CERTIFICATE OF COMPLIANCE.pdf
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- Attached to
- Microbulk Tanks
- Solicitation number
- N4215826QE054
About this file
This is a Certificate of Compliance form for Solicitation #N4215826QE054 issued by Norfolk Naval Shipyard. The form is a template used by vendors to attest that materials furnished under the contract comply with all contractual requirements. Vendors must complete material identification sections 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 as applicable.
The form requires two separate certifications, both signed by Quality Assurance Officials with dates. The first certification attests that all items furnished are in full compliance with contract requirements. The second certification confirms that inspection and test reports provided represent the actual attributes of furnished items and indicate full compliance, with a checkbox indicating this second certification is marked as "N/A" (Not Applicable). Vendors must deliver one copy of the completed certification with the shipped material and mail the original to Norfolk Naval Shipyard, CODE 2305.6 Expediting Section, Building 297, Portsmouth, VA 23709-5000. The form notes that prompt return of completed certifications expedites receipt and payment.
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Text version
CERTIFICATE OF COMPLIANCE
SOLICITATION # N4215826QE054
VENDOR NAME
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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