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09/09/2003 12:58 3607921212 TRI TEK SYSTEMS PAGE 01
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Tri-Tek Systems FOR THE CITY OF
1421 Sunset Vista
Bremerton WA.98310
Phone/Fax 360-373-8373
Fire Alarm System Confidence Report
Central Station Account No.-7 5-7 7- I.S 3 5
Occupied as(major tenant) �l
Address ?_ S,- Own Zip Code. Phone No.
Type of Test: Monthly Quarterly Semi-Annual Annual - cce,� ptan e
Number of Initiating circuits )Number of signaling circuits__ 3
Fire control panel manufacturer �'� T �G,�, �t Model No. �,,'{%L4
Central Station transmitter manufacturer L l V Model No. Z r d
Lk
Battery Voltage Charge Circuit Voltage Z?, ( Battery under load Z .
Alarms tripped by which initiating circuit
CENTRAL STATION
FIRE CONTROL PANEL TRANSMITTER
Smoke detectors cleaned?
System operates on AC power Yes ❑ No ❑ NA Yes ❑ No
"Alarm Silence"results in tbl.sig. JV Yes ❑ No ❑ NA ❑ Yes No
Loss of AC results in trouble signal JR Yes ❑ No ❑ NA CR Yes ❑ No
System operates on battery Yes ❑ No ❑ NA W Yes ❑ No
All circuits checked for elec.supv. Yes ❑ No ❑ NA Yes ❑ No
Test meets manufacturer's specs. Yes ❑ No ❑ NA Yes ❑ No
All auxiliary equipment operates ❑ Yes ❑ No 10 NA
Key to fire control panel available Yes ❑ No ❑ NA
Operating instructions posted 1�) Yes ❑ No ❑ NA
Test record posted at control panel Yes ❑ No ❑ NA Yes ❑ No
Automatic time delay of general alarm minutes
Time initiated Time received by Central Station
EQUIPMENT TESTED
NO.OF UNITS SATISFACTORY NO.OF UNITS
TYPE OF EQUIPMENT TESTED YES NO NA IN BUILDING
)ls,Jqo�_ Ch.,Voice Alarms,Speakers,Water Gongs 1
Visual Alarm Devices
Trouble Indicators VrA f
Heat Detectors
Smoke Detectors
Smoke Beams
Sprinkler Waterflow Alamo
Sprinkler Supervisory Switches
Manual Pull Stations
Ventilation Controls Operate
Annunciators
Elevator Recall
Fire Dampers/Smoke Dampers
Phone lacks
Automatic Door Release
Other
THIS IS TO CERTIFY THAT THIS FIRE ALARM SYSTEM/CENTRAL STATION TRANSMITTER HAS BEEN PROPERLY IF=AND INSPECTED FOR
RELIABILITY TO COVER THE rJAMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTANANCE STANDARDS
/MANUFACTURER'S W AND ALL CORECTIONS HAVE BEEN/HAVE NOT BEEN MADE.
Signature of Inspector Date Q (Zk
Problems Found
Corrections Made
MASON COUNTY FIRE MARSHAL
Mason County Bldg. III 426 W.Cedar
P.O. Box 186 Shelton,Washington 98584
(360)427-9670 Ext.273
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03549 American Business Forms
[C)lMonitoring Information & Agreement
DATE - • - •
This Agreement is made this day of ,b(y�,,nddbbetw en Alarm Center,Inc.,a Washington
corporation,hereinafter referred to as"ACI",and �aNrJ� /py�/{�`t�erein referred to as"Subscriber."
whose address is: //'' , r
Street Address /G /1 City �//� , Sta Zip Code 0S�/r
Phone Number_( ) Billing Address
COMMUNICATOR � ' �
PASSWORD or NUMBER
NAME P ase print) (Maximum of 12 characters)
CONTACT , � (l O
SUBSCRIBER'SLn
4Z+hC)ry-y__
e print) PHONE NUMBER OZ
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SPECIAL • 6.
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OPEN CLOSED HOLLIDAYS j� OPEN CLOSE HOLIDAYS OPEN CLOSE
MON i ���
TUE ( ( yyaw
WED
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THU 1)
FRI
• ' • • Job Number
�1
SAT Account Number Assigned Assigned By Date
Entered By Date Passcards Sent By Date
SUN
• • 'A=AUDIBLE,S=SILENT ❑COMMERCIAL ❑ RESIDENTIAL I ❑OPEN/CLOSE ❑ BY INDIVIDUAL
Cond- Cond- Cond-
CODE ition A/S' DESCRIPTION CODE ition A/S' DESCRIPTION CODE ition A/S' DESCRIPTION
t.DEALER AGREEMENT: Subscriber has,or is about to contract with condition does not exist.ACI shall notify Dealer of each alarm received if
("Dealer")for an alarm Subscriber has submitted a written request to ACI for such notification.
system and/or service at the premises indicated on this Agreement ACI may attempt to verify the nature of the emergency by telephoning
(hereinafter called"Premises").Dealer and Subscriber have entered into Subscriber's premises prior to notifying emergency personnel or anyone
an Agreement wherein and whereby Dealer will provide monitoring on Subscriber's notification instructions.
services for Subscriber,such services to consist solely of those described 3.RECEIPT OF COPY: SUBSCRIBER ACKNOWLEDGES RECEIPT OF
herein.Dealer has subcontracted such monitoring services to ACI which A COPY OF THIS AGREEMENT.
has agreed to perform the same solely as the agent of Dealer upon the SUBSCRIBER HAS READ AND UNDERSTANDS ALL OFTHIS AGREE-
terms and conditions set forth in this Agreement.All monitoring fees are MENT, PARTICULARLY PARAGRAPHS 4, 11 AND 12, WHICH SET
paid to ACI by Dealer. FORTH ACTS MAXIMUM LIABILITY IN THE EVENT OF ANY LOSS OR
2. MONITORING SERVICES PROVIDED: ACI, upon receipt of a DAMAGE TO SUBSCRIBER OR ANYONE ELSE. SUBSCRIBER AC-
signal from Subscriber's premises,shall make every reasonable effort to KNOWLEDGES THAT HE HAS DISCUSSED THE LIMITATION OF
notify the police, fire, or other authorities and/or the person or persons LIABILITY SET FORTH IN PARAGRAPH 11 WITH DEALER'S AGENT,
whose names and telephone numbers are set forth in the notification AND UNDERSTANDS THAT SUBSCRIBER MAY OBTAIN A HIGHER
instructions to be completed by Subscriber and submitted to ACI,or as LIMITATION OF ACTS LIABILITY BY PAYING AN ADDITIONAL PERI-
same may be changed on written notification by Subscriber from time to ODIC CHARGE.THE TERMS AND CONDITIONS SET FORTH ON THE
time, unless there is reasonable cause to assume that an emergency REVERSE SIDE ARE INCORPORATED HEREIN.
DEALER SUBSCRIBER
By X Date By X /� Date 7 � 3
ACI APPROVAL Title J �. ��. �✓G
By X Date ❑Corporation Partnership ❑Sole Proprietorship
Authorized Officer ether(describe)
THIS AGREEMENT SHALL NOT BE BINDING UPON ACI UNLESS APPROVED IN WRITING RY AN OFFICER OF AC1_