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r a <br /> SYSTEM RECORD OF INSPECTION AND TESTING <br /> This form is to be comp/eted by the system inspection and testing contractor at the time of a system test. <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 /> Inspection/Test Start Date/Time: 12-30-16 Inspection/Test Completion Date/Time: 12:OOpm <br /> Supplemental Fortn(s)Attached: Yes (yes/no) <br /> 1. PROPERTY INFORMATION <br /> Name of property: Bridgewater Bank <br /> Address: 2445 Shadywood Road,Orono,MN 55331 <br /> Description of property: Bank <br /> Name of property representative: Caitin Kelly <br /> Address: <br /> Phone: 952-201-6153 Fax: E-mail: <br /> 2. TESTING AND MONITORING INFORMATION <br /> Testing organization: City View Electric Inc. <br /> Address: 14309 Lake Drive NE Columbus,MN 55025 <br /> Phone: 651-659-9496 Fax: E-mail: davids@cityviewelectric.com <br /> Monitoring organization: Wright Hennipen International Response Center <br /> Address: 6800 Electric Drive,Rockford,MN 55373 <br /> Phone: 1-800-858-7811 Fax: E-mail: admin@whirc.com <br /> Account number: ST0788 Phone line 1: 952-471-2611 Phone line 2: 952-471-2616 <br /> Means of transmission: P.O.T.S.Lines(Public Phone Network) <br /> Entity to which alarms are retransmitted: WHIRC Phone: 1-800-858-7811 <br /> 3. DOCUMENTATION <br /> On-site location of the required record documents and site-specific software: At FACP and on flash drive inside FACP <br /> 4. DESCRIPTION OF SYSTEM OR SERVICE <br /> 4.1 Control Unit <br /> Manufacturer: Silent Knight Modei number: 5700 <br /> 4.2 Software and Firmware <br /> Firmware revision number: 15 <br /> 4.3 System Power <br /> 4.3.1 Primary(Main)Power <br /> Nominal voltage: 120VAC Amps: 3 Location: FACP <br /> Overcurrent protection type: Breaker Amps: 20 Disconnecting means location: PNL 1 CKT 8 <br /> Copyright�2012 National Fire Prolection 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 1? <br />