Attachment_2_-_Statement_of_Completion.pdf
PDF 10 KB Posted
- Attached to
- Replace Elevator CPU/Test Federal contract opportunity
- Solicitation number
- W9128F-16-T-H005
About this file
Statement of Completion
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Elevator_CPU_PWS_2.0.pdf | ||
| W9128F-16-T-H005.pdf | ||
| Attachment_1_-_MRO_Form_1669.pdf | ||
| Attachment_3_Inspection_Certificate.pdf |
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Text version
STATEMENT OF COMPLETION
SUBJECT: ANNUAL ELEVATOR INSPECTION, CORPS OF ENGINEERS, OMAHA DISTRICT
DATE: _________________________________________
PURCHASE ORDER NO. ____________________________
I hereby certify that the annual elevator inspection in the ______________________________________________
______________________________________________________________ was performed in accordance with
“American National Standard Safety Code for Elevators, Dumbwaiters, Escalators and Moving Sidewalks” (A17.1-
2013) and was completed by _____________________________________________________ on
CLASSIFICATION NUMBER
(1) Elevator, Passenger _________
(2) Elevator, Freight _________
RECEIPT ACKNOWLEDGED
Signature Signature
Title (Government Representative) Title (Contractor’s Inspector)
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