Microsoft word - iq certification progam application.doc

Date: ___________________
IQ Certification Program
Are you applying for Recertification?
What are you applying for?
Contact Information
Name of Business/Legal Corporate Name:
Street Address (for each location; attach an additional sheet if necessary):
City: State/Province:
Phone Number:
Fax Number:
Email Address:
IQ Compliance Information
Compliance Officer:
Phone Number:
Email Address:
List the names and titles of the people on the Quality Control Team:
IQ Monitoring Company Information
Name of IQ Certified monitoring company or companies (if more than one attach information):
Point of Contact and title of position:
Street Address:
City: State/Province:
Phone Number:
Fax Number:
Business Information
Are you a licensed business entity for all jurisdictions for which you do business and where licenses are required?
License Numbers (if applicable): Attach Copy of License(s) for all areas you are applying for
If you answer yes to any of the following four (4) questions; the IQ Certification Board will contact you:
1. Are there any past or pending license revocation actions:
2. Are any members of your organization under indictment at this time?
3. Are there any outstanding unpaid judgments against your company?
4. To the best of your knowledge, has any member of your organization ever been convicted of a felony or crime of moral

Do you have insurance for:
No, (if Yes, Company?) ____________________________________________ No, (if Yes, Company?) ____________________________________________ No, (if Yes, Company?) ____________________________________________ Attachments

Include along with this signed and competed application, copies of each:

Signed copy of Compliance Officer Certification Form signed by the IQ Compliance Officer and the Company CEO Signed copy of the IQ guidelines signed by the IQ Compliance Officer and the Company CEO Copy of a written company policy that requires IQ Certification compliance by all employees. Needs to be signed by IQ Compliance Officer named above, and the company CEO Affiliations
Are you a member of the National Burglar & Fire Alarm Association (NBFAA)?

(If not would you like information on joining?)

Are you a member of the Canadian Alarm and Security Association (CANASA)?

(If not would you like information on joining?)

What other associations, if any, are you a member of?
The IQ Certification Board, in performing functions in accordance with their objectives, assume or undertake to discharge
any responsibility of the instal ing or monitoring company or any other party. The opinions and findings of the IQ Certification Board
represent its professional judgment given with due consideration to the necessary limitations of practical operation and state of the art at
the time the IQ Certification Guidelines are approved. The IQ Certification Board shall not be responsible to anyone for the use or reliance
upon this program for any reason. The IQ Certification Board shall not incur any obligation or liability for damages, including consequential
damages, arising out of or in connection with the use, interpretation of or reliance upon this program.
I hereby certify that the answers and any other information on this application and attachments are true and correct. I understand that, if
accepted, any misrepresentation or omission of facts on my part will be justification for revoking my company’s certification.
_____________________________________________________________________ _____________________________________
Compliance Officer Date

_____________________________________________________________________ _____________________________________
Business Owner/Authorized Officer Date

Return this completed application with appropriate materials to:
The Installation Quality Certification Board
Copyright 2008, The IQ Certification Program



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