PRODUCER STATEMENT by NickyvGraham

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									PRODUCER STATEMENT
ISSUED BY: TO: TO BE SUPPLIED TO: Bob the Builder Extraordinaire
(Suitably Qualified and Approved Author of Producer Statements)

Postman Pat
(Owner)

TAUPO DISTRICT COUNCIL PRIVATE BAG 2005 TAUPO has been engaged by Tickity Boo Builders Ltd
(Owner/Developer, Contractor)

Einstein Engineering Services
(Design Firm, Installer etc)

to provide

Design of membrane deck and installation B1, B2, & E2

services in respect of the

requirements of clause(s)

of the New Zealand Building Code on:

√ All

Part only as specified B1, B2/AS1

of the building work. The design/installation has been done in accordance with E2/AS1, H1/AS1, BRANZ Appraisal # 1234
(Verification Method(s)/Acceptable Solutions/Appraisal Certificate)

(respectively) of the approved documents

issued by the Department of Building and Housing / BRANZ / Product Manufacturer and the work is to be / which has been constructed on: Street/Road Number: described on and numbered 123
(Design Firm)

Lot

007

DP(S)
Town:

56789 Taupo

Name:

Anywhere Road drawings titled

Dexter’s Dodgy Designs and Plans Sheets A1 to A3

Dwelling for Joe Bloggs

on the specifications and other documents according to which

the building is to be / has been constructed. As an independent design professional / approved installer / licensed building practitioner…etc and covered by a current policy of Professional Indemnity Insurance to a minimum value of $200,000 (two hundred thousand dollars), I HERBY CERTIFY / BELIEVE ON REASONABLE GROUNDS that subject to: (i) the site verification of the following assumptions, the ground bearing is a minimum of 100kPa / the substrate has been constructed in accordance with NZS 3604: 1999 ….etc and (ii) all proprietary products meeting the performance specification requirements, the drawings, specifications, and other documents according to which the building is proposed to be constructed / the building work as completed comply(s) with the relevant provisions of the New Zealand Building Code.

Date:
(Signature Approved Author of Producer Statements)

31 December 1999

BLegoSc, Dip Tech (SS)
(Professional Qualifications)

Registration Number: Member:

01234

PO Box 1234, Taupo
(Address)

MEBANZ, RMICBA
(Professional Organisation)

APPROVED:
DOCUMENT: Form 506 – Producer Statement Example

PAGE 1 OF 1
DATE: 22 October 2008


								
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