CPSIA Certificate of Conformity-Sample - Download as DOC

							                                        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
IMPROVEMENTS Item No.
         Vendor Item No.
            Container No.
          IMPROVEMENTS
          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.