APPLICATION FOR ADDITIONAL COMPANY LISTING

UNDER AN ICC-ES EVALUATION REPORT

EVALUATION REPORT NUMBER OR FILE NUMBER:

HOLDER OF EVALUATION REPORT (COMPANY NAME):

Desires to add the following company (referred to hereafter as “Applicant”) to the subject evaluation report, as an additional company listing:

COMPANY NAME

MAILING ADDRESS

CITY/ STATE/ ZIP CODE

COUNTRY

(If other than USA)

COMPANY PHONE NUMBER

COMPANY E-MAIL ADDRESS

COMPANY WEBSITE

This box is for ICC-ES internal use only:

File Number:	Date received:	Fee:	Processed by:

Report Number:

In consideration of the processing of this application, the Applicant agrees to abide by any conditions attached to any report or renewal thereof issued pursuant to this application, or any later amendment of said report or renewal, and the applicable ICC-ES Rules of Procedure as they now exist and as they may be reasonably modified in the future. Applicant acknowledges reviewing the applicable Rules of Procedure. Applicant also agrees that the provisions on the second page of this application constitute a part of the applicant’s agreement..

Applicant understands that any approval of this application will be automatically vacated upon any expiration or revocation of said evaluation report. Applicant also agrees and understands that the holder of the above-referenced evaluation report may at any time withdraw any rights of Applicant which may result from this application; ICC Evaluation Service, LLC, however, is to have a reasonable period of time within which to delete any reference to the Applicant from the evaluation report. Applicant also agrees that any rights resulting from this application may be revoked by ICC Evaluation Service, LLC, separate and apart from any revocation of the above-referenced evaluation report for any reason considered valid by ICC Evaluation Service, LLC, even if such reason is not a ground for revocation of the evaluation report itself.

INDEMNIFICATION PROVISIONS:

An ICC Evaluation Service, LLC (ICC-ES), evaluation report does not imply any guarantee or warranty (expressed or implied, and including but not limited to merchantability) by ICC-ES against defects or failures in service nor any responsibility in regard to patent or trademark infringement, misuse of trade name or trade secrets, or any other aspect of unfair competition. Affirmative actions of ICC-ES are based primarily on the data submitted by the applicant and/or holder of the report and the validity and integrity thereof as implicitly represented by the applicant and/or holder in submitting the same. Applicant agrees that it shall have no cause of action or claim against ICC-ES or its parent corporation, the International Code Council, Inc., or the officers, directors, members and employees of either entity from time to time arising out of any evaluation report issued pursuant to this application, whether or not such evaluation report is subject to conditions, or out of any denial of this application except that the applicant shall have a course of action against ICC-ES for any intentional or willful and wanton act or omission of ICC-ES. Applicant agrees to hold ICC-ES, its parent corporation, the International Code Council, Inc., or any of their affiliates, parent, brother or sister corporations or their Successor-In-Interest or assigns, and the officers, directors, members, and employees of both such entities (“ICC” collectively throughout this paragraph) harmless, and to defend and indemnify them, with respect to any claim, liability, action or judgment arising from the use or operation by any person of the product or service to which the application relates, actual or asserted, whether related to the matters set forth in the first sentence of this paragraph or otherwise, whether for personal injury, wrongful death, property damage, or any type of injury or damage whatsoever, whether or not of the same kind or nature as any of the foregoing. ICC's rights pursuant to the foregoing sentence, and applicant's obligations thereunder, shall not apply if ICC was solely negligent for any intentional or willful and wanton act or omission of ICC. If any part or portion of this paragraph, or any application thereof to particular facts, should be determined invalid, the provisions hereof shall be severable so as to achieve for ICC the maximum legal protection. If this application is for a renewal of an existing evaluation report, the provisions of this paragraph shall apply from the date of first granting of that evaluation report, whether upon application or without application by applicant or a predecessor and regardless of: intervening modifications to said report or modifications pursuant to application for renewal; any prior change in the number assigned to the report; and any prior change in ownership rights in or rights to said report, or any additional listing included in the report, whether one or more, since granting of said first additional listing.

Authorized Signature for Applicant

Name of Signer and Title (type or print)

Date

The undersigned, "holder" of the above-referenced evaluation report, consents to the above-requested action on the terms and conditions above set forth. (Holder of the report signing below must be a corporate officer, a partner, or sole proprietor.)

Name of Report Holder (Company Name)

Signature for Holder

Name of Signer and Title (type or print)

Date