Certificate of Compliance.pdf

This is a Certificate of Compliance form used for federal contract deliverables, specifically requisition N42158-6216ZN02. The form serves as a quality assurance certification document that contractors must complete and submit to verify that delivered materials fully comply with all contract requirements.

The form requires contractors to complete material identification fields 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 the certificate: one attesting that all items furnished are in full compliance with contract requirements, and another certifying that inspection and test reports represent the actual attributes of items furnished and indicate full compliance. The form indicates that inspection and test reports are not applicable (marked N/A). Upon shipment of items, contractors must complete the certification and return it to Norfolk Naval Shipyard, Code 2305.6, Expediting Section, Building 297, Portsmouth, VA 23709-5000. One copy of the completed certificate must be delivered with the material. The form notes that prompt return of completed certifications will expedite receipt and payment of invoices.