Report 1777 PH B101 FM200 Service call 4-5-21.pdf

(ATTACH ADDITIONAL SHEETS IF NECESSARY)

YES NO

YES NO

YES NO

MATERIALS USED

MAINTENACE & INSPECTION REPORT

(ONE FOR EACH PIECE OF EQUIPMENT)

WILL MATERIALS NEED TO BE ORDERED? HOW LONG IS THE LEED TIME?

EXPLAIN BELOW

HAVE NOT BEEN MET

(BELOW) FOR ADMINISTRATION USE ONLY

DATE IT WILL BE RECEIVED :

PROPER PPE BEING WORN

YES

CONTRACTOR: TECHNICIANS NAME:

LOCATION WEATHERBUILDING NAME or #

CONTRACTOR/SIGNATURE CCI/ SIGNATURE SITE INSPECTOR/SIGNATURE

CONTRACT # ELIN # REPORT NO.

HAVE BEEN MET

DATE:

General Direct Condition Rating

TYPE OF EQUIPMENT MAKE MODEL

WORK DESCRIPTION & PROBLEMS FOUNDS

TIME TO COMPLETE TASK

IS INSPECTION CHECK LIST ATTACHED?

SAFETY REQUIREMENTS

WAS WORK COMPLETED?

IF NO EXPLAIN BELOW

General Direct Condition Rating Notes ( Explain Conditions found for the Rating given above)

N40085-17-D-7201

NO

HOUSE KEEPING COMPLETE

YES

NO

MAXIMO # Work Order #

4/5/2021

FM200 release panel Autopulse IQ318 2 Dean & Allyn, Inc. Barry Prescott

Prospect Harbor 101 Cool/drizzle Green +

Service call to check repeated intermittent trouble from module 1M018. Checked connections and replaced the module with a new FMM-1 module from customer stock.

x

1777E002AB

(Print) Name of Authorized Buyer

TERMS OF THIS AGREEMENT ARE:

The price for work to be performed under this agreement shall be based on prevailing Dean & Allyn prices for material, labor and related items, in effect at the time supplied under this agreement.

Description of work or material:

Dean & Allyn, Inc. for and in consideration of the prices herein named, proposed to furnish the work and/or materials hereinafter described, subject to the conditions outlined below, and on the reverse side of this order.

Cust. P.O. No.

LOCATION OF WORK TO BE PERFORMED (PLEASE PRINT)

116 Lewiston Road Gray, Maine 04039 207/657-5646 fax 207/657-5647

Job Name__________________________________________

Street_____________________________________________

City___________________State ________ Zip ___________

BILLING ADDRESS Telephone No. ____________________

SERVICE

WORK ORDER

Customer__________________________________________

Street_____________________________________________

City___________________State ________ Zip ___________

(HEREINAFTER CALLED “BUYER”)

Service Representative Terms

NET TEN (10) DAYS

Customer has inspection contract: with

■ Yes

■ No

Dean & Allyn Other

A.

B.

C.

The terms of payment for invoices rendered against this order shall be net 10 days from date of invoice. Invoices may be rendered on a “Progress” basis, and the Buyer agrees to pay such progress billing in full, in accordance with the terms of payment.

Travel time will be included in the hours on all time and material orders.

See reverse side of this order for other General Terms and Conditions.

■ Time and Material ■ Lump Sum $______________________________

Any changes to scope and price of the work will be described in a “Field Change Order” and must be acknowledged by the Buyer.

TERMS OF THIS AGREEMENT ARE:

ADDITIONAL TERMS:

BUYERʼS ACCEPTANCE:

Title

Signature

Date

No.

DATE _____________________________

DEAN & ALLYN, INC.

FIRE PROTECTION • SPECIAL HAZARD

OFFICE

04/05/2021

Prospect Harbor Naval station CCI

Prospect Harbor Maine

Barry Prescott

Service call for an intermittent and repeated trouble on the FM200 release alarm panel. Checked history o arrival and found multiple troubles from module 1-M018. Checked connections and replaced with a new F module from customer stock.

Labor - 1 service call

Derek McCaslin