APPENDIX I - ANNEX 1

CERTIFICATE OF THE CONTRACTOR'S DESIGN

OF PERMANENT WORKS

Part 1

(To be signed by a professionally qualified member of Ihe Contractors slaff, or of hissub-contractor’s staff, responsible for the Contractors Design)

Contract No. & Name: Works Contract M767-4

Part of Works Designed:

Drawings as Listed In Attachment 1 (Number of Drawings:

- no.)

Calculations Title:

Prepared by:

Dated: No. of Pages - Rev.: -

Method Statement Title: -

Submission No: - Rev.: -

Certification

I certify that the part of the Permanent Works described above has been designed inaccordance with the Contract and that the design has been checked and foundsatisfactory by the undersigned.

Signed: Date:For and on behalf of the Contractor

Name and qualifications of signatory:

Contract M767-4 PS AII 1/4 AAA 27/06/14Design, Supply and Installation of Automated FOD Detection Systems (Electro-optical System)Particular Specification – Appendix I – Annex I

APPENDIX I - ANNEX 1

Part 2

(To be signed by the Checking Engineer)

Certification

I certify that the part of the Permanent Works described above has been designed

using all the skill and care to be expected of a professionally qualified and competent

designer experienced in work of a similar nature and scope and that I have checked

the design and drawings and found them satisfactory.

Signed: Date:

Name and qualifications of the CheckingEngineer:

Name of firm or company:

Refer to Attachment 1 (also to be endorsed by Contractor and Checking Engineer)

Contract M767-4 PS AII 2/4 AAA 27/06/14Design, Supply and Installation of Automated FOD Detection Systems (Electro-optical System)Particular Specification – Appendix I – Annex I

APPENDIX I - ANNEX 1

Attachment 1 to the Certificate of the Contractor’s Design of Permanent Works

Contract No. & Name :

Element of WorksDesigned :

Drawing No. Rev Tittle

- - -

- - -

- - -

- - -

- - -

- - -

- - -

Signed: Date:For and on behalf of the Contractor

Signed: Date:Checking Engineer

Contract M767-4 PS AII 3/4 AAA 27/06/14Design, Supply and Installation of Automated FOD Detection Systems (Electro-optical System)Particular Specification – Appendix I – Annex I