10.0__Attachment_10_-_Example_of_a_Certificate_of_Demilitarization.docx
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Example of certificate of demilitarization doc.
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SP453017R000X
Guam HW Example of a Certificate of Demilitarization
DEMILITARIZATION CERTIFICATION AND VERIFICATION CERTIFICATE
For use of this form, see AR 700-144; the proponent agency is DCS, G-4
I, am an officer or employee of
(Name and Title of Prime of Subcontractor’s Representative)
(Name of Company)) responsible for ensuring demilitarization requirements have been accomplished. I certify that the items and quantities identified below were demilitarized in accordance with the Demilitarization Clauses provided in procurement contract number
| NSN or CAGE and P/N |
| ITEM NAME |
| QUANTITY |
When an NSN is not available, the commercial and government entity (CAGE) code and the item’s part number (P/N) will be used.
Note: Use as many lines as needed and number consecutive pages.
| NAME AND TITLE OF CONTRACTOR REPRESENTATIVE CERIFING THE DEMILITARIZATION |
| SIGNATURE OF CONTRACTOR REPRESENTATIVE |
| NAME AND TITLE OF CONTRACTOR REPRESENTATIVE VERIFING (witnessing) THE DEMILITARIZATION |
| SIGNATURE OF GOVERNMENT REPRESENTATIVE |
WARNING: SIGNING A FALSE DEMILITARIZATION CERTIFICATE CONSTITUTES A FELONY AND MAY SUBJECT THE INDIVIDUAL TO CRIMINAL PROSECUTION.
DA FORM 7579, JAN 2006
File details come from the government source that posted it. Updated .