Pre-Engineered Restaurant Fire Suppression Systems Report FUEL SHUT-OFF^ SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE

Transcription

1 Pre-Engineered Restaurant Fire Suppression Systems Report Name., IPCTTY FTRR ^ 5708 S.W. 25TH STREET HOLLYWOOD, FL (954) (954) ^ GUSTIER y ANNUAL SEM^A^AL" RECHARGE INSTALLATION RENOVATION LOCATION OF OP SYSTEM CVLIND^ CVUNDE UL300 Di "MA^FACTUR^ Y MODEL number I WET [ DRY CHEMICAL CHEMICAI ^2^ Jo I - CYLINDER SIZE MASTM ~ CYLINDER SIZE SLAVE 1 CYLINDER SIZ^LAVE FUSE LINKS 360 P. FUSE LINKS 450 P. FUSE LINKS 500" P. FUEL SHUT-OFF^ RKT Address Telephone g,^,^ ZIP^^ - >/-^3r- store NO Owner or Manager / ^ ^ COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE MANUFACTURER-S MANUAL REFERENCE PAGE NUMBER: DRAWING NUMBER: 1. All appliances properly covered w/correct nozzles 2. Duct and plenum covered w/correct nozzles 3. Check positioning of all nozzles. 4. System Installed In accordance w/mfg UL listing 5. Hood/duct penetrations sealed w/weld or UL device 6. Check If seals intact, evidence of tampering 7. If system has been discharged, report same 8. Pressure gauge in proper range (If gauged) 9. Check cartridge weight (If applicable) 10. Hydrostatic test date *7^/^ 11.6 year maintenance date 12. Inspect cylinder and mount 13. Operate system from terminal link 14. Test for proper operation from remote 15. Check operation of micro switch 16. Check operation of gas valve 17. Clean nozzles 18. Proper nozzle covers in place 19. Check fuse links and clean r 20. Replaced fuse links 21. Check travel of cable nuts/s-hooks 22. Piping & conduit securely bracketed 23. Proper separation between fryers & flame 24. Proper clearance-flame to filters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this pre-englneered fire suppression system was inspected and operationally tested in accordance with the fire suppression^yst^ regjjifements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above. ICHNICIAN Edwin Fuentes / PERMIT NO. DATE: CUSTOMER'S AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. CUSTOMER (White Copy) DISTRIBUTOR (Yellow Copy) AUTHORITY HAVING JURISDICTION (Pink Copy)

2 aty Fire 5708 SW 25th St Hollywood. FL Phone: Fax: INVOICE Invoice No: Account Code: PBCS Date; 10/02/2014 Billing Addrese SCHOOL DISTRICT OF PALM BCH COUNTY 3300 FORREST HILL BLVD SUITE A-323 WEST PALM BEACH. FL Work Address SYSTEM 243 ADDISON MIZNER ELEMENTARY 199 SW 12TH PLACE BOCA RATON, FL Date Item Description Rate Qty Charges 10/22/2014 Ticket TICKET Sys inspc FIRE SYSTEM INSPECTION $ $ Link 360 FUSIBLE LINKS $ $53.10 Sales Tax (at 0.00%): Total: Amount Paid: Amount Still Due: $0,00 $ $ Notes: SEMI ANNUAL INSPECTION PO# TECH: EDWIN Notes: represents taxable item/service.

3 Pre-Engineered Restaurant Fire Suppression Systems Report DATE OF SERVICE A.M. I. PM CITY FIRE ANNUAL 1 SEMI-ANNUAL I RECHARGE Oil OF SYSTEM CVl>NDERS INSTALLATION RENOVATION 5708 S.W. 25TH STREET MANUEACTURER HOLLYWOOD. FL zl_ Z- CYLINDER SIZE MASTEf CYLINDER Si (954) Fax (954) cyui^^r s^e WASTg^y^ ^lindersi FUSE UNKS"3aO-"R MODEL NUMBER FUSE LINKS 450 RF. ze SLAVE j FUSE LINKS 500 F, DRY CHEMICAL CYLINDER SIZE SLAVE <S'^ Address '/ ^ FUEL SHUT-OFF EL^RIC Telephone ^/^syav store No. Owner or Manager _j_ ' 1 COOKING APPLIANCE l^c^ions: LEFT TO RIGHT 2IP ^ SERIAL NUMBER NUFACTURER'S MANUAL REFERENCE LAST HYDRO TEST DATE srr vii ^ DRAWING noa\*/i ^tl NUMBER iiljdcf PAGE NUMBER: : GAS^ 74 LAST RECHARGE DATE ( 1. All appliances property covered w/correct nozzles 2. Duct and plenum covered w/correct nozzles 3. Check positioning of ail nozzles. 4. System installed in accordance w/mfg UL listing 5. Hood/duct penetrations sealed w/we(d or UL device 6. Check if seals intact, evidence of tampering 7. If system has been discharged, report same 8. Pressure gauge in proper range (If gauged) 9. Check cartridge weight (If applicable) 10. Hydrostatic test date 11.6 year maintenance date 12. Inspect cylinder and mount 13. Operate system from terminal link 14. Test for proper operation from remote 15. Check operation of micro switch 16. Check operation of gas valve 17. Clean nozzles 18. Proper nozzle covers in place 19. Check fuse links and clean 20. Replaced fuse links 21. Check travel of cable nuts/s-hooks 22. Piping & conduit securely bracketed 23. Proper separation between fryers & flame 24. Proper clearance-flame to filters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANiCES OR DEFICIENCIES BELOW COMMENTS: On this date, this pro-engineered fire suppression system was inspected and operationally tested in accordance with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results Indicated above. fchnician Edw'^ I iT'js, 46oz7l;': PERMIT NO. _ CUSTOMER'S AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. DISTRIBUTOR (White Copy) CUSTOMER (Yellow Copy)

4 city Fire 5708 SW 25th St Hollywood, FL Phone: Fax: ; INVOICE Invoice No: Account Code: PBCS Date: 05/15/2014 Billing Address SCHOOL DISTRICT OF PALM BCH COUNTY 3300 FORREST HILL BLVD SUITE A-323 WEST PALM BEACH. FL Work Address SYSTEM 243 ADDISON MiZNER ELEMENTARY 199 SW 12TH PLACE BOCA RATON. FL Date Item Description Rate Qty Charges 05/15/2014 Ticket TICKET Misc ANSUL R-102 SYSTEM COMPONETS AND PARTS $ $ Misc PIPING CHROME MISC PARTS $ $ Labor HOURLY LABOR RATE 1.00 Misc 4 CIN ANSUL NOZZLES $ $ Subtotal: Sales Tax {at 0.00%): Total: $ Amount Paid: Amount Still Due: $ Notes: SYSTEM REPAIRS PO# TECH: EDWIN Notes: represents taxable item/service.

5 CITY FIRE 5708 SW 25th Street - Hollywood FL Phone Fax Proposal Submitted to Address School District of Palm Beach County Phone Job Name Fax 3300 Forrest Hill Blvd Suite # A-323 City, State & Zip code West Palm Beach, FL Contact Addison Mizner Elementary Job Location 199 SW 12 Ave Boca Raton, FL Date Payment Schedule: 100 % Balance Upon Final We hereby submit specifications and estimates for: Ansul R 102 (9.0 Gal.) Fire Suppression System Installation Includes: Gallon fire suppression system components & parts. 1 Quick-seals, Piping, Conduit, Chrome Sleeve, Fittings, ect. 1 Labor for 2 technicians onsite to perform installation. Cost$ $ $ $ Total Cost of repairing 1 Fire Suppression Systems = $ Permit Fees & Taxes Excluded Wrong nozzle over the Char Broiler must be replaced with correct nozzle for proper coverage. All electrical connections to micro-switch will be performed by separate contractor. Upon system activation the following must occur; All gas and electrical under protected hood must shut down. Exhaust fans must activate (or remain running ) while fresh air shuts down. Fire alarm or horn strobe must annunciate. All material is guaranteed to be as specified. All equipment Is to be ccmsidered property of City Fire Inc. until all balarwes are paid in full. All worlr to be completed in a worftman like manner according to standard practices and Florida State law. Any alteration or deviation from above specifications involving extra cost will be executed only upon request and will become an extra cfiarge over and beyortd the estimate. Our workers and service vehicles are fully insured and covered by Workers Compensation Insurance. Authorized Signature: Josh Velez (Rep) Offer valid for 10 days from issue date. Acceptance of Proposal The atx}ve prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work spectried. Payment will be made as outlined.

6 Proposal Submitted to School District of Palm Beach County Address 3300 Forrest Hill Blvd Suite # A-323 City, State & Zip code Contact West Palm Beach, FL CITY FIRE 5708 SW 25th Street - Hollywood FL Phone Fax Phone Job Name Fax Addison Mizner Elementary Job Location Payment Schedule: 100 % Balance Upon Final 199 SW 12 Ave Boca Raton. FL Date We hereby submit specifications and estimates for; Ansul R 102 (9.0 Gal.) Fire Suppression System Instaffation Includes: Gallon fire suppression system components & parts. 1 Quick-seals, Piping, Conduit, Chrome Sleeve, Fittings, ect. 1 Labor for 2 technicians onsite to perform installation. Cost $ $ $ $ Total Cost of repairing 1 Fire Suppression Systems = $ Permit Fees & Taxes Excluded Wrong nozzle over the Char Broiler must be replaced with correct nozzle for proper coverage. All electrical connections to micro-switch will be performed by separate contractor. Upon system activation the following must occur; All gas and electrical under protected hood must shut down. Exhaust fans must activate (or remain running ) while fresh air shuts down. Fire alarm or horn strobe must annunciate. All malerial is guaranteed to be as specified. All equipment is to be ccrtsidered property of City Fire Inc. until all balances are paid in full. All work to be completed in a workman like manner according to standard practices and Florida Slate law. Any alteration or deviation from above specifications involving extra cost Mil be executed only upon request and will become an extra charge over and beyond the estimate. Our workers and service vehicles are fully insured and covered by Workers Compensation Instranoe. Authorized Signature: Josh Velez (Rep) Offer valid for 10 days from issue date. Acceptance of Proposal The above prices, specifications artd corxjitions are satisfactory and are hereby accepted. You are authtorized to do Che work specified. Payment will be made as outlined. Signature

7 Ansul 5-Star Program Parts Pricing I Billing Worksheet PO No.: ANSUL R-102 All Accounts - Dist Pricing Work Sheet Tag/File No.: fpricinq Effective Date: 2/27/2014) Date: Prep By: Josh V, LABOR ESTIMATE (MRS) 2 $ System Size Permit Fees 0 Annual Line Blow Down 0 Nozzle Relocation 0 School Name: Hvdrostatic Testing 0 Addison Mizner Elementary Black Iron Pipe & Chrome Fittings 4 $ SW 12 Ave Conduit & Fittings 4 $69.76 Boca Raton. PI Total Equipment Value $ NOTE: Only (he PO specified ANSUL Distributor Suppiied Parts are to be List Less 25% With the exception of pipe, conduit & fittings etc. ONLY genuine ANSUL Factory Components & Extinguishers can be used. IJl. Clas-sified flenerlr. part.s C.ANNQT tie suih.slitiited Total Job Value $ List less 25% Extended QTY Part No. DESCRIPTION List Price (Each) Net Total Nozzle -1N 25/package {pkg. price) (with Metal Blow-off Caps) S Nozzle Swivel Adaptor 25/package (pkg. price) $ ISub-Total S /9/2014 Paga i of 1

8 Ansul 5-Star Program Parts Pricing I Billing Worksheet Pp No.: _ tag/file No.: Date; Prepay: System Size Josh V. School Name: Addison Mizner Elementary 199 SW12 Ave Boca Raton, Fl ANSUL R-102 (Pricing Effective Date: 2/27/2Q14) LABOR ESTIMATE (HRS) ^rmit Fees Annual Line Blow Down Nozzle Relocation Hydrostatic Testing Black Iron Pipe & Chrome Fittings Conduit & Fittings Total Equipment Value NOTE: Only the PO specified ANSUL DIsthbutor Supplied Parts are to be List Less 25% Widi the exception of pipe, conduit & fittings etc. ONLY genuine ANSUL Factory Components & Extinguishers can be used. UL Classified generic parts CANNOT be subsbluted. Total Job Value All Accounts Dist Pricing Worksheet $ _ $b.bo' $90.32 $89.76 $ $ QTY Part No. DESCRIPTION List Price Nozzle -1N 25/package (pkg. price) (with Metal Blow-off Caps) S7^Nozz(e Swivel Adaptor 25/p8Ckage (pkg. price) List less 25% (Each) Extended Net Total $ $._62.76 isub-total $ /9/2014 Pegs 1 of 1

9 Pre-Engineered Restaurant Fire Suppression Systems Reporl CITY FIRE DATE OF 5EWCE VM. ' PM i I X i "annual I SEMI-zy^NUAL 1 RECHARGE I INSTALLATION RENOVATION ~ r- / LOCATION OF SYSTEM CVIINOERS / ^ I UL300 Address City 5708 S.W. 25TH STREET HOLLYWOOD. FL ^ I fe? I ' 1 80n fiqo 1 '^'^8 - /(/ ' I 1 CYLINDER SIZE MASTER > CYLINDER SIZE SLAVE (954) Fax (954) cvlin^sizb master size sla^ cuin^siz^e - Pt 1. FUSE LINKS 3^ I FUSE LINKS 450 F. FUSE LINKS 500 F. I OTHER State.^^ ^ _, ^ERIAL SERIAL NUMBER j LAST HYDRO TEST DATE I LAST RECHARGE DATE ^ ^C- i MANUFACTURER'S MNUFACTURER'S MANUAL REFERENCE ~~~ Ud.exS'goo -s^r' Telephone,"'*^^^'' ^ Store No. sud.exs'gosj MANUFACTURER MODEL NUAIBER DRY CHEMICAL PAGE NUMBER; DRAWING NUMBER; Owner or Manager COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT -2^.^ I I 1. All appliances properly covered w/correct nozzles 2. Duct and plenum covered w/correct nozzles 3. Check positioning of all nozzles. 4. System installed in accordance w/mfg UL listing 5. Hood/duct penetrations sealed w/weld or UL device 6. Check if seals intact, evidence of tampering 7. If system has been discharged, report same 8. Pressure gauge in proper range (If gauged) 9. Check cartridge weight (If applicable) 10. Hydrostatic test date 7^^^ 11.6 year maintenance date 12. inspect cylinder and mount 13. Operate system from terminal link 14. Test for proper operation from remote 15. Check operation of micro switch 16. Check operation of gas valve 17. Clean nozzles 18. Proper nozzle covers In place 19. Check fuse links and clean ~y7^ 20. Replaced fuse links 21. Check travel of cable nuts/s-hooks 22. Piping & conduit securely bracketed 23. Proper separation between fryers & flame 24. Proper clearance-flame to filters 25. Exhaust fan in operating order 26. Ail filters in place 27. Fuel shut-off in on position 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANICES CR DEFICIENCIES BELCW COMMENTS: ^ ; ^ FUEL SHUT-OF^?'^ SHUT-OFF/- ELEC F T "T S)?y /tor- On this date, this pre-engineered fire suppression system was inspected and operationaily tested in accordance with the fire suppression system i^fl«trgments of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above. 1 46t.i?UjOQ22004 PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT The above service technician certifies that the system was personally Inspected and found conditions to be as Indicated on this report. DISTRIBUTOR (White Copy) CUSTOMER (Yellow Copy)

10 City Fire 5708 SW 25th St Hollywood, FL Phone: Fax: INVOICE Invoice No: Account Code: PBCS Date: 10/03/2013 Billing Address SCHOOL DISTRICT OF PALM BOH COUNTY 3300 FORREST HILL BLVD SUITE A-323 WEST PALM BEACH, FL Work Address SYSTEM 243 ADDISON MIZNER ELEMENTARY 199 SW12TH PLACE BOCA RATON, FL Date Item Description Rate Qty Charges 10/23/2013 Tcket TICKET Sys Inspc FIRE SYSTEM INSPECTION $ $ Link 360 FUSIBLE LINKS $ $53.10 Subtotal: Sales Tax (at 0.00%): Total: Amount Paid: Amount Still Due: $ $ $ Notes; SEMI ANNUAL INSPECTION P0# TECH: EDWIN Notes: * " represents taxable item/service.

11 Pre-Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY GUY FIRE, INC. ^08 S.W. 25th Street Hollywood, FL DATE OF 'Wy3//3 ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION LOCATION OF SYSTEM CYLINDERS ^^ v UL300 MANUFACTURER MODEL NUMBER DRY CHEMICAL CYUNDER SIZE MAST So CYLINDER SIZESLAVE FUSE LINKS 380» F FUSE LINKS 450" F. FUSE LINKS 500» F. OTHER Name # PUEL UEL SHUT-OFF Address City. Telephone Owner or Manager yo ^ /SERIAL NUMBER ' LAST HYDRO TEST DATE LAST RECHARGE REG DATE State store No. COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT MANUFACTURER'S MANUAL REFERENCE DRAWING NUMBER: DATE /SyitS7 1. All appliances properly covered w/correct nozzles 2. DUct and plenum covered w/correct nozzles 3. Check positioning of all nozzles. 4. System installed in accordance w/mfg UL listing 5. Hood/duct penetrations sealed w/weld or UL device 6. Check if seals intact, evidence of tampering 7. If system has been discharged, report same 8. Pressure gauge in proper range (If gauged) 9. Check cartridge weight (If applicable) 10. Hydrostatic test date 11.6 year maintenance date 12. Inspect cylinder and mount 13. Operate system from terminal link 14. Test for proper operation from remote 15. Check operation of micro switch 16. Check operation of gas valve 17. Clean nozzles 18. Proper nozzle covers in place 19. Check fuse links and clean 20. Replaced fuse links 21. Check travel of cable nuts/s-hooks 22. Piping & conduit securely bracketed 23. Proper separation between fryers & flame 24. Proper clearance-flame to filters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position 28. Manual & remote set/seals in place ^ 29. Replace systems covers 30. System operational & seals in place ^. 31. Slave system operational 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system y 35. Proper hand portable extinguishers y^ 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this suppression ineered fire suppression system was inspected and operationally tested in accordance with the fire fequirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above. Edwin Fuentes / ^ SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CU^OMER'S AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. CUSTOMER COPY

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13 NIVHD 27x44 TILTSKLLET ADDISON MIZNER ELEMENTARY SCHOOL ^ j.; 14' LONG 10X28 10X28 17X27 RANGE STEAMER CONV OVEN

14 City Fire 5708 SW 25th St Hollywood, FL Phone: Fax: INVOICE Invoice No: Account Code: PBCS Date: 03/13/2013 Billing Address SCHOOL DISTRICT OF PALM BCH COUNTY 3300 FORREST HILL BLVD SUITE A-323 WEST PALM BEACH. FL Work Address SYSTEM 243 ADDISON MIZNER ELEMENTARY 199 SW12TH PLACE BOCA RATON, FL Date Item Description Charges 03/22/2013 Ticket TICKET Sys Inspc FIRE SYSTEM INSPECTION Subtotal; $ Sales Tax (at 0.00%): 0.00 Total: $ Amount Paid: Amount Still Due: $ Notes: SEMI ANNUAL INSPECTION P0# TECH: EDWIN Notes: " represents taxable item/service.

15 Pre-Engineered Restaurant Fire Suppression Systems Report ^ - ' "ATE OF y/ 7 9- ^ /in) CITY FIRE ANNUAL SEML^N^AL RECHARGE INSTALLATION LOCATION OF SYSTEM CYLINDERS RENOVATION I ^L300 YES NO 5708 S.W. 25TH STREET HOLLYWOOD, FL (954) Fax (954) CUSTOMER MA /hfuy I NUFACTURER MODEL NUMBER WET CYLINDER SIZE MASJER SO. FUSE LINKS 360' F. ^ c5^ CYLINDER SIZE^AVE ko DRY CHEMICAL CYLINDER SIZE SLAVE FUSE LINKS 450'F. FUSE LINKS 500 F. OTHER Na.e Address ni.y ^ ^, j SERIAL NUMBER [ LAST HYDRO TEST DATE TPlPphnnpr^^-^- Owner or Manager state ^ 7^ No. MANUFACTURER'S MANUAL REFERENCE PAGE NUMBER: DRAWING NUMBER: LAST RECHARGE DATE DATE.SlS COOKING APPLIANCE LOCA ION5: Lthl luhiumi S>17) /e. 1. All appliances properly covered w/correct nozzles 2. Duct and plenum covered w/correct nozzles 3. Check positioning of all nozzles. 4. System installed in accordance w/mfg UL listing 5. Hood/duct penetrations sealed w/weld or UL device 6. Check if seals intact, evidence of tampering 7. If system has been discharged, report same 8. Pressure gauge in proper range (If gauged) 9. Check cartridge weight (If applicable) 10. Hydrostatic test date 11.6 year maintenance date 12. Inspect cylinder and mount 13. Operate system from terminal link 14. Test for proper operation from remote 15. Check operation of micro switch 16. Check operation of gas valve 17. Clean nozzles 18. Proper nozzle covers in place 19. Check fuse links and clean 20. Replaced fuse links 21. Check travel of cable nuts/s-hooks 22. Piping & conduit securely bracketed 23. Proper separation between fryers & flame 24. Proper clearance-flame to fitters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DiSCREPANIGES OR DEFICIENCIES BELOW -7^ COMMENTS:- On this date, this pre^ suppression sj jineered fire suppression system was inspected and operationally tested In accordance with the fire S^errtents of NFPA17 or 17A. 96 and the manufacturer's manual with^he results indicated above. Ecfwin Fuentes / RVIC^JtECHNICIAN PERMIT no. DATE: TIME; AM PM CUSTOMER'S AUtffORIZED AGENT The above service technician certifies that the system was personally Inspected and found conditions to be as indicated on this report. DISTRIBUTOR (White Copy) CUSTOMER (Yellow Copy)

16 City Fire 5708 SW 25th St Hollywood, FL Phone: Fax: INVOICE Invoice No: Account Code: PBCS Date: 04/07/2014 Billing Address SCHOOL DISTRICT OF PALM BOH COUNTY 3300 FORREST HILL BLVD SUITE A-323 WEST PALM BEACH. FL Work Address SYSTEM 243 ADDISON MIZNER ELEMENTARY 199 SW 12TH PLACE BOCA RATON. FL Date Item Description Rate Qty Charges 04/11/2014 Ticket TICKET Sys Inspc FIRE SYSTEM INSPECTION $ $ Link 360 FUSIBLE LINKS $ $53.10 Subtotal: Sales Tax (at 0.00%): $ Total: $ Amount Paid: Amount Still Due: $ Notes; SEMI ANNUAL INSPECTION PO# TECH: EDWIN Notes: " represents taxable item/service.