Sample Certificate of Compliance
CERTIFICATE OF COMPLIANCE For Contract ___________________ I certify that the material listed below complies with the material and workmanship requirements of the Caltrans Contract Plans, Special Provisions, Standard Specifications and Standard Plans for the contract listed above. I also certify that I am an official representative for __________________, the manufacturer of the material listed below. Furthermore, I certify that where California Test methods, physical, or chemical test requirements are part of the specifications, that the manufacturer has performed the necessary quality control to substantiate this certification.
Manufacturer: ____________________________ Model: _________________________________ Serial Number (if applicable): ________________________ Quantity to be supplied: ____________________________ Remarks: ______________________________________________________
Signed by: __________________________ Printed Name: ________________________ Title: ______________________________ Company: __________________________ Date: ______________________________