VA Outpatient Clinic QT-SP-3-3-26 - No Deficiencies.pdf

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Inspection Summary

Customer Information

Name VA Outpatient Clinic

Building Information

Name Veterans Admin Outpatient Clinic

Address 4303 Pittman St, Lawton, OK, 73503

Contact Information

Name Nathaniel Eastham

Role Engineering

E-Mail nathaniel.eastham@va.gov

Phone 4054561755

Account Information

Service Provider Johnson Controls North America

Office Address 2835 S. Utah OKC, OK

Office Phone 405-246-1000

Office License 0731/280

Inspector Name Michael Evans

Inspector License 4880

Inspection Information

Start Date 03/03/2026

Date 03/03/2026

Inspection Type Joint Commission

Work Order# 60803950

Timezone GMT-06:00

Inspection Summary

The following Tests and Inspections have been covered in this inspection

EP 2-2 - Valve Tamper Switches and Water Flow devices

EP 2-9 - Main Drains

EP 2-10 - Fire Department Connections

NFPA 25 - 2011

General Inspection Notes

1. Performed Quarterly Sprinkler Test and Inspection.

System is Green Tagged.

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

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INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

TEST PERFORMED DEVICE TYPE TOTAL PASSED FAILED CANNOT INSPECT % INSPECTED TOTAL

EP 2-2 - Valve Tamper Switches and Water Flow devices Tamper Switch 2 2 0 0 100 2

EP 2-2 - Valve Tamper Switches and Water Flow devices Water Flow Switch 1 1 0 0 100 1

EP 2-9 - Main Drains Main Drain - Wet Pipe Valve 1 1 0 0 100 1

EP 2-10 - Fire Department Connections Fire Dept. Connection 1 1 0 0 100 1

NFPA 25 - 2011 Check Valve 1 1 0 0 100 1

NFPA 25 - 2011 Inspectors Test Valve 1 1 0 0 100 1

NFPA 25 - 2011 Sprinkler Box 1 1 0 0 100 1

NFPA 25 - 2011 System Control Valve 2 2 0 0 100 2

NFPA 25 - 2011 Wet System 1 1 0 0 100 1

TOTAL 11 11 0 0 100 11

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VALVE TAMPER SWITCHES AND WATER FLOW DEVICES

CUSTOMER NAME: VA Outpatient Clinic

BUILDING NAME: Veterans Admin Outpatient Clinic

BUILDING ADDRESS: 4303 Pittman St, Lawton, OK, 73503

CONTACT NAME: Nathaniel Eastham

CONTACT E-MAIL: nathaniel.eastham@va.gov

CONTACT ROLE: Engineering

CONTACT PHONE: 4054561755

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 2835 S. Utah OKC, OK

OFFICE PHONE: 405-246-1000

OFFICE LICENSE: 0731/280

INSPECTOR: Michael Evans

INSPECTOR LICENSE: 4880

INSPECTION START DATE: 03/03/2026

INSPECTION END DATE: 03/03/2026

WORK ORDER: 60803950

TIMEZONE: GMT-06:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Tamper Switch 2 2 0 0 100 2

Water Flow Switch 1 1 0 0 100 1

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-2-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard PE.04.01.01 EP2-2 (Formerly EC.02.03.05 EP2) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Valve Tamper Switches and Water Flow Devices | 03/03/2026

Customer: VA Outpatient Clinic | Building: Veterans Admin Outpatient Clinic

PE.04.01.01 EP2-2 (Formerly EC.02.03.05 EP2)

At least semi-annually, the facility tests water-flow devices and at least semi-annually the facility tests supervisory valve tamper switches. The completion date of the tests is documented.

Valve Tamper Switches and Water Flow devices

For additional guidance on performing tests, see NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Device Test Method

Control Valve Tamper Switch:

14.4.2.2-14.(i).(1)

Valve shall be operated and signal receipt shall be verified to be within the first two revolutions of the hand wheel or within one-fifth of the travel distance, or per the manufacture's specifications

Mechanical, Electro-sonic, or Pressure-Type Water flow Device:

14.4.2.2-14.(j)

Water shall be flowed through an inspector's test connection indicating the flow of water equal to that from a single sprinkler of the smallest orifice size in the system for wet-pipe systems, or an alarm test bypass connection for dry-pipe, pre-action, or deluge systems in accordance with NFPA 25.

Note 1: For additional guidance on performing tests, see NFPA 72-2010: Table 14.4.5.

Note 2: Mechanical water-flow devices (including, but not limited to, water motor gongs) should be tested quarterly.

The results and completion dates are documented. (For full text, refer to NFPA 25-2011: Table 5.1.1.2)

A.1.1.1.2 There are times when a single inspection or test can meet the requirements of both NFPA 25 and NFPA 72 (e.g., operation of a tamper switch). This standard does not necessarily require that two separate inspections or tests be conducted on the same component, provided the inspection or test meets the requirements of both standards and the individual performing the inspection or test is qualified to perform the inspection or test required by both standards.

Element of Performance - EP-2-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard PE.04.01.01 EP2-2 (Formerly EC.02.03.05 EP2) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Valve Tamper Switches and Water Flow Devices | 03/03/2026

TAMPER SWITCH

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Mechanical Room 212 Backflow #1 Tamper

Switch BTFY Tamper Switch — Michael R Evans 03/03/2026 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

2 Mechanical Room 212 Backflow #2 Tamper

Switch BTFY Tamper Switch — Michael R Evans 03/03/2026 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

WATER FLOW SWITCH

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Mechanical Room 212 Waterflow Switch Paddle Water Flow Switch — Michael R Evans 03/03/2026 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 25

Open test connection/bypass. Did water flow activate the alarm? Yes

Inspector Signature

Inspector Name Michael Evans Date 03/03/2026

Signature of the

Maintenance

Printed name of the Maintenance Jed Davis Date 03/03/2026

Element of Performance - EP-2-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard PE.04.01.01 EP2-2 (Formerly EC.02.03.05 EP2) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Valve Tamper Switches and Water Flow Devices | 03/03/2026

MAIN DRAINS

BUILDING NAME: Veterans Admin Outpatient Clinic

BUILDING ADDRESS: 4303 Pittman St, Lawton, OK, 73503

CONTACT NAME: Nathaniel Eastham

CONTACT E-MAIL: nathaniel.eastham@va.gov

CONTACT ROLE: Engineering

CONTACT PHONE: 4054561755

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 2835 S. Utah OKC, OK

OFFICE PHONE: 405-246-1000

OFFICE LICENSE: 0731/280

INSPECTOR: Michael Evans

INSPECTOR LICENSE: 4880

INSPECTION START DATE: 03/03/2026

INSPECTION END DATE: 03/03/2026

WORK ORDER: 60803950

TIMEZONE: GMT-06:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Main Drain - Wet Pipe Valve 1 1 0 0 100 1

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-2-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard PE.04.01.01 EP2-9 (Formerly EC.02.03.05 EP9) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Main Drains | 03/03/2026

PE.04.01.01 EP2-9 (Formerly EC.02.03.05 EP9)

Every 12 months the facility tests the main drains at the system low point or at all system risers. A main drain test shall be conducted annually at each system riser and any time the valve is closed at each system riser or feed main after the control valve has been closed to determine whether there has been a change in the condition of the water supply piping and control valves. The completion date of the tests is documented.

Main Drain

For additional guidance on performing the annual / quarterly tests, see NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Device Test Method

Main Drain 1. Record the pressure indicated by the supply water gauge.

2. Close the alarm control valve on alarm valves.

3. Fully open the main drain valve.

4. After the flow has stabilized, record the residual (flowing) pressure indicated by the water supply gauge.

5. Close the main drain valve slowly.

6. Record the time taken for the supply water pressure to return to the original static (non-flowing) pressure.

7. Open the alarm control valve.

** 13.2.5.1 In systems where the sole water supply is through a backflow preventer and/or pressure reducing valves, the main drain test of at least one system downstream of the device shall be conducted on a quarterly basis.

Element of Performance - EP-2-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard PE.04.01.01 EP2-9 (Formerly EC.02.03.05 EP9) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Main Drains | 03/03/2026

MAIN DRAIN - WET PIPE VALVE

# LOCATION DESCRIPTION DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Mechanical Room 212 Main Drain Test Main Drain - Wet Pipe

Valve

— Michael R Evans 03/03/2026 Passed

Test Pipe Located? At Riser

Size of Test Pipe? 2”

Previous Main Drain Test Date 01/24/2025

Previous Main Drain Static Pressure 50

Previous Main Drain Residual Pressure 40

Static Supply Pressure? 50

Residual Pressure? 40

Time to return to Normal System Pressure? 1 Second

Static Pressure after completion of test? 50

Main Drain-PSI Comparable Yes

Main drain opened & free of obstruction discoloration? Yes

Inspector Signature

Inspector Name Michael Evans Date 03/03/2026

Signature of the

Maintenance

Printed name of the Maintenance Jed Davis Date 03/03/2026

Element of Performance - EP-2-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard PE.04.01.01 EP2-9 (Formerly EC.02.03.05 EP9) EP 2-

1458c43b-9c28-4412-a362-10dd3331e768 | Main Drains | 03/03/2026

FIRE DEPARTMENT CONNECTIONS

BUILDING NAME: Veterans Admin Outpatient Clinic

BUILDING ADDRESS: 4303 Pittman St, Lawton, OK, 73503

CONTACT NAME: Nathaniel Eastham

CONTACT E-MAIL: nathaniel.eastham@va.gov

CONTACT ROLE: Engineering

CONTACT PHONE: 4054561755

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 2835 S. Utah OKC, OK

OFFICE PHONE: 405-246-1000

OFFICE LICENSE: 0731/280

INSPECTOR: Michael Evans

INSPECTOR LICENSE: 4880

INSPECTION START DATE: 03/03/2026

INSPECTION END DATE: 03/03/2026

WORK ORDER: 60803950

TIMEZONE: GMT-06:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Fire Dept. Connection 1 1 0 0 100 1

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-2-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard PE.04.01.01 EP2-10 (Formerly EC.02.03.05 EP10)

EP

2-

1458c43b-9c28-4412-a362-10dd3331e768 | Fire Department Connections | 03/03/2026

PE.04.01.01 EP2-10 (Formerly EC.02.03.05 EP10)

Every quarter the facility inspects all fire department water supply connections. The completion date of the tests is documented.

Fire Department Connections

For additional guidance on performing the tests, see NFPA 25-2011: 13.7; Table 13.1.1.2

Device Test Method

Fire Department Connections

1. The fire department connections are visible and accessible.

2. Couplings or swivels are not damaged and rotate smoothly.

3. Plugs or caps are in place and undamaged.

4. Gaskets are in place and in good condition.

5. Identification signs are in place.

6. The check valve is not leaking.

7. The automatic drain valve is in place and operating properly.

8. The fire department connection clapper(s) is in place and operating properly.

Element of Performance - EP-2-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard PE.04.01.01 EP2-10 (Formerly EC.02.03.05 EP10)

EP

2-

1458c43b-9c28-4412-a362-10dd3331e768 | Fire Department Connections | 03/03/2026

FIRE DEPT. CONNECTION

1 SW Side of Bld Fire Department

Connection Fire Dept. Connection — Michael R Evans 03/03/2026 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date N/A

FDC Check Valves Internal Inspection Date 02/17/2026

FDC 5 Year Questions

FDC Hydrostatic Test performed at 150 psi (10 bar) for 2 hours with a pressure loss of less than 5 psi (0.3 bar) and no visual signs of leakage. N/A

FDC Check Valves Internal Inspection Yes

Notes:

• FDC

Images: DEVICE NOTES IMAGES APPENDIX 1.1

Inspector Signature

Inspector Name Michael Evans Date 03/03/2026

Signature of the

Maintenance

Printed name of the Maintenance Jed Davis Date 03/03/2026

Element of Performance - EP-2-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard PE.04.01.01 EP2-10 (Formerly EC.02.03.05 EP10)

EP

2-

1458c43b-9c28-4412-a362-10dd3331e768 | Fire Department Connections | 03/03/2026

NFPA 25 - 2011

BUILDING NAME: Veterans Admin Outpatient Clinic

BUILDING ADDRESS: 4303 Pittman St, Lawton, OK, 73503

CONTACT NAME: Nathaniel Eastham

CONTACT E-MAIL: nathaniel.eastham@va.gov

CONTACT ROLE: Engineering

CONTACT PHONE: 4054561755

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 2835 S. Utah OKC, OK

OFFICE PHONE: 405-246-1000

OFFICE LICENSE: 0731/280

INSPECTOR: Michael Evans

INSPECTOR LICENSE: 4880

INSPECTION START DATE: 03/03/2026

INSPECTION END DATE: 03/03/2026

WORK ORDER: 60803950

TIMEZONE: GMT-06:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

System Control Valve 2 2 0 0 100 2

Wet System 1 1 0 0 100 1

Check Valve 1 1 0 0 100 1

Sprinkler Box 1 1 0 0 100 1

Inspectors Test Valve 1 1 0 0 100 1

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

NFPA 25 - 2011

N

FP

A

1458c43b-9c28-4412-a362-10dd3331e768 | NFPA 25 - 2011 | 03/03/2026

SYSTEM CONTROL VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

Mechanical Room

Backflow #1 BTFY

System Control Valve

— Michael R Evans 03/03/2026 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 6”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

Mechanical Room

Backflow #2 BTFY

System Control Valve

— Michael R Evans 03/03/2026 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 6”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

CHECK VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

Mechanical Room

Fire Department Connection Check

Valve Swing Check Check Valve — Michael R Evans 03/03/2026 Passed

What is the Size of this Check Valve 4

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 02/17/2026

Notes:

• FDC Check Valve Images: DEVICE NOTES IMAGES APPENDIX 2.1

INSPECTORS TEST VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

NE Storage Wall

Hatch Inspectors Test Drain Gate Inspectors Test Valve — Michael R Evans 03/03/2026 Passed

Inspectors Test Valve Functional Test Yes

NFPA 25 - 2011

N

FP

A

1458c43b-9c28-4412-a362-10dd3331e768 | NFPA 25 - 2011 | 03/03/2026

SPRINKLER BOX

Mechanical Room

Spare Head Box at

Riser Sprinkler Box — Michael R Evans 03/03/2026 Passed

Sprinkler Box Annual Questions

Is the buildings sprinklers inventory list located within the sprinkler spare head cabinet? N/A

Are appropriate number of extra sprinklers and sprinkler wrenches available on the premises? Yes

Notes:

• Spare Head Box Images: DEVICE NOTES IMAGES APPENDIX 2.2

WET SYSTEM

# LOCATION DESCRIPTION DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

Mechanical Room

Wet System Wet System — Michael R Evans 03/03/2026 Passed

Wet Systems - Weekly - Monthly Questions

Make and Model Central Alarm Valve

What Size Is This Wet Pipe Valve 4

Hydraulic Name Plate Present Yes

Record The Coverage Area Defined On The Hydraulic Plate 1500 sq ft

Record The GPM On The Hydraulic Plate 411

Record The PSI On The Hydraulic Plate 42

Inspect Alarm Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Alarm Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The Water Supply Pressure Gauge. 50

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 50

Retard Chamber Leak Tight And In Good Condition N/A

Date of Internal Inspection of Wet System Valve Strainers, Filters, And Restriction Orifices. N/A

Date of Check Valves Internal Inspection 02/17/2026

Date the internal pipe inspection was performed? 02/17/2026

Date of Gauges Replacement 02/17/2026

Wet Systems Quarterly - Semi Annual - Annual - Questions

Did check valves, water flow alarm devices, and retards test satisfactorily? Yes

Inspector's Test Valve Opened & Free Of Obstruction / Discoloration? Yes

Wet Systems - 5 Year Questions

All Gauges over 5 Years Replaced Yes

Internally Inspect Alarm Valve Strainers, Filters, And Restriction Orifices. Yes

NFPA 25 - 2011

N

FP

A

1458c43b-9c28-4412-a362-10dd3331e768 | NFPA 25 - 2011 | 03/03/2026

NFPA 25

NFPA 25 Questions

1. Has there been any changes in the occupancy classification, machinery or operations since the last inspection? No

2. Has there been any changes or repairs to the fire protection systems since the last inspection? No

3. If a fire has occurred since the last inspection have all damaged sprinkler system components been replaced? Not Applicable

4. Have you had an internal pipe inspection performed in the last 5 years? Yes

5. Date the internal pipe inspection was performed? 02/17/2026

6. Are Special Ladders or Lifts Required to perform the 5 Year Internal Pipe Inspection? If So, please list Size and Type. (12 Foot Stepladder, 20 Foot Scissor Lift Etc…)

Not Applicable

7. Have The Sprinkler Systems Been Extended To All Areas Of The Building? Yes

8. Are All Exterior Openings Protected Against The Entrance Of Cold Air? Yes

9. Are the building areas protected by a wet system heated, including its blind attics and perimeter areas? Yes

10. Date Backflow Devices Were Tested 01/20/2026

11. Date of Forward Flow Test Not Applicable

12. Date of Backflow 5 Year Internal Inspection Not Applicable

13. Number Of Water Gauges? Not Applicable

14. Number Of Air Gauges? Not Applicable

15. Mainline Strainers Inspected and Cleaned Not Applicable

16. Are all Tanks, Fire Pumps, and Fire Department Connections Inspected and Tested Per NFPA 25? Yes

17. Has The Private Fire Main Been Flow Tested In The Last 5 Years? Not Applicable

18. Date That The Private Fire Main Been Flow Tested? 01/20/2026

19. Have Master Pressure Regulating Devices been tested at full flow within the past year? Not Applicable

20. Date The Master Pressure Regulating Devices Full Flow Test Was Performed Not Applicable

21. Has The Pressure Reducing Valves Test Been Performed In The Last 5 Years Not Applicable

22. Date The Pressure Reducing Control Valve Test Was Performed Not Applicable

23. All Systems Restored To Normal? Yes

NFPA 25 - 2011

N

FP

A

1458c43b-9c28-4412-a362-10dd3331e768 | NFPA 25 - 2011 | 03/03/2026

NFPA 25 Questions

Control Valves

1. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position? Yes

2. Are all control valves sealed, locked, or supervised, in the appropriate open or closed position? Yes

Water Supplies

1. What type of water supply does this sprinkler system use? City Water

Alarms

1. Did the electric alarms operate during testing? Yes

2. Did the supervisory alarms operate during testing? Yes

Sprinklers and Piping

1. Were All Sprinklers Made After 1920 Yes

2. Standard Response Sprinklers 50 Years Or Older No

3. Quick Response Sprinklers 20 years or older? No

4. Dry Pendent Sprinklers 10 Years Or Older No

5. High Temperature Sprinklers (Greater Than 325F Or 163C) 5 Years Or Older Not Applicable

6. Corrosive Environment Sprinklers 5 Years Or Older Not Applicable

7. Are Any Extra High Temperature Solder Sprinklers Regularly Exposed To Temperatures Near 300°F Not Applicable

8. Do sprinklers generally appear to be free of corrosion, paint, or loading and visible obstructions? Yes

9. Is the buildings sprinklers inventory list located within the sprinkler spare head cabinet? Not Applicable

10. Are appropriate number of extra sprinklers and sprinkler wrenches available on the premises? Yes

11.

Type of sprinkler heads

.5” Tyco 3231 QR 155 degree white semi recessed pendants 2004. .5” Grinnell F950 165 degree chrome pendant 1977. .5” Tyco 3211 165 degree chrome pendant 2004. .5” Tyco 3311 165 degree chrome sidewall 2003.

12. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? Yes

13. Does the exposed exterior condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers and strainers appear to be satisfactory

Yes

14. Does the hand hose on the sprinkler system appear to be in satisfactory condition? Not Applicable

Inspector Signature

Inspector Name Michael Evans Date 03/03/2026

Signature of the

Maintenance

Printed name of the Maintenance Jed Davis Date 03/03/2026

NFPA 25 - 2011

N

FP

A

1458c43b-9c28-4412-a362-10dd3331e768 | NFPA 25 - 2011 | 03/03/2026

Terms And Conditions

1. Limitation of Liability; Limitations Of Remedy. It is understood and agreed by the Customer that Company is not an insurer and that insurance coverage, if any, shall be obtained by the Customer and that amounts payable to Company hereunder are based upon the value of the services and the scope of liability set forth in this agreement and are unrelated to the value of the Customer's property and the property of others located on the premises. Customer agrees to look exclusively to the Customer's insurer to recover for injuries or damage in the event of any loss or injury and that Customer releases and waives all right of recovery against Company arising by way of subrogation. Company makes no guaranty or Warranty, including any implied warranty of merchantability or fitness for a particular purpose that equipment or services supplied by Company will detect or avert occurrences or the consequences there from that the equipment or service was designed to detect or avert.<br />It is impractical and extremely difficult to fix the actual damages, if any, which may proximately result from failure on the part of Company to perform any of its obligations under this agreement. Accordingly, Customer agrees that, Company shall be exempt from liability for any loss, damage or injury arising directly or indirectly from occurrences, or the consequences therefrom, which the equipment or service was designed to detect or avert. Should Company be found liable for any loss, damage or injury arising from a failure of the equipment or service in any respect, Company's liability shall be limited to an amount equal to the agreement price (as increased by the price for any additional work) or where the time and material payment term is selected, Customer's time and material payments to Company. Where this agreement covers multiple sites, liability shall be limited to the amount of the payments allocable to the site where the incident occurred. Such sum shall be complete and exclusive. If Customer desires Company to assume greater liability, the parties shall amend this agreement by attaching a rider setting forth the amount of additional liability and the additional amount payable by the Customer for the assumption by Company of such greater liability, provided however that such rider shall in no way be interpreted to hold Company as an insurer. IN NO EVENT SHALL COMPANY BE LIABLE FOR ANY DAMAGE, LOSS, INJURY, OR ANY OTHER CLAIM ARISING FROM ANY SERVICING, ALTERATIONS, MODIFICATIONS, CHANGES, OR MOVEMENTS OF THE COVERED SYSTEM(S) OR ANY OF ITS COMPONENT PARTS BY THE CUSTOMER OR ANY THIRD PARTY. COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO DAMAGES ARISING FROM THE USE, LOSS OF THE USE, PERFORMANCE, OR FAILURE OF THE COVERED SYSTEM(S) TO PERFORM. The limitations of liability set forth in this agreement shall inure to the benefit of all parents, subsidiaries and affiliates of Company, whether direct or indirect, Company's employees, agents, officers and directors.

2. Limited Warranty. COMPANY WARRANTS THAT ITS WORKMANSHIP AND MATERIAL FURNISHED UNDER THIS AGREEMENT WILL BE FREE FROM DEFECTS FOR A PERIOD OF NINETY

(90) DAYS FROM THE DATE OF FURNISHING. Where Company provides product or equipment of others, Company will warrant the product or equipment only to the extent warranted by such third party. EXCEPT AS EXPRESSLY SET FORTH HEREIN, COMPANY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE SERVICES PERFORMED OR THE PRODUCTS, SYSTEMS OR EQUIPMENT, IF ANY, SUPPORTED HEREUNDER. COMPANY MAKES NO WARRANTY OR REPRESENTATION, AND UNDERTAKES NO OBLIGATION TO ENSURE BY THE SERVICES PERFORMED UNDER THIS AGREEMENT, THAT COMPANY'S PRODUCTS OR THE SYSTEMS OR EQUIPMENT OF THE CUSTOMER WILL CORRECTLY HANDLE THE PROCESSING OF CALENDAR DATES BEFORE OR

AFTER DECEMBER 31, 1999.

3. Indemnity. Customer agrees to indemnify, hold harmless and defend Company against any and all losses, damages, costs, including expert fees and costs, and expenses including reasonable defense costs, arising from any and all third party claims for personal injury, death, property damage or economic loss, including specifically any damages resulting from the exposure of workers to Hazardous Conditions whether or not Customer pre-notifies Company of the existence of said hazardous conditions, arising in any way from any act or omission of Customer or Company relating in any way to this agreement, including but not limited to the Services under this agreement, whether such claims are based upon contract, warranty, tort (including but not limited to active or passive negligence), strict liability or otherwise. Company reserves the right to select counsel to represent it in any such action.

4. Hazardous Materials. Customer represents that, except to the extent that Company has been given written notice of the following hazards prior to the execution of this agreement, to the best of Customer's knowledge there is no:

a. "permit confined space," as defined by OSHA, or space in which work must be performed that, because of its construction, location, contents or work activity therein, accumulation of a hazardous gas, vapour, dust or fume or the creation of a risk of infectious disease

b. need for air monitoring, respiratory protection, or other medical risk

c. asbestos, asbestos-containing material, formaldehyde or other potentially toxic or otherwise hazardous material contained in or on the surface of the floors, walls, ceilings, insulation or other structural components of the area of any building

d. All of the above are hereinafter referred to as "Hazardous Conditions". Company shall have the right to rely on the representations listed above. If hazardous conditions are encountered by Company during the course of Company's work, the discovery of such conditions shall constitute an event beyond Company's control and Company shall have no obligation to further perform in the area where the hazardous conditions exist until the area has been made safe by Customer as certified in writing by an independent testing agency, and Customer shall pay disruption expenses and re-mobilization expenses as determined by Company. This agreement does not provide for the cost of capture, containment or disposal of any hazardous waste materials, or hazardous materials, encountered in any of the Covered System(s) and/or during performance of the Services. Said materials shall at all times remain the responsibility and property of Customer. Company shall not be responsible for the testing, removal or disposal of such hazardous materials.

5. Equipment Disconnections. This represents Company's notice to you that the system(s)/device(s) listed on the face of this agreement as temporarily or permanently disconnected are no longer in service and, thus, cannot detect, perform and/or report

6. General. Unless otherwise specified, work shall be performed during company's regular business hours,, exclusive of Saturdays, Sundays and Company holidays. All work is subject to review and rebilling in accordance with the terms and conditions of Customer's agreement/contract with Company, if one is in effect. Company shall not be responsible for failure to render services due to causes beyond its control, including but not limited to material shortages, work stoppages, fires, civil disobedience or unrest, severe weather, fire or any other cause beyond the control of Company. Customer is aware that the Limitation of Liability and other provisions set forth in any existing agreement/contract, if one is in effect, or set forth above, apply to services performed and materials supplied. The terms of this agreement shall govern notwithstanding any inconsistent or additional terms and conditions in any purchase order or other document submitted by Customer.

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DEVICE NOTE IMAGE APPENDICES

EP10

LOCATION DESCRIPTION DEVICE BARCODE IMAGES

SW Side of Bld Fire Department Connection Fire Dept. Connection — DEVICE NOTES IMAGES APPENDIX 1.1

Notes:

• FDC

NFPA 25

LOCATION DESCRIPTION DEVICE BARCODE IMAGES

Mechanical Room 212 Fire Department Connection Check Valve Check Valve — DEVICE NOTES IMAGES APPENDIX 2.1

Notes:

• FDC Check Valve

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Mechanical Room 212 Spare Head Box at Riser Sprinkler Box — DEVICE NOTES IMAGES APPENDIX 2.2

Notes:

• Spare Head Box

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