CERTIFICATE OF COMPLIANCE. RSMA.pdf

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Attached to
NNSY - RSMA DISPOSAL BOX
Solicitation number
N4215826QE029
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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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