AMERICAN BUREAU OF SHIPPING CHECK SHEET ON SOLAS SURVEYS - "AIS" RADIO TECHNICIAN'S SURVEY (ORIGINAL TO BE RETAINED ONBOARD BY VESSEL'S MASTER)

VESSEL ----~M~IS~S:....::E=M:.:.:.M=A~M=C=C:....:.AL=L=--------- CLASS NO. _____ _

Associated REPORT NO. _________ DATE '"'"'M"-'A'-"-Y...;;;2:....:..1.i....:2=0=2=0 _______ _

AUTOMATIC IDENTIFICATION SYSTEM (AIS) Test Report Ship's details: CALL SIGN WDG8742 MMSI NUMBER _3"-'3=8""--1 o...,.o __ oo....,o.__ ______ _

PORT OF REGISTRY ...,;C~A...!!.M!.!.!E=..!.R~O!..!.N!>....!::!LA~-----------------------IMO NUMBER _9=2=8=96=5=9 __________ _ GROSSTONNAGE_4=9=3 _______ _

DATE KEEL LAID _,2=0=-0><-3 _________ _ OFFICIAL NUMBER _1~1=36,._,9=02=--------

Inspection Details NAME OF RADIO TECHNICIAN ROBERT POAGE

INSPECTION DATE --=0=5/=2..:..:..1/=20=2=-0 _______ _

COMPANY PREMIUM ELECTRONICS SERVICES

INSPECTION LOCATION BEAUMONT,TX

1. Installation details Item Status

1.1 lA.IS transponder type: FURUNO FA-150 OK 1.2 Type approval certificate OK 1.3 Initial installation configuration report on board? OK 1.4 Drawings provided? (Antenna-, AIS-arrangement and block diagram) OK 1.5 Main source of electrical power, OK 1.6 Emergency source of electrical power, OK 1.7 Capacity to be verified if the AIS is connected to a battery OK 1.8 Pilot plug near pilots operating position? OK 1.9 120 V AC provided near pilot plug? (Panama and St. Lawrence requirement) OK

2. AIS programming - Static information 2.1 MMSI number OK 12.2 IMO number OK 12.3 Radio call sign OK 12 .4 Name of ship OK 2.5 !Type of ship OK 2.6 Ship length and beam OK 2.7 Location of GPS antenna OK

3. AIS programming - Dynamic information 3.1 Ships position with accuracy and integrity status (Source: GNSS) OK 3.2 !Time in UTC (Source: GNSS) OK 3.3 Course over ground (COG) (will fluctuate at dockside) (Source GNSS) OK 3.4 Speed over ground {SOG) (zero at dockside) (Source: GNSS) OK 3.5 Heading (Source: Gyro) OK 3.6 Navigational status OK 3.7 Rate of turn, where available (ROT) OK 3.8 lA.ngle of heel, pitch and roll, where available OK

AIS-TECH Revision 0 Page 1 of2

VESS EL ------=M~IS=S;...=E:.:.::M~M:.:.:..A..,_,M=-C=-C.:.:A~L=L'--______ CLASS NO. ------Associated REPORT NO. _________ DATE MAY 21 2020

4. AIS proqramming - vovaqe related information

4.1 Ships drauqht 14.2 Type of carqo

14.3 Destination and ETA (at masters discretion)

14.4 Route plan (optional)

14.5 Short safety-related messages

5. Performance test usinq measuring instrument

5.1 Frequency measurements AIS ch. 1 and 2, GMDSS ch. 70

5.2 Transmitting output, AIS ch. 1 and 2, GMDSS ch. 70 5.3 Polling information ch. 70 5.4 Read data from AIS 5.5 Send data to AIS 5.6 !Check AIS response to "virtual vessels"

6. "On air" performance test ~. 1 Check reception performance ~.2 Confirm reception of own signal from other shipNTS ~.3 Polling by VTS/shore installation

Electromagnetic interference from AIS observed to other installations?:

Radio Technician's Remarks:

The AIS has been tested according to IMO SN/Circ.227 and resolution MSC.74(69), annex 3

~\,.ECTRONi ~ ~~ C # 7i£aioecnic1an's Signature

~ ~ ~ ROBERT B p 11' ROBERT POAGE

OAGE 011 Radio I echnic1an's Printed Name Cl DM00001967

\ :

OK OK OK OK OK

OK OK OK OK OK OK

OK OK OK

ISi ~o, PREMIUM ELECTRONCS SERVICES +,.,-'- -.: ..... (J.,.,~.._ _ ___;,....:....:.::==~::C:..:o=-m.:....:p..:..:a::.;ny:..=::::....::;::.:..;~=~---•y rAIN~-..;

BEAUMONT, TX May 21, 2020 Place and Date

AIS-TECH Revision O Page 2 of 2