CERTIFICATE OF COMPLIANCE_N4215826QE075.pdf
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- N4215826QE075- ADAPTERS
- Solicitation number
- N4215826QE075
About this file
This is a Certificate of Compliance form used by Norfolk Naval Shipyard for federal contract compliance documentation. The form is associated with requisition number N4215826QE075 and serves as an attestation that materials furnished under a contract meet all specified requirements.
The certificate requires completion of material identification details including contract number, order number, 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, attesting that all items furnished are in full compliance with contract requirements. A second Quality Assurance Official must verify that inspection and test reports (when applicable) accurately represent the actual attributes of items furnished and confirm full compliance with all contract requirements. The form includes a checkbox option to indicate whether inspection and test reports are required or not applicable. Upon shipment, the completed certificate must be mailed to Norfolk Naval Shipyard, CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000, with one copy delivered with the material to expedite receipt and payment processing.
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Other files
| File | Type | Posted |
|---|---|---|
| Solicitation - N4215826QE075.pdf | ||
| Technical Capability Statement _N4215826QE075.pdf | ||
| Addendum TO 52.212-1.pdf | ||
| Continuation Sheet.pdf |
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Text version
CERTIFICATE OF COMPLIANCE
Requisition Number: N4215826QE075
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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