Sample Certificate of Compliance COMPANY LETTERHEAD

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Sample Certificate of Compliance COMPANY LETTERHEAD Powered By Docstoc
					Sample Certificate of Compliance
COMPANY LETTERHEAD
_______________________________________________________________

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.

Material Description:

Manufacturer: ____________________________ Model: _________________________________ Serial Number (if applicable): ________________________ Quantity to be supplied: ____________________________ Remarks: ______________________________________________________

Signed by: __________________________ Printed Name: ________________________ Title: ______________________________ Company: __________________________ Date: ______________________________