OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION “Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs” STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-759 (REV 12/16/15) Page 1 of 3 APPLICATION FOR OSHPD SPECIAL SEISMIC CERTIFICATION PREAPPROVAL (OSP) OFFICE USE ONLY APPLICATION #: OSP – 0128-10 OSHPD Special Seismic Certification Preapproval (OSP) Type: New Renewal Manufacturer Information Manufacturer: Trane Manufacturer’s Technical Representative: Shawn Jennings Mailing Address: 101 William White Boulevard, Pueblo CO 81001 Telephone: 719-585-4392 Email: [email protected]Product Information Product Name: CGAM Product Type: Air Cooled Liquid Chiller with Scroll Compressors Product Model Number: Sizes 20 Ton to 120 Ton (List all unique product identification numbers and/or part numbers) General Description: Cataloged chillers available from 20 Ton to 120 Ton. Mounting Description: Base mounted on external spring vibration isolators. Applicant Information Applicant Company Name: The VMC Group Contact Person: John Wilson, Jr. Mailing Address: 113 Main Street, Bloomindale NJ 07403 Telephone: 973-838-1780 Email: [email protected]I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2016. Signature of Applicant: Date: 12-1-16 Title: CEO Company Name: The VMC Group 02/06/2017 OSP-0128-10 Page 1 of 8
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OSHPD Special Seismic Certification Preapproval(SOP)...Description Mfr/Model Input1Voltage Output1Rating1Range1 [Voltage/Current/ Power] UUT Operator1Interface1 (Main1Controller) Dynaview1CH530
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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-759 (REV 12/16/15) Page 1 of 3
APPLICATION FOR OSHPD SPECIAL SEISMIC CERTIFICATION PREAPPROVAL (OSP)
OFFICE USE ONLY
APPLICATION #: OSP – 0128-10
OSHPD Special Seismic Certification Preapproval (OSP)
I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2016.
Signature of Applicant: Date: 12-1-16
Title: CEO Company Name: The VMC Group
02/06/2017 OSP-0128-10 Page 1 of 8
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
California Licensed Structural Engineer Responsible for the Engineering and Test Report(s)
Company Name: The VMC Group
Name: Kenneth Tarlow California License Number: SE2851
Mailing Address: 980 9th Street, 16th Floor, Sacramento CA 95814
Supports and attachments are preapproved under OPM- (Separate application for OSHPD Preapproval of Manufacturer’s Certification (OPM) of Supports and attachments is required)
Supports and attachments are not preapproved
Certification Method
Testing in accordance with: ICC-ES AC156
Other (Please Specify):
Testing Laboratory
Company Name: UC Berkeley & Trentec
Contact Name: Don Clyde (UC Berkeley) & Timothy Geers (Trentec)
Mailing Address: 1301 South 46th Street, Richmond CA 94804 & 4600 East Tech Drive, Cincinnati OH 45245