CERTIFICATE OF COMPLIANCE. RSMA.pdf
PDF 342 KB Posted
- Attached to
- NNSY - RSMA DISPOSAL BOX
- Solicitation number
- N4215826QE029
About this file
This is a Certificate of Compliance form required for federal contract deliverables under Order No. N42158-26-Q-E029 at Norfolk Naval Shipyard. The form serves as a quality assurance documentation template for contractors to attest that all items furnished comply with contract requirements.
The certificate requires contractors to complete material identification information including item number, National/Local Stock Number (NSN/LSN), manufacturer's part number, serial number, drawing and piece number, and manufacturer's lot/heat numbers. A Quality Assurance Official must sign and date the form, certifying that all items furnished are in full compliance with all contract requirements. Additionally, the form requires attestation that inspection and test reports (if applicable) represent the actual attributes of furnished items and indicate full compliance. The form indicates that inspection and test reports are marked as "Not Applicable" (N/A). Contractors must deliver one copy of the completed certification with the material shipment and mail the original to Norfolk Naval Shipyard, CODE 2305.6, Expediting Section, Building 297, Portsmouth, VA 23709-5000. The form emphasizes that prompt completion and return of certification will expedite receipt and payment processing.
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Text version
CERTIFICATE OF COMPLIANCE
Requisition Number N42158-6042ZN01
MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)
CONTRACT NO. ORDER NO N42158-26-Q-E029
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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