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Metric Importers of North America (MINA)


MINA designed; NIST approved format for section 280.5 (c) MANUFACTURERS CERTIFICATE OF CONFORMANCE.
English Language Version


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CERTIFICATE OF CONFORMANCE
MANUFACTURERS CERTIFICATE OF CONFORMANCE
Per Section 280.5 (c) Fastener Quality Act

Manufacturer:

Address:

Customer:

Address:
Product Description: Purchase Order Number:
Product Standard:

Date of Manufacture:

Nominal Dimensions:

Finish:

Material Grade and Standard: Head Marking:
Mfg. Lot No.:
Mark the appropriate box for either Part 1 or Part 2 of this certificate.

Part 1
 We certify that the above listed fasteners have been manufactured according to the requirements of the applicable standards and specifications and found to conform with its requirements and; have been inspected and tested by a laboratory accredited in accordance with the Fastener Quality Act.

This lot or portion is accompanied by a laboratory test report with a serial number of:

Date of Issue:

Mfg.'s Authorized Signature:

Title:

Date:

 

Part 2.
 We certify that the above listed fasteners have been manufactured according to the requirements of the applicable standards and specifications and; have NOT yet been inspected and tested by a laboratory accredited in accordance with the Fastener Quality Act.

Mfg.'s Authorized Signature:

Title:

Date:

 

The importer hereby assumes responsibility for the inspection and testing of the above listed lot or portion to be conducted by a laboratory accredited in accordance with the Fastener Quality Act.

Importing Company Signature:

Title:

Date:
filename: conforme.doc rev 3 5/31/98 MINA

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