ESBD_371089_1723062969469_ATTACH~2.PDF

ATTACHMENT G.N.1 - ELLINGTON AFB (EF) MANUFACTURER’S

CERTIFICATE OF PROPER INSTALLATION

PROJECT MANAGER: ______________ EQPT SERIAL NO: ________________

EQPT TAG NO: ________________________ EQPT/SYSTEM: ___________________

PROJECT NO: _________________________ SPEC. SECTION: __________________

I hereby certify that the above-reference equipment/system has been (Check Applicable):

Installed in accordance with Manufacturer’s recommendations. Inspected, checked, and adjusted.

Serviced with proper initial lubricants.

Electrical and mechanical connections meet quality and safety standards. All applicable safety equipment has been properly installed.

System has been performance tested and meets or exceeds specified performance requirements. (When complete system of one manufacturer)

Comments:

I, the undersigned Manufacturer’s Representative, hereby certify that I am (I) a duly authorized representative of the manufacturer, (ii) empowered by the manufacturer to inspect, approve, and operate his equipment and (iii) authorized to make recommendations required to assure that the equipment furnished by the manufacturer is complete and operational, except as may be otherwise indicated herein. I further certify that all information contained herein is true and accurate.

Date ___________________, 20__

Manufacturer: ____________________________________________________________

By Manufacturer’s Authorized Representative: _______________________________________

(Authorized Signature)