<p>DATE BID DATE CONTACT COMPANY PHONE EMAIL PROJECT</p><p>☐ CONDITIONS GPM PSI LISTING ☐ UL ☐ FM Other: ☐ Indoor ☐ Outdoor ☐ Factory Packaged with House ☐ Factory Packaged without House PUMP ☐ Horizontal ☐ In-Line ☐ End Suction ☐ Vertical Turbine ☐ Positive Displacement DRIVER ☐ Electric ☐ Diesel ☐ Steam HP: RPM: POWER ☐ 1 phase ☐ 3 phase ☐ 120 ☐ 200-208 ☐ 230-240 ☐ 460-480 ☐ High Voltage: ☐ Other WATER ☐ City PSI: ☐ Tank PSI: PSI: SPECIAL INSTRUCTIONS</p><p>FITTINGS & ACCESSORIES ☐ 125# ☐ 250# fittings ☐ Eccentric Suction Reducer ☐ Main Relief Valve ☐ Concentric Discharge Increaser ☐ Enclosed Waste Cone ☐ Test Header with Valves, Caps & Chains ☐ Flow Meter: ☐ Butt-Weld ☐ Grooved ☐ Flanged ☐ Test Header Ball Drip Valve ☐ Fuel Tank: ☐ Single Wall ☐ Double Wall Other Fitting(s): </p><p>FIRE PUMP CONTROLLER ☐ Diesel ☐ Wye-Delta Closed ☐ Limited Service (not FM approved) ☐ Autotransformer ☐ Across-the-line ☐ Soft Start ☐ Primary Resistance ☐ Variable Frequency ☐ Part Winding ☐ Automatic Transfer Switch ☐ Wye-Delta Open ☐ Remote Alarm Panel</p><p>CONTROLLER OPTIONS Fuel Tank Alarms ☐ Low ☐ High ☐ Spill ☐ Automatic Stop with Run Period Timer Extra ☐ Pump Running ☐ Phase Reversal ☐ Power Failure ☐ Sequential Start Timer Zone pumping integration ☐ Low zone / High zone ☐ Power Failure Start Water Tank/Reservoir Alarms ☐ Low ☐ High ☐ RMS Withstand Rating: ☐ Space Heater ☐ 120 volt ☐ 240 volt ☐ Pump Lockout ☐ Low Pump Room Temperature Alarm & Thermostat NEMA Enclosure: ☐ 2 ☐ 3R ☐ 4 ☐ 4X ☐ 12 Other Option(s): </p><p>JOCKEY PUMP & JOCKEY PUMP CONTROLLER ☐ Yes ☐ No GPM PSI ☐ Circulation Relief Valve ☐ Run Period Timer ☐ Power Available Light POWER ☐ 1 phase ☐ 3 phase ☐ 120 ☐ 200-208 ☐ 230-240 ☐ 460-480 Highlighted fields are the minimum mandatory information required in order to provide a quotation.</p>