BACnet TESTING LABORATORIES

LISTING APPLICATION FORM
Revision 9.0.final
Revised December 1, 2011

BACnet is a registered trademark of ASHRAE. ASHRAE does not endorse, approve or test products for compliance with ASHRAE standards. Compliance of listed products to the requirements of ASHRAE Standard 135 is the responsibility of BACnet International (BI). BTL is a registered trademark of BI.

BACnet Testing Laboratories –Listing Application Form

Introduction

This form is used to officially request that one or more products be awarded a BTL Listing. Prior to filling out this form, the Vendor must ensure that the product qualifies for a listing. One of the following conditions must exist to use this form:

1)The product was tested directly at the BTL Lab,

2)The product has been tested by another certified testing lab,

3)The product meets the requirements of ‘sameness’ for a product that was directly tested at alab as described in the Qualification Questions Document.

Documents that are required for a BTL Listing are as follows:

-This form

-A BACnet Testing Laboratories Standard Product Listing Agreement signed by the Applicant’s company

-A Completed BTL Functionality Checklist document (if not directly tested by a lab)

-A Completed PICS statement

A BTL Listing may also require the payment of a listing fee. Please contact the BTL Manager for additional information about fees and requirements for BTL Listings.

Applicant Information:

Name / Chad Ziehm
Job Title / Field Support Engineer
Company & Division / Siemens – Industry – Building Technologies
Address / 1000 Deerfield Parkway
Buffalo Grove, IL 60089
Country / USA
Telephone Number / 847-941-5109
Fax Number / 312-604-7862
E-mail Address /

Testing Lab Information:

Enter the name, location and contact information of the laboratory where the product was tested. If the product was tested at the BTL Lab, this may be left blank.

Lab Name
Location
Contact
Telephone Number

Product Information:

Enter Vendor and Test Case Number that the listed product is based on.

CompanyName (exactly as you wish it to appear in the Catalog of Manufacturers on the BACnet International web-site) / Siemens
URL of your company (exactly as you wish it to appear in the Catalog of Manufacturers on the BACnet International web-site) /
Test Case Number* / Siemens TC51110

* Note: Products tested prior to July 2006 may not have a unique test number assigned and in this case the exact product name and model that was tested at a lab should be placed here. If this is an OEM product, you may obtain the Test Case Number from the OEM supplier.

In the table below, list each product for which a BTL Listing is requested. Each line in the table below represents a separate BTL Listing. To list families of products on the same BTL Listing, place the product family name in the Product Name column and then list all applicable model numbers in the Model Number column.

Product Name / Model Number / Version for Listing
APOGEE Insight with BACnet Operator Workstation / 571-010-3P12-USB
and 571-188
571-020-3P12-USB
and 571-188 / 3.12
(Please add rows as necessary)
/ I have reviewed the BTL Listing Qualification Questionnaire and determined that this/these device(s) qualifies/qualify for a BTL Listing.

I have reviewed the requirements for listing my device(s). To the best of my knowledge, the information provided in this form is correct. I grant the BTL Manager permission to request information from the test laboratory in order to verify the listing qualifications.

Applicant's Signature:
Print Name: / Chad Ziehm
Date: / 06/12/2012

Please submit this form to:

Attention: BTL Manager

BACnet International

PMB 321

2900 Delk Road Suite 700

Marietta, GA 30067-5350

Tel: +1 (770) 971-6003

Fax: +1 (678) 229-2777

Or email directly to

Version / Date / Author / Change
5.0.1 / 3-Nov-2008 / Lori Tribble /
  • Added revision history table
  • Updated version from 4.0.4 to 5.0.1

5.0.2 / 24-Feb-2009 / Lori Tribble /
  • Updated BI phone number
  • Updated version from 5.0.1 to 5.0.2

5.0.final / 26-Jun-2009 / Lori Tribble /
  • Updated to final revision

6.0.1 / 24-Jan-2011 / Duffy O’Craven /
  • Added to the form request for Company Name (exactly as it should appear) and desired URL

9.0.1 / 13-Oct-2011 / Duffy O’Craven /
  • Updated to the Delk Road address

9.0.2 / 23-Nov-2011 / Duffy O’Craven /
  • Made new data entry fields align flush left-bottom.

9.0.final / 01-Dec-2011 / Duffy O’Craven /
  • Updated BACnet International fax number, then to 9.0.final

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