Certificate of Compliance.pdf
PDF 357 KB Posted
- Attached to
- NNSY BlueLevel, BlueMeter& Case
- Solicitation number
- N4215826QE064
About this file
This document is a Certificate of Compliance form used for federal contract deliveries to Norfolk Naval Shipyard. The form is associated with Requisition Number N42158-6119ZN01-ZN03 and serves as a quality assurance certification mechanism for materials furnished under naval contracts.
The certificate requires completion of material identification sections including contract number, order number, 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. Two quality assurance officials must sign attestations: the first certifying that all items furnished are in full compliance with all contract requirements, and the second confirming that inspection and test reports represent the actual attributes of items furnished and indicate full compliance. The second certification section is marked as not applicable (N/A) on this template. The completed form must be delivered with the material shipment and mailed to Norfolk Naval Shipyard, CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000. The instructions note that prompt completion and return of certifications will expedite receipt and payment of deliveries.
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Other files
| File | Type | Posted |
|---|---|---|
| Solicitation - N4215826QE064.pdf | ||
| Technical Capabilities Statement.pdf | ||
| 52.212-1 Addendum.pdf |
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Text version
CERTIFICATE OF COMPLIANCE
Requisition Number N42158-6119ZN01-ZN03
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
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