extConnect oGles TECHNOL Installer and Customer A, oval Date 14/16/2021 Installation Start Date: JobNumber: |” NXJ214650 ‘Scheduled Complete: 11/18/2021 41/18/2021 Installation Dates are non-negotiablo unless otherwise directed by NextConnect Program Management Time in: G26 Site Location Madison Heiahts Primary Care 27483 DEQUINDRE RD STE 303A Madison Heights MI 48071 Site ID: 11660566 Office Manager Project Name: Scope of Worl 1) Called to open the service ticket - 913-832-0222 2) Met with data tech for support 3) Repaired or replaced damaged circuits and tested 4) Worked with data tech to make sure screens working 5) Took digital pictures of work performed and outlet tests 6) Called to clsoe the service call Time out: (2°52 Total hours: Techs on Site:_“2-__ Technician Inital Each ‘tem Complete 5) iaeeeaie a= ye oa sas oo ”. eye %, 10) 34) 32) | certify that the installation/service has beep€ompletd in a If No, please describ 1s back of this form if Customer Sig) Print Name: Customer ApprovaJ——~ The Scone of Work has been performed to mv satistactiog? Yes / No ici ary). jonal manner. as ovr fand verified site Dat Date: PY | NextConnect Technologies