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. `- <br /> 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 /> !t shall be permitted to modify this form as needed to provide a more complete andlor 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: 12-30-16 Supplementat Pages Attached: 10 <br /> 1. PROPERTY INFORMATION <br /> Name of property: Bridgewater Bank <br /> Address: 2445 Shadywood Road,Orono,MN 5533 <br /> Description of property: Bank <br /> Name of property representative: Caitin Kelly <br /> Address: <br /> Phone: 952-201-6153 Fax: E-mail: <br /> 2. INSTALLATION, SERVICE,TESTING, AND MONITORING INFORMATION <br /> Installation contractor: City View Electric Inc. <br /> Address: 14309 Lake Drive NE,Columbus,MN 55025 <br /> Phone: 651-659-9496 Fax: 651-641-0503 E-mail: <br /> Service organization: City View Electric Inc. <br /> Address: 14309 Lake Drive NE,Columbus,MN 55025 <br /> Phone: 651-659-9496 Fax: 651-641-0503 E-mail: <br /> Testing organization: City View Electric Inc. <br /> Address: 14309 Lake Drive NE,Columbus,MN 55025 <br /> Phone: 651-659-9496 Fax: 651-641-0503 E-mail: <br /> Effective date for test and inspection contract: <br /> Monitoring organization: Wright Hennepin 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 /> This is a: �New system ❑Modification to existing system Permit number: <br /> NFPA 72 edition: 2010 <br /> 4.1 Control Unit <br /> Manufacturer: Silent Knight Model number: 5700 <br /> 4.2 Software and Firmware <br /> Firmware revision number: 15 <br /> 4.3 Alarm Verification �This system dces not incorporate alarm verification. <br /> Number of devices subject to alarm verification: Alarm verification set for seconds <br /> Copyright m 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 /> ip. 1 of 3} <br />