REGISTER CERTIFICATE OF VISUAL INSPECTION AND TESTING OF

BOOM SUPPORTED ELEVATING WORK PLATFORMS

CERTIFICATE No. WH14JD-2201
Name and Address of Owner

MSX- K.S.A.
Name and Address of the Manufacturer

Date of last thorough examination.

GENIE

NA

Type

Relevant Standard.

Diesel, Electric Powered, Telescopic Boom ,Man

Elevating Working Platform
Location

Survey Requested By

Rated Capacity

KASC,JEDDAH
Serial No.

Year of manufacture

227 kg.

S125-465

2001

Model No.

Owner I.D.

NA

Licence Plate No.

S-125

Test Load Applied

NA

Date of last Proof load Test

NIL

NIL

Validity of this certificate

Relief Valve Adjustment

06 months from date of inspection

Next due date of Inspection:

Satisfactory

1 Mar.2015

Description of Item

Maximum Platform height

Maximum Horizontal reach
Wind Speed

NA

ANSI/SIA A92.5-2006

Comments

38.1 m
24.4 m
12.5 m/s

NONE

The certificate is issued subject to the condition that it is understood and agreed that nothing in this report shall be deemed to relieve any designer, manufacturer, seller,
supplier, repairer or operator of any warranty, expressed or implied, and TUV Sud Middle East, LLC shall be limited to the acts or omissions of its employees, agents and
subcontractors. Under no circumstances whatsoever shall TUV Sud Middle East, LLC be liable for any injury or damage to any person, or occurring by reason of
negligent operation or any defect in materials, machinery, equipment or other items other than such defects ascertainable by normally accepted testing standards and
only those items inspected by TUV Sud Middle East, LLC and which are covered by this certificate.

Time Sheet No: 67353

Page 1 of 2

sticker no:JD-5560

DOC.NO.QF/DC-MPC-02 (REV0)

CERTIFICATE No. WH14JD-2201

SECTION

DEFICIENCIES (if any)

General

CORRECTIVE ACTIONS

Satisfactory

Tyres and wheels/shoes.

Shall be monitored

Mast and basket-carrier

Satisfactory

Load Chain

NA

Side Rollers

Satisfactory

Roll-over cage

Satisfactory

Man basket

Satisfactory

Horn and Safety Devices

Satisfactory

Hydraulic System

Satisfactory

Electrics, Lights, Rotating Beacon

Satisfactory

Engine Compartment

Satisfactory

Exhaust System

Satisfactory

Cooling System

Satisfactory

Steering/Reverse Alarm

Satisfactory

Operational Controls

Satisfactory

Gauges in Cab

Satisfactory

Fire Extinguisher

NI

Maintenance

Satisfactory

Condition

Good

THIS IS TO CERTIFY THAT the undersigned, a competent inspector, did, attend the site for testing to examine and ascertain that this
Boom Lift, its machinery, gears, lifting appliances, structural supports/fixtures and associate apparatus have withstood the proof load
testing, without injury or permanent deformation to the Boom Lift; and no adverse defects that would impair the safe use of this Boom Lift
was observed. This Boom Lift is safe for its intended use within the limits specified providing there is continuous maintenance and
qualified operators employed.

Inspected by

Approved by

WALEED HAMZA

Date/ 1 Sep.2014

Inspection Engineer

FERAS AL KHALAF
Branch Manager

stamp
LIABILITY - the Client or his assignee or supervisor in interest agrees to indemnify and hold harmless TV Sd Middle East, LLC from and against any and
all claims, demands, lawsuits or actions for damages, including legal fees to persons and / or property tangible, intangible or otherwise which may be
brought against TV Sd Middle East, LLC incidental to, arising out of or in connection with the work to be done, services to be performed or material to be
furnished hereunder except for those claims caused solely and completely by the negligence of TV Sd Middle East, LLC, its directors, officers, employees
or sub-contractors.
Under no circumstances whatsoever shall TV Sd Middle East, LLC be liable for any injury or damage to any person or property occurring by reason of
any defect in all design, materials, machinery, equipment or other items which it is the responsibility of TV Sd Middle East, LLC to inspect under the terms
specified hereunder. Nothing herein contained shall be deemed to relieve any seller or manufacturer of its warranties, express or implied.
In the event TV Sd Middle East, LLC is proven negligent in any respect, the liability of, TV Sd Middle East, LLC its agents, employees and
subcontractors for Proprietors claims shall not exceed the greater of US$ 1,000 or five (5) time the total compensation paid to TV Sd Middle East, LLC for
the work. Proprietor shall save, defend and hold TV Sd Middle East, LLC harmless against in excess of US$ 1,000 or five (5) times the total
compensation paid to TV Sd Middle East, LLC.

Time Sheet No: 67353

Page 2 of 2

sticker no: JD-5560

DOC.NO.QF/DC-MPC-02 (REV0)