ATTACH 1_COC - Certificate of Compliance.doc

“SAMPLE”

CERTIFICATE OF COMPLIANCE

SOLICITATION N4215822QE001

MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)

CONTRACT NO.

ORDER NO ___________

ITEM NO. _______________________

NATIONAL/LOCAL STOCK NUMBER NSN/LSN ________________________

MANUFACTURER’S PART NO. ____________________________

MANUFACTURER’S SERIAL NO. __________________________

DRAWING AND PIECE NO. ______________________________

MANUFACTURER’S LOT/HEAT NOS. AS MARKED ON THE MATERIAL:

I ATTEST all items furnished on this contract are in full compliance with all contract requirements.

SIGNATURE _________________________________ DATE _______

QUALITY ASSURANCE OFFICIAL

TITLE _________________________________

The inspection and test reports (as applicable) provided represent the actual attributes of the items furnished on this contract and indicate full compliance with all contract requirements.

REQ’D

N/A

[ X ]

SIGNATURE _________________________________ DATE _________

QUALITY ASSURANCE OFFICIAL

TITLE ________________________________

“NOTE”: WHEN ITEM(S) HAVE BEEN SHIPPED, PLEASE COMPLETE CERTIFICATION(S) AND RETURN. THIS WILL EXPEDITE RECEIPT AND PAYMENT.

MAIL TO:

NORFOLK NAVAL SHIPYARD

ATTN: CODE 2305.6, EXPEDITING SECTION

BLDG. 297

PORTSMOUTH, VA 23709-5000

DELIVER ONE (1) COPY WITH MATERIAL

ATTACHMENT (1)