Attachment (1) - Certificate of Compliance.pdf
PDF 436 KB Posted
- Attached to
- ADAPTER
- Solicitation number
- N4215826QE033
About this file
This is a Certificate of Compliance form used by the federal government, specifically for the Department of the Navy. The form corresponds to Requisition Number N42158-5296-7366 and Contract/Order Number N42158-Q-E-033. The certificate requires completion of material identification information including item number, National/Local Stock Number (NSN/LSN), manufacturer's part number, manufacturer's serial number, drawing and piece number, and manufacturer's lot/heat numbers as marked on the material.
The form contains two attestation sections completed by Quality Assurance Officials. The first section certifies that all items furnished on the contract are in full compliance with all contract requirements, requiring signature and date. The second section certifies that inspection and test reports provided represent the actual attributes of items furnished and indicate full compliance with contract requirements, with a checkbox indicating whether inspection and test reports are required or not applicable. The completed form must be mailed to Norfolk Naval Shipyard, Code 2305.6 Expediting Section, Building 297, Portsmouth, Virginia 23709-5000, with one copy delivered with the material shipment to expedite receipt and payment.
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Other files
| File | Type | Posted |
|---|---|---|
| RFQ - N4215826QE033.pdf | ||
| Attachment (2) - Technical Capability Statement.pdf |
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Text version
CERTIFICATE OF COMPLIANCE
Requisition Number N42158-5296-7366
MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)
CONTRACT NO. ORDER NO N42158-Q-E-033
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
ENCLOSURE (1
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