CERTIFICATE OF COMPLIANCE_N4215826QE076.pdf
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This is a Certificate of Compliance form used by Norfolk Naval Shipyard to verify that materials furnished under federal contracts meet all contractual requirements. The document is associated with Requisition Number N42158-61746007 and serves as a quality assurance certification mechanism for contract deliverables.
The form requires completion of material identification information including contract number, order number, item number, National/Local Stock Number (NSN/LSN), manufacturer's part number, serial number, drawing reference, and manufacturer's lot/heat numbers. Two Quality Assurance Officials must certify compliance: the first attests that all items furnished are in full compliance with contract requirements, and the second confirms that inspection and test reports accurately represent the actual attributes of items furnished and indicate full compliance. The form indicates that inspection and test reports are not required (marked N/A with an X). Upon shipment, one completed copy must be delivered with the material and a second copy mailed to Norfolk Naval Shipyard, CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000. Timely completion and return of this certification expedites receipt and payment processing.
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Text version
CERTIFICATE OF COMPLIANCE
Requisition Number: N42158-61746007
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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