CPSIA Certificate of Conformity Sample

							Certificate of Conformity Consumer Product Safety Improvement Act of 2008
Section 14(g) of the Consumer Product Safety Act, 15 U.S.C. § 2063(g) requires manufacturers, importers, and private labelers (foreign & domestic) to certify that all products manufactured on or after November 12, 2008, are compliant with all applicable standards, rules, and bans enforced by the CPSC. Compliance shall be evidence by a declaration or certificate of conformity. This certificate is not required to be signed; issuance of the certificate satisfies the requirements of the Consumer Product Safety Act. This certification MUST be provided in English and based on a test of each product or a reasonable testing program. Item 1: Identification of the product covered by this certificate. Product Description TravelSmith Item No. Vendor Item No. Container No. TravelSmith Purchase Order Item 2: Citation to each CPSC product safety regulation to which this product is being certified. PLEASE PLACE AN “X” IN THE APPROPRIATE BOX and Include the SPECIFIC section(s) of the acts where compliance is being declared and note any claimed exemptions to the acts here as well Federal Hazardous Substances Consumer Product Safety Act Flammable Fabrics Act Act CPSA FHSA FFA Section(s) Section(s) Section(s) Children’s Gasoline Burn Prevention Poison Prevention Packaging Act Refrigerator Safety Act Act PPPA RSA CGBPA Section(s) Section(s) Section(s) Virginia Graham Baker Pool and Not subject to any CPSC Standards, Bans, Rules or Regulations Spa Safety Act VGBPSSA Section(s)

ATTENTION: IF THE ITEM IS SUBJECT TO ANY OF THE ABOVE LISTED ACTS, THE BELOW INFORMATION MUST BE COMPLETED
Item 3: Identification of the US importer or domestic manufacturer certifying compliance of the product: Name Full Mailing Address Phone # Item 4: Contact information for the individual maintaining records of test results: Name Full Mailing Address Phone # Email address Item 5: Date and place where this product was manufactured: Date(s) of Manufacture (MM/YYYY) Full Mailing Address including street, city, country Item 6: Date and place where this product was tested for compliance with the regulation(s) cited above. Date(s) of Testing (MM/YYYY) Testing Location including city, country or administrative region Item 9: Identification of any third-party laboratory on whose testing the certificate depends. Laboratory Name Laboratory Full Mailing Address Laboratory Phone #

Certificate of Conformity Consumer Product Safety Improvement Act of 2008
General Instructions for completing the Certificate of Conformity Item 1: Describe the product covered by this certification in enough detail to match the certificate to each product it covers and no others. Item 2: The certificate must identify separately each applicable rule, ban, standard or regulation under the Acts administered by the Commission that is applicable to the product. The section reference should be identified in the text field, as well as any “exemptions” to the regulation being claimed. Act Title Section References (for illustrative purposes only, may not be an exhaustive list) Consumer Product Safety 16CFR1201 – Architectural Glazing Materials Act (CPSA) 16CFR1202 – Matchbooks 16CFR1203 – Bicycle Helmets 16CFR1204 – Antennas 16CFR1205 – Lawnmowers 16CFR1207 – Swimming Pool Slides 16CFR1209 – Interim Standard for Cellulose Insulation 16CFR1210 – Cigarette Lighters 16CFR1211 – Garage Door Openers 16CFR1212 – Multi-purpose Lighters 16CFR1213 – Entrapment in Bunk Beds 16CFR1301 – Refuse Bins 16CFR1302 – Flammable Contact Adhesives 16CFR1303 – Lead-Containing Paint 16CFR1304 – Consumer Patching Compounds 16CFR1305 – Artificial Emberizing Materials 16CFR1306 – Lawn Darts 16CFR1401 – Self-Pressurized Consumer Products 16CFR1402 – CB Base Station/TV Antennas 16CFR1404 – Cellulose Insulation 16CFR1406 – Coal and Wood Burning Appliances Federal Hazardous 16CFR1500 – Hazardous Substances / Toys and Other Articles Intended for Use by Substances Act (FHSA) Children 16CFR1501 – Small Parts (Children <3 years) 16CFR1505 – Electrically Operated Toys and Other Electrically Operated Articles Intended for Use by Children 16CFR1507 – Fireworks Devices 16CFR1508/1509 – Baby Cribs 16CFR1510 – Rattles 16CFR1511 – Pacifiers 16CFR1512 – Bicycles 16CFR1513 – Bunk Beds Flammable Fabrics Act 16CFR1610 – Clothing Textiles / Wearing Apparel (FFA) 16CFR1611 – Vinyl Plastic Film 16CFR1615/1616 – Children’s Sleepwear 16CFR1630/1631 – Carpets and Rugs 16CFR1632 – Mattresses and Mattress Pads Poison Prevention 16CFR1700 Packaging Act (PPPA) Refrigerator Safety Act 16CFR1750 (RSA) Item 3: Provide the name, full mailing address, and telephone number of the domestic manufacturer or US importer of the product. Item 4: Provide the name, full mailing address, e-mail address and telephone number of the person maintaining test records in support of the certification. Item 5: Provide the date(s) when the product was manufactured by at least month and year. For the place of manufacture, if different from the manufacturer’s address in item 3, provide at least the city and country or administrative region, of the place where the product was finally manufactured or assembled. If the same manufacturer operates more than one location in the same city, provide the street address of the factory. Item 6: Provide the date(s) of the tests or test report(s) on which certification is being based and the location(s) of the testing. Item 7: If a third-party laboratory tested the product or conducted a testing program on which the certification is based, provide the name, full mailing address and telephone number of the laboratory.