Fire Suppression System Installation Request, WTC

NYC 9/11 Public Portal Document

8 Superintendent of Construction I, the undersigned, agri-ee to take responsibility tor superintending the uae ot materials and their incorporation into the work to be perlonmed lor this wb. Last Name SALA ’ PiMN^ HENR7 niT ; SENTINEL riRE CONT^VL, INC. BusinessPhon, ( z J 2-^94-05,90 Address 1S5 E. 109tK St, City Nzm yp/ik, ' ' - suti/y ZIP 1 0 029 I R.A. I X I Other: Taspayer ID No. 22- 1 9 0 7 S S 1 Lie. No. 2 5 6C Name SaaHP.E.orR.A.) Sata. Signature Date 6-15-92

Notarization SUt.OfN.wVo^,J^yiy^)( HiiiiAon Seal Sworn to before me this J 5th. P*yoi/j Ju.W.£ 19 7?

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_9_Slte_Safet^_Mana2er Last Nams First Nams M.l.

Business Name Business Phone ( » Address City SUte ZIP

Social Security No.

Sa Contractor's Statsmont for Sits Satsty Plan I have advised the individual named above that he has been designated as the Site I agree to waive the objectionsand defense that he is not the proper party-defendant in Safety Manager. any criminal proceeding based upon the failure of the Site Safety Manager referenced above, to comply with his duties as set forth in the Department of Buildings regulations I hereby state that the individual designated to be Site Safety Manager is an employee of for Site Safety Managers. the Contractor and meets the qualifications for Site Safety Manager. The individual designated by me shall function as Site Safety Manager for all construction work to be I acknowledge, certify, and accept all of the above. performed at the location referenced above which is covered by the Department of Buildings regulations for Site Safety Programs. Contractor I agree to either aubetitute myaeK aa a defendant in the place of the Site Safety Manager Name in any proceedings brought againat the Site Safety Manager by a governmental authority Title for all of the acts, errorsand omissionsof the designated Site Safety Manager or agree to have a proceeding commenced against it as a condition for the Corporation Counsel of Signature □ate the City of New York to withdraw the proceeding against the said Site Safety Manager.

Site Safety Manager Name I, as Site Safety Manager, wilt perform, on behalf of the Contractor, all of the functions required of a Site Safety Manager as setforth in the Department of Buildings rules and Title regulations. Signature Date lacknowledge, certify, and accept all of the above.

Notarization______ state ot New York, County of Seal Sworn to before ma this day of IB

Signature

NYC-WTC_000166102