N390406156V628 Attachment 1 to Exhibit A _ HOSE ASSEMBLIES.pdf
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- Attached to
- VARIOUS HOSE ASSEMBLIES PNSY
- Solicitation number
- N39040Q6156V628
About this file
This document is a Certificate of Compliance Template required as Attachment 1 to Exhibit A (DD Form 1423) for hose assemblies contracts. It is a vendor submission form that must accompany each shipment.
The template requires vendors to complete and provide the following information: company name, contract number, order number, item number(s), and material identification details (lot, batch, part number, or serial number). The vendor's Quality Assurance Official must sign and date the certificate, attesting that all inspections and test reports required by Exhibit A have been completed and are included with the shipment. The Statement of Compliance section confirms that the inspection and test reports provided represent the actual attributes of furnished items and demonstrate full compliance with all contract requirements. This document serves as traceability documentation ensuring that delivered hose assemblies meet all specified contract and technical requirements.
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Text version
TECHNICAL SPECIFICATION: HOSE ASSEMBLIES
Certificate of Compliance Template
(Attachment 1 to Exhibit A, DD FORM 1423)
The vendor shall complete and submit the following certificate with each shipment:
COMPANY NAME __________________________________________________
CONTRACT NO. __________________________________________________
ORDER NO. __________________________________________________
ITEM NO(S). __________________________________________________
MATERIAL IDENTIFICATION
(Lot / Batch / Part No./ Ser. No.)
STATEMENT OF COMPLIANCE:
All inspections and test reports required by Exhibit A (DD Form 1423) for traceability to each contract item must accompany this signed statement. 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. I attest all items furnished on this contract are in full compliance with all contract requirements.
SIGNATURE:
DATE:
QUALITY ASSURANCE OFFICIAL (PRINT):
File details come from the government source that posted it. Updated .