SURGE PROTECTIVE DEVICE FOR 120V or 120/240V

Effective Date: 06/17/2015

Document Identifier: CM-620-2.7.1-01

Printed copies are for reference only; they are not controlled. Latest version is on-line.

FDOT Traffic Engineering Research Laboratory (TERL) Surge Protective Device (SPD) for 120V or 120/240V Compliance Matrix	By signing this form, the applicant declares that he/she has read and understands the provisions of Section 620 of the FDOT Standard Specifications for Road and Bridge Construction and all implemented modifications. The requirements listed on this matrix are derived from Section 620, and are the basis for determining a product’s compliance and its acceptability for use on Florida’s roads.

Date:	Click here to enter a date.	Applicant’s Name (print):
Manufacturer:
Item, Model No.:	Signature:

ID No	Section	Requirement	Item Comply? (Yes/No)	Comments (Applicant must provide information as indicated)	TERL Evaluation Method
1	620-2.7.1	SPD is intended for installation at a utility disconnect.	Provide product literature, specifications, user manual,or similar information that indicates compliance. (Indicate specific configurations by model number or series).	Document Review
Indicate location of requested information in submittal.
2	SPD intended for installation at utility disconnect includes L-N, L-G, and N-G protection.	Provide a first or third-party test report that demonstrates the device meets this requirement. The test report must meet the requirements of FDOT Product Certification Handbook (PCH), section 7.2.	Document Review
Indicate location of requested information in submittal.
3	SPD intended for installation at utility disconnect has a maximum surge current rating of 50kA per phase or greater.	Provide a first or third-party test report that demonstrates the device meets this requirement. The test report must meet the requirements of FDOT PCH, section 7.2.	Document Review
Indicate location of requested information in submittal.
4	SPD intended for installation at utility disconnect meets the requirements of UL 1449, Third Edition, and is listed by an NRTL.	Provide a first or third-party test report that demonstrates the device meets requirements of UL 1449, Third Edition. The test report must meet the requirements of FDOT PCH, section 7.2. Indicate listing (UL, ETL, etc.).	Document Review
Indicate location of requested information in submittal.
5	SPD is intended for installation where the supply circuit enters an equipment cabinet.	Provide product literature, specifications, user manual,or similar information that indicates compliance. (Indicate specific configurations by model number or series).	Document Review and Physical Inspection
Indicate location of requested information in submittal.
6	SPD intended for installation where the supply circuit enters an equipment cabinet includes L-N, L-G, and N-G protection.	Provide a first or third-party test report that demonstrates the device meets this requirement. The test report must meet the requirements of FDOT PCH, section 7.2.	Document Review
Indicate location of requested information in submittal.
7	SPD intended for installation where the supply circuit enters an equipment cabinet has a maximum surge current rating of 50kA per phase or greater.	Provide a first or third-party test report that demonstrates the device meets this requirement. The test report must meet the requirements of FDOT PCH, section 7.2.	Document Review
Indicate location of requested information in submittal.
8	SPD intended for installation where the supply circuit enters an equipment cabinet meets the requirements of UL 1449, Third Edition, and is listed by an NRTL.	Provide a first or third-party test report that demonstrates the device meets requirements of UL 1449, Third Edition. The test report must meet the requirements of FDOT PCH, section 7.2. Indicate listing (UL, ETL, etc.).	Document Review
Indicate location of requested information in submittal.
9	SPD has a visual indication system that monitors the weakest link in each mode and shows normal operation or failure status and also provides one set of normally open (NO)/normally closed (NC) Form C contacts for remote alarm monitoring.	Provide product literature, specifications, user manual,or similar information that indicates compliance. (Indicate specific configurations by model number or series).	Document Review and Physical Inspection
Indicate location of requested information in submittal.
10	SPD enclosure has a NEMA 4 rating.	Applicant may provide comments in this field.	Compliance Matrix Review
11	620-2.7.4	SPD is permanently marked with manufacturer name or trademark, part number, and date of manufacture or serial number.	Applicant may provide comments in this field.	Physical Inspection
12	All parts are made of corrosion-resistant materials, such as plastic, stainless steel, anodized aluminum, brass, or gold-plated metal.	Provide product literature, specifications, user manual, or similar information that indicates compliance. (Indicate specific configurations by model number or series).	Document Review and Physical Inspection
Indicate location of requested information in submittal.
12	620-2.7.5	SPD operates properly during and after being subjected to the temperature and humidity test described in NEMA TS 2, Section 2.2.7, and the vibration and shock tests described in NEMA TS 2, Sections 2.2.8., and 2.2.9.	Provide a first or third-party test report that demonstrates the device meets this requirement. The test report must meet the requirements of FDOT PCH, section 7.2.	Document Review
Indicate location of requested information in submittal.