OCCUPANT’S FUMIGATION PREPARATION NOTICE & DISCLAIMER
TIGER TERMITE CONTROL INC.
4195 Chino Hills Pkwy., PMB #148 w Chino Hills, CA 91709
(909) 597-6953 w Fax (909) 597-0584

JOB ADDRESS___________________________________ CITY/ZIP___________________________

OWNER OR AGENT______________________ EMERGENCY PHONE (     )___________________

DATE OF FUMIGATION__________________ DATE YOU CAN RE-ENTER_____________________

FUMIGANT TO BE USED: q VIKANE (V) use with tear-gas (Chloropicrin) added, as a warning agent.

STRUCTURE(S) TO BE FUMIGATED:________________________ ORGANISM TO BE EXTERMINATED:_____________

Key(s) to be taken and returned to (where):______________________________________________________________

PLEASE BE ADVISED THAT THE JOB TIME GIVEN TO YOU IS APPROXIMATE AND SUBJECT TO CHANGE WITHOUT NOTICE. IT IS THE RESPONSIBILITY OF THE HOMEOWNER AND/OR HIS AGENT TO HAVE ALL ITEMS ON THIS CHECK LIST DONE BEFORE THE FUMIGATION CREW ARRIVES. HOWEVER, IN CASE OF RAIN, STRONG WINDS OR JOB BEING IMPROPERLY PREPARED, THE JOB MAY HAVE TO BE POSTPONED TO A LATER DATE. IN CASE OF RESCHEDULING OR RE-DO’S TIGER TERMITE CONTROL (HEREINAFTER REFERRED TO AS T.T.C.) IS NOT RESPONSIBLE FOR ANY COST INCURRED FOR LODGING FOR OWNER, TENANTS AND GUESTS; AND, ANY FOOD OR MEALS, OR BOARDING OF ANY ANIMAL OR PET.

1. OWNER/OCCUPANT/AGENT: After reading this notice, please leave one signed copy in a pre-assigned spot in the structure to be fumigated or hand it over to our field representative BEFORE you leave the job site. Keep one copy for your records. This MUST be in our possession in order for us to proceed.

2. Remove all people and pets, including fish and birds. Pets must be removed form yards - THIS INCLUDES CATS. Water in fish tanks does not have to be drained. Please advise neighbors of fumigation. This may prevent their animals from being caught in the fumigation.

3. Remove all interior and exterior plants, whether potted or hanging in/or on the building (s).

4. Remove all mattresses enveloped with plastic covers such as baby mattresses, etc. or remove covers (except water beds).  Unzip plastic covers over clothing.

5. Remove food and medicines NOT sealed (original manufacturer’s seal) in glass or metal containers. This includes anything your orally ingest, such as gum or candy. It also includes food in freezers and refrigerators. In lieu or removal, these items may be placed in poly-ethylene bags of 4 mil or greater thickness and sealed with tape or clamps. IF T.T.C. HAVE TO BAG FOODS OR MEDICINES, THERE WILL BE A CHARGE OF $25.00 PER BAG. IF FOOD OR MEDICINES ARE THROWN AWAY, T.T.C. IS NOT RESPONSIBLE FOR REPLACEMENT OF SAME.

NOTE: The reason for removal or bagging of food items is the fact that Vikane is not registered for fumigation of prepared foodstuff. Therefore, food must be removed or bagged as a requirement, rather than our of fear of contamination.

6. The Occupant must soak the soil with water at least 12” from foundation outward. This can be done the evening before and this may help protect plant root growth. Please turn off TIMERS to sprinkler systems. The Occupant must cut back plant growth where possible 12 to 18 inches away from exterior of structure(s) to be fumigated. THIS INCLUDES IVY, VINES AND BOUGAINVILLEAS. Clean debris away from structure(s), i.e., plumbing pipes, wood piles, trash, etc. Trim trees that hang over any roof, or grow next to or under eaves of the structure(s0. JOB WILL BE POSTPONED IF DEBRIS IS NOT CLEANED AWAY FROM THE STRUCTURE(S) AND IF IVY, BOUGAINVELLA AND TREES ARE NOT TRIMMED TO ENABLE US TO GET A PROPER GROUND SEAL. Also See Items “H” & “I” on the reverse side.

7. The Occupant must turn off any air conditioning unit, thermostat operated or otherwise. If any burglar alarms are to be left on, leave instructions on operation; movement alarm and exterior lights must be turned off, including FLOOD LIGHTS ON TIMERS.

8. We request Occupants to remove TV antennas where possible. Also weather vanes, or objects that protrude from or around the roof such as a flag pole. If T.T.C. remove them, T.T.C. will not assume responsibility for any damage to and/or replacement or alignment of antennas. Old and oxidized antennas are usually prone to be damaged when removed and replaced.

9. All vehicles, boats, trailers, campers, etc., must be removed from garages/carports, driveways and RV parking areas during the fumigation. T.T.C. will not assume responsibility for any damage to same.

10. We must have access to all areas within the structure, including rooms or garages kept locked. SO PLEASE MAKE KEY ARRANGEMENTS BEFORE THE DAY OF THE FUMIGATION. THIS IS REQUIRED BY LAW. Please indicate where the keys are to be left after the fumigation, in the space provided on the top of this form. If walk-in or large safes exist, you must be present to open safe for our inspection before re-locking it.

11. All exterior doors (including water heater cabinets) to the building(s) being fumigated MUST be able to be locked. If no hasp or other lockable interior/exterior locking device exist, state law requires these doors shut. If the homeowner or his/her agent has not provided such locks, and nailing is then performed by the fumigation licensee, T.T.C. will not assume any liability for damage to the door or door jamb. Nailing or locking is required to keep out any person, such as a small child, from being accidentally trapped inside.

12. For insurance purposes, we request you remove and take with you any valuables you deem necessary, such as jewelry, furs, etc. Also see item G on reverse.

13. We must extinguish all open flames. To accomplish this we turn your gas off at the meter. When the fumigation is complete we re-light all pilot lights previously on. In the event special expertise is required in re-lighting, we request you contact the gas company to restore operation of problem units.

14. To ensure complete gas ventilation, the fumigator may open your drawers cabinets and closets. This eliminates gas being trapped in these areas. You may wish to open them in advance of our crew arrival.

15. DELICATE ROOF AND MOBILE HOMEOWNERS (AND/OR) AGENT: Your signature is required on Item E on the reverse side.

16. The undersigned acknowledges to have received a copy of the VIKANE FACT SHEET.

17. I/We the undersigned have read, reviewed, and agree to all provisions contained herein and have acknowledged receipt of an exact copy of the “OCCUPANT'S FUMIGATION NOTICE & DISCLAIMER.” In case that I/We do not comply with the requirements as stated therein, I/We agree to hold TIGER TERMITE CONTROL harmless of any liabilities connected with the fumigation procedure. I/We further stipulate that if the building(s) have tenant occupants that we or our authorized agent or manager has/will disperse copies of this Notice to all such occupants by the use of U.S. mail, posting on the front door, or hand deliver same.

Signature_____________________________ Print Name_____________________________ Title______ Date_______
Owner or Co-owner;s Signature(s) or Authorized Agent or Manager’s Signature, Name and Title

________________________________________________________________________________________________
Field Representative Signature Verifying Signature Above

A. We do not wish to inconvenience you by having you wait for our arrival on the day of the fumigation. When you decide on a date, talk it over with your termite inspector, or make arrangements with regard to keys, and leave with the assurance that your building will be properly fumigated and will be safe for your return. IN CASE OF RAIN OR STRONG WINDS, THE JOB MAY HAVE TO BE POSTPONED TO A LATER DATE; BE SURE TO LEAVE AN EMERGENCY PHONE NUMBER WHERE WE CAN REACH YOU. FORCIBLE ENTRY, IF NECESSARY WHEN ALL KEYS ARE NOT LEFT, WILL RESULT IN DAMAGE AND THEREFORE T.T.C. WILL NOT BE RESPONSIBLE FOR ANY SUCH DAMAGE AND FOR ITS REPAIR.

B. Where climbing plants, fences, trellises and vines must be detached from the building, and the homeowner/occupant has not done this, any damage to doing so by T.T.C. will not be T.T.C.’s liability.

C. Fumigation's where masking tape is used and where the painted surface is new, old or oxidized, may result in some peeling of paint. Some painted surfaces will chip or peel if the undercoating was not properly applied, even though these surfaces appear to be in good condition. The tape we use will not peel paint that is properly applied, therefore T.T.C. will assume no responsibility for any such damages.

D. WARNING FOR EXPECTED ROOF DAMAGE. The roof surface and perimeter areas of the building must be walked upon, and damages may/will occur, although the utmost care will be exercised. T.T.C. will not assume any liability for such damage or consequential damage that may/will occur to roofs or roof coverings and areas below same, gutters, electrical wiring, patio and awning coverings, solar heating panels or related plumbing, and living plants, trees or landscaping at/adjacent to the subject property. In case of old brittle wood shingles, shake, or composition, new or old tile or aluminum roofs or specialty roofs, there is always the possibility that severe damage may or will occur to the roof.

E. WAIVER, RELEASE AND DISCHARGE OF CLAIMS FOR ROOF DAMAGE: I hereby waive, release and discharge T.T.C. from any and all responsibility for roof damage that T.T.C. may cause during fumigation services, as well as any and all preexisting roof damage.

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OWNER OR AUTHORIZED AGENT’S SIGNATURE                                                                    DATE

F. Due to the fragile nature in which mobile homes are constructed, some damage may or will occur to carports, roofs, roof rails, sidings, awnings or trim. Decorative ground cover will be disturbed and plastic beneath ground covering may or will be torn in order to get a proper ground seal. T.T.C. can assume no responsibility for damage to and/or replacement of any of these damages mentioned above.

G. SECURITY OF PERSONAL PROPERTY OR CONTENTS: During the fumigation and aeration period, the possibility of burglary exists as it does any time you leave your home; therefore, we recommend you take any steps that you feel necessary to prevent this. We do not provide on-site security during the fumigation procedure or after the tent(s) or seals are removed and as such our insurance does not cover malicious vandalism or theft (screened windows are left open and unlocked for fumigant ventilation of the structure). If the homeowner or occupant wished such security services, same would be at his/her own expense and is not the liability of T.T.C. We recommend that you remove personal property and contents, including, but not limited to, cash, jewelry, and other personal items, from the (building/residence) prior to fumigation services. Customer understands that T.T.C. will not be responsible for the theft or disappearance of any personal property or contents from the (building/residence) during the fumigation process.

H. WARNING FOR POTENTIAL PLANT DAMAGE. T.T.C. may cause damage to plants located within 18” of the exterior perimeter of the (building/ residence). The fumigation crew will be careful as possible, but it is the homeowner and/or his authorized agent or occupant’s responsibility to trim all foliage, trees and vines 12” to 18” from the structure(s). Foundations must be free of decorative ground coverings, roots above the ground, debris, etc. Ivy, vines and bougainvillea must be trimmed, pulled back or dropped from trellises. All these are necessary so that T.T.C. can get a proper ground seal and assure you a proper fumigation. PLEASE BE AWARE: Any plant, vines, grass, trees, etc., that must be covered in the fumigation and introduced to Vikane gas - “THESE PLANTS AND FOLIAGE WILL DIE.”

I. WAIVER, RELEASE AND DISCHARGE OF CLAIMS FOR PLANT DAMAGE: I hereby waive, release and discharge T.T.C. from any and all responsibility or liability for plant damage that T.T.C. may cause during fumigation services, as well as any and all preexisting plant damage.

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OWNER OR AUTHORIZED AGENT’S SIGNATURE                                                                    DATE

J. State law requires that you be given the following information at least 48 hours prior to fumigation:CAUTION - PESTICIDES ARE TOXIC CHEMICALS. Structural pest control operators are licensed and regulated by the Structural Pest Control Board and apply pesticides which are registered and approved for use by the California Department of Food and Agriculture and the United States Environmental Protective Agency. Registration is granted when the state finds that based on scientific evidence there are no appreciable risks if proper use conditions are followed or that the risk are outweighed by the benefits. The degree of risk depends upon the degree of exposure. so exposure should be minimized. If within 24 hours following application you experience symptoms similar to common seasonal illness comparable to the flu, contact TIGER TERMITE CONTROL AT (909) 597-6953, and/or your physician or poison control center, 1 (800) 777-6476. The time for ventilation varies, therefore, due to hyper-sensitivity of some people or pets to the tear-gas warning agent that may still linger inside, the building may not be posted as safe for re-entry until the third day, when our locks are then removed. To enter prior to this will be at our own health risk. So therefore, that we may be assured and guaranteed of no such problem with relation to the fumigant, we as a company require an additional 24 hours for your protection and well-being. Listed below is a partial list of symptoms other than flu- like; for further enlightenment and//or complete list of all symptoms, instructions if exposed, or antidotes of the pesticides used, contact for pesticide application information the offices of County Agricultural Commissioner at (818) 575-5471 L.A.; (714) 680-7903 O.C.; (909) 275-3000 RIV; (909) 387-2105 S.B. OR (805) 933-3165 or (619) 694-2739.

Vikane (Sulfuryl Fluoride) — *respiratory irritation or pulmonary edema.

Tear-Gas (Chloropicrin) — *depending on exposure, moderate to severe irritation of the eyes, nose, throat, lungs and skin.

K. This Notice has been printed in the English language. By signature hereon, the homeowner, agent, or occupant(s), agrees that he/she has had this form explained in their native tongue by their own interpreter.

L. If tarping of the (building/residence) require entrance into your neighbor’s yard by the fumigators, his pets must be removed or tied up in the yard to prevent such animals from being poisoned and allow our crew access. It will be up to you to inform your neighbor(s) of the impending fumigation and date of same and your lacking to do so will not be T.T.C.’s liability. Also your neighbor's plants may be affected if they are growing on/or directly adjacent to your building. Please acquire your neighbor's release/permission and have him sign below.

I/We the undersigned have read, reviewed, and agree to all the provisions contained herein and to the items listed on the reverse side hereof that would be pertinent to me/us.

Neighbor(s) Signature (if Applicable)                                Address                                                            Date
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
 

ACKNOWLEDGMENT BY TENANT OCCUPIED STRUCTURES. Tenant occupant(s) signatures to be signed below and/or on an attached sheet,
if applicable I/We have read, reviewed, and agree to all the provisions contained herein and to all items listed on the reverse side hereof:

x _______________________ Unit _______ Date _______ X ______________________ Unit ________ Date ________
x _______________________ Unit _______ Date _______ X ______________________ Unit ________ Date ________
x _______________________ Unit _______ Date _______ X ______________________ Unit ________ Date ________
x _______________________ Unit _______ Date _______ X ______________________ Unit ________ Date ________

WARRANTY

TIGER TERMITE CONTROL (T.T.C.) warrants against the reappearance of drywood termites in the structure(s) for a period of two (2) years from the date of completion of the fumigation. The method of treatment is solely within the discretion of T.T.C. and may be locally treated or the structure may be re-fumigated. Any treatment should be in accordance with the Structural Pest Control Board Rules and Regulations, i.e., there should be actual evidence of LIVE infestation of the target organism. Regardless of the treatment, the owner shall be obligated to pay for all costs of preparation in connection with the treatment. In the event that T.T.C. elects to re-fumigate the structure, the owner must agree to the terms and conditions stated in the then-existing Occupant’s Fumigation Notice and Disclaimer. In like manner, should T.T.C. requires the execution of releases by owner for damages to the roof, other structures or vegetation as a result of the preparation or treatment, the owner agrees to execute any such releases. This warranty does not extend to any expense incurred by the owner, his or her agent, or his or her tenant in connection with any such treatment, nor does the warranty extend to cover any restitution for any inconvenience caused by treating the structure. In order to obtain T.T.C. performance under this warranty, the owner must notify T.T.C. of any reappearance of termites in writing, addressed to TIGER TERMITE CONTROL'S place of business within (2) years from the date of the initial treatment. This warranty shall be void and have no effect whatsoever if the owner fails to comply with the terms stated herein.