Certificate of Compliance.pdf
PDF 356 KB Posted
- Attached to
- NNSY Microbulk Tank
- Solicitation number
- N4215826QE059
About this file
This is a Certificate of Compliance form used by the Norfolk Naval Shipyard to verify that materials furnished under a federal contract meet all specified requirements. The form is associated with Requisition Number N42158-6092-ZN01 and serves as documentation for contract performance and payment processing.
The form requires contractors to complete material identification information, including contract number, order number, item number, National/Local Stock Number (NSN/LSN), manufacturer's part number, serial number, drawing reference, and lot/heat numbers. Two Quality Assurance Officials must attest to compliance: the first certifies that all items furnished are in full compliance with all contract requirements, and the second confirms that inspection and test reports accurately represent the actual attributes of the items and indicate full compliance. The form notes that inspection and test reports are not required (N/A checkbox is marked). Upon shipment, contractors must complete and return the certification to expedite receipt and payment. One copy must be delivered with the material shipment to Norfolk Naval Shipyard, CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000.
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 N42158-6092-ZN01
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
ENCLOSURE (1
File details come from the government source that posted it. Updated .