Address ___________________________



Check if yes                                                                   Amount

___ Fire Hydrants                                            ______(# of hydrants)

___ Storm drains                                              ____(should never be covered with snow)

___ Speed bumps                                            ______

___ Trash dumpsters                                             ______(can't pile snow around)

___ Low lighting                                                   ______

___Protruding Curbs                                            ______

___Natural Gas Shut offs                                     ______

___ Fuel Oil Fill                                                   ______

___ Fire Dept. Siamese Connections                     ______

___ Light Poles                                                    _____Can snow be stacked around them? ___

___ Electrical Boxes or Traffic Control boxes      ______

___ Parking lot islands (Shrubs, etc)                     _____ Can snow be stacked on them? ___

___ Gravel areas                                                  _______

___ Fire Lanes                                                    _______(Must be kept open during storms)


Check if yes                                              Amount

__Many uneven gaps in the walk sections  ______(shovels and blowers find every one, every time)

__Asphalt patch over concrete surface      ______ (will erode away, and machines will snag on it)

___Crosswalks (street corners)                  ______(# of openings to break open after plowing)

___ Fire Dept Siamese Connections           ______

___ Crosswalks in the parking area            ______(# of openings to break open after plowing)

___ Fences running parallel with walks       ______(limit where the snow can be cleared to)

___ Handrails                                            ______(that limit what equipment can be used)

___ Staircases                                           ______    # of steps each ____ _____   _____

___ Handicap Ramps                                 ______ (railings often affect easy clearing)

___ Steep Inclined sections                       ______

___ Stairwells ( steps leading down)       ______ ( these can be a nightmare when snow is blowing / drifting)

___ Slate steps                                         ______ (these ice up easily, and can be dangerous)

___ Drains                                               ______(have to be found and cleared)


The snow will be stacked (piled up) (eg; "left back corner")___________________________ of the parking lot.

Estimate for deicer per application -parking lot(s)_____  walks___(bags or yards) price$______


*Draw a diagram of the job site on the back of this sheet, or buy a pad of graph paper.*


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