Coverage Zones

SLA Commitments

Emergency Response SLA (hours) *

After-Hours Emergency Coverage *

Current Capacity Utilization

Max Simultaneous Work Orders

Section 6

Business History & References

Disclose any relevant business history and provide three professional references.

ℹ️

Honest disclosures required

Answer all questions truthfully. A "Yes" answer does not automatically disqualify your application — but misrepresentation will.

Business Disclosures

Has your company filed for bankruptcy in the last 7 years? *

No Yes — provide explanation below

Does your company have active liens, judgments, or legal disputes? *

No Yes — provide explanation below

Has any contractor license been suspended or revoked? *

No Yes — provide explanation below

Any OSHA violations or recordable safety incidents in the last 3 years? *

No Yes — provide explanation below

Explanation (if any "Yes" answers above)

Subcontractor Experience

Have you previously worked as a subcontractor for a systems integrator? *

Yes No — this would be our first subcontract relationship

If yes — describe companies worked with, scope, and duration

Professional References

Provide three references. At least two must be clients or partners who can speak to field work quality.

#	Company / Contact Name	Relationship	Phone	Email
Ref 1 *
Ref 2 *
Ref 3

Section 7

Review & Sign

Review your application, sign, and export a PDF to email to EyeQ Partner Programs.

Certification Statement

⚖️

Legal attestation

By signing below, you certify that all information provided is true and accurate. Misrepresentation may result in disqualification or termination from the EyeQ EWP network. You authorize EyeQ to verify all information and contact listed references.

Authorized Signatory (Print Name) *

Title / Role *

Date

Signature *

Draw your signature above ·

Application complete. Export a PDF and email it to EyeQ Partner Programs.

Email to: ewp@eyeqmonitoring.com · Subject: EWP Application — [Your Company Name]

Company Information

Company Information

Points of Contact

Licensing & Insurance

Technical Capability

Coverage Zone Selection

Selected Coverage Zones

Business History & References

Review & Sign