Exhibit 5 Inspection Form G55A.pdf

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Notice of local area set-aside
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CERTIFICATE OF ELEVATOR INSPECTION

GENERAL SERVICES ADMINISTRATION - PUBLIC BUILDINGS SERVICE

BUILDING CITY

ELEVATOR NO. I CAPACITY (l'otmds)

TYPEaFDUTY NO. OF PASSENGERS (Including Op'ral()/~

INSPECTED

DATE ELEVATaR MECHANIC ELEVATaR ENGINEER

NOTICE: In case af elevatartrauble ar emergency, cail ____________

GSA FORM 55 (REV. 7-02)

ACKNOWLEDGMENT OF ELEVATOR INSPECTION CERTIFICATE

BUILDING CITY

ELEVATaR NO. CAPACITY (Pollllds)

TYPE aF DUTY NO.. aF PASSENGERS (Indtlding OpemIO/)

CERTIFICATION

I CERTIFYTHAT I RECEIVED THE ORIGINAL OFTHIS CERTIFICATE OF INSPECTION (GSA

FORM 55), THAT IT HAS BEEN COUNTERSIGNED BYTHE ELEVATOR MECHANIC, AND IS

POSTED INTHE CAR OFTHE ELEVATORTOWHICH IT PERTAINS.

DATE I SIGNATURE aF SUPERINTENDENT

THE ORIGINAL OF THIS CERTIFICATE INSTRUCTS THE OPERATOR, IN CASES OF

ELEVATORTROUBLE OR EMERGENCY,TO CALL:

GSA FORM 55-A (REV. 7-02)

Solicitation 60RRBH22Q0006

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