DRXXX | MMYY

Evaluation ID: DR-XXXX Effective Date:

Re-evaluation Date:

Product Name: Product Name

Manufacturer: Manufacturer

Address

City, State Zip

(XXX) XXX-XXXX

General Description:

System / Description / Label
Rating / Drawing
Number
1
2


General Description (continued):

System / Description / Label
Rating / Drawing
Number
3
4
5
6

Component Dimensions:

System / Overall Size / Panel Size / Maximum Daylight
Opening Size
1 / Inswing:" x "
Outswing: " x " / " x " / " x "
2 / Inswing:" x "
Outswing: " x " / " x " / " x "
3 / Inswing:" x "
Outswing: " x " / " x " / " x "
4 / Inswing:" x "
Outswing: " x " / " x " / " x "
5 / Inswing:" x "
Outswing: " x " / " x " / " x "
6 / Inswing:" x "
Outswing: " x "” / " x " / " x "


Components and Hardware:

System / Component / Quantity / Attachment Method
1-6

Product Identification (Certification Agency Label on Door):

System
1 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards
2 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards
3 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards
4 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards


Product Identification (Certification Agency Label on Door) - continued:

System
5 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards
6 / Certification Agency
Manufacturer’s Name or Code Name
Product Name
Drawing
Test Standards

Impact Resistance:

System / Impact Resistant / Requirement
1-6 / No / Provide an impact protective system when installing the product in areas that require windborne debris.

Installation:

System
1-6 / Type of Installation
Wall Framing
Fasteners
Fastener Embedment
Fastener Location/Spacing / Head
Sill
Side Jambs
Hinges

Note: The manufacturer’s installation instructions must be available on the job site during installation. Use corrosion resistant fasteners as specified in the IRC, the IBC, and the Texas Revisions.

Texas Department of Insurance | www.tdi.texas.gov Page 3 of 4