SCHEDULE "A"

THE CORPORATION OF THE CITY OF PORT COQUITLAM
No. | Fire Hall, 2352 McAllister Avenue

Port Coquitlam, BC V3C 2B2
TELEPHONE: (604) 944-5466 FAX: 944-5406

TO THE OWNER, OCCUPIER and/or MANAGER OF:

The Fire Department has attended at the above address. This Building may be UNSAFE for
occupancy due to the following apparent deficiencies:

Fire Alarm: Sprinkler System:

( ) OUT OF SERVICE ( ) OUT OF SERVICE
( ) Reset - Requires Service ( ) Requires Repairs

( ) Other (See Below) ( ) (See Below)

Additional Deficiencies:

It is the owner, occupier and manager’s responsibility to maintain the required Fire Protection
Equipment in proper operating order at all times. The deficiencies noted should be corrected
immediately.

Hall No. Date & Time

I acknowledge the above deficiencies and will take the necessary precautions until they have
been corrected. If the fire alarm system or sprinkler system is out of service, I will provide fire
sentries until the system is restored te normal operating conditions.

Owner/Occupier/Manager

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