16Q0001_Section_J_Attachments_(Sample_of_Certificate_of_Conformance).pdf

Uniformed Services University (USU) Certification of Conformance to Manufacturer’s Specifications and Operability

HU0001-16-Q-0001

[Insert Contractor Name] certifies that all services, including preventive maintenance, on the following instrument have been completed in accordance with the original equipment manufacturer’s, [Insert OEM Name], specifications and is operating at 100% the OEM specifications:

Contract/Agreement Number: ____________________________________________________________ Period of Performance: __________________________________________________________________ Instrument Maker and Model: ____________________________________________________________ Instrument Serial Number: _______________________________________________________________ Instrument Location (USU Room Number): __________________________________________________ Name(s) of Independent Service Provider(s): _________________________________________________

All underlined fields to be completed by the contractor.

[Signature of Offeror]

[Name and Title of Signer (Type or Print)]

[Date Signed]