F-76_Traceability_Signature_Page.docx

F-76 Traceability Signature Page Contract or Solicitation Number:

CLIN:

Order Number:

Shipment Number:

F-76 fuel supplied under the above contract, CLIN, order number and shipment number maintains traceability with respect the materials composition, additives and their concentration levels. This signed statement certifies that at no point have any unauthorized un-hydrotreated light cycle oils, other unauthorized materials, or additives been blended into the final product or any of its associated blend components per the most recent revision of MIL-DTL-16884 at date of contract award. All materials and additives are listed below. The percentage of each material as defined in section 3.2 and 3.2.1 (i.e. refined hydrocarbon distillate fuel, Fischer- Tropsch, Hydroprocessed Renewable Diesel, etc.) and the concentration level for each additive are also shown. For the purposes of the offeror submission this signed statement attests that no unapproved additives or materials will be added to batches or components of batches of F-76 for delivery under government contracts.

Signature:

Printed Name:

Title:

Company Name:

Date: