CERTIFICATE OF COMPLIANCE. LSTR.pdf
PDF 342 KB Posted
- Attached to
- NNSY - LS/TR DISPOSAL BOX
- Solicitation number
- N4215826QE030
About this file
This is a Certificate of Compliance form used for federal contract delivery and quality assurance purposes. The document is associated with Requisition Number N42158-6042ZN02 and Contract/Order Number N42158-26-Q-E030 issued by Norfolk Naval Shipyard. The form requires contractors to complete material identification information including item numbers, National/Local Stock Numbers (NSN/LSN), manufacturer's part numbers, serial numbers, drawing numbers, and manufacturer's lot/heat numbers as marked on materials.
The certificate contains two attestation sections requiring Quality Assurance Official signatures and dates. The first attests that all items furnished are in full compliance with contract requirements. The second addresses inspection and test reports, with a checkbox indicating that inspection and test reports are not applicable (N/A is marked) but must be provided if required to demonstrate actual item attributes and full compliance. The form must be completed and returned to Norfolk Naval Shipyard, Attention CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000, with one copy delivered alongside the material shipment to expedite receipt and payment processing.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CERTIFICATE OF COMPLIANCE
Requisition Number N42158-6042ZN02
MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)
CONTRACT NO. ORDER NO N42158-26-Q-E030
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
File details come from the government source that posted it. Updated .