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SYSTEM RECORD OF COMPLETION <br />This form is to be completed by the system installation contractor at the time of system acceptance and approval. <br />It shall be permitted to modify this form as needed to provide a more complete and/or clear record. <br />Insert N/A in all unused lines. <br />Attach additional sheets, data, or calculations as necessary to provide a complete record. <br />Form Completion Date: ?j ' Lk - a3 Supplemental Pages Attached: <br />PROPERTY INFORMATION <br />Name of property: IL <br />c MF_XTtS� /� A (� <br />Address: .� t�3 C� �C.Q.A� +� 0 Pt � D� IV L) & R2 03 <br />Description of property: �? <br />Name of property representative: l�O e. tTC_ �S ry 1 <br />Address: <br />Phone: `ias_ o Lis J9 Fax: E-mail: c6 p& TS&I II kMurLLC.Cbm <br />2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION <br />Installation contractor: _S'V <br />Address: <br />Phone: 3(00 (09 J YAW Fax: <br />E-mail: h1fi1_ /9 11L41'6 (4) Wru AdD <br />Service organization: `-iVIE QS MCA) � �'� <br />Address: <br />Phone: <br />Fax: <br />E-mail: <br />Testing organization: PLUP-P L f1l a f - <br />Address: �030(0 ;)15� `3r SLJ MO%)AI-C ►M 71-12R A f <br />Phone: <br />Fax: <br />E-mail: <br />Effective date for test and inspection contract: <br />Monitoring organization: AflU4�r�AQ� <br />Address: ?0 ELU I SQ <br />Phone: !?!J(1 1121 Mq? Fax: E-mail: <br />Account number: <br />Phone line 1: Phone line 2: <br />Means of transmission: L'rE, orrAu2nN) <br />Entity to which alarms are retransmitted: <br />3. DOCUMENTATION <br />Phone: <br />On -site location of the required record documents and site -specific software: �142 E PQ ti E <br />4. DESCRIPTION OF SYSTEM OR SERVICE <br />This is a: ❑ New system Modification to existing system Permit number: <br />NFPA 72 edition: <br />4.1 Control Unit bb <br />Manufacturer: lAnAR . !.IT-( Model number: L LTD �c�.6 gQ <br />4.2 Software and Firmware <br />Firmware revision number: <br />4.3 Alarm Verification <br />Number of devices subject to alarm verification: <br />.'This system does not incorporate alarm verification. <br />Alarm verification set for seconds <br />Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. <br />(p 1 of 3) <br />