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3. Contract Number:


4. Contract Modification Number:

5. Approved Deviations and/or Concessions:
6. Purchaser:

7. Deliver Address:
8. Applicable to:

Partial Delivery Number:

Final Delivery Number:

8. Framework Agreement Item:
9. Product Description:
10. Quantity:
11. Shipment Document:
12. Undelivered Quantity:

13. Remarks or comments:

14. Contractor Statement of Conformity:

It is certified that apart from the approved deviation permits/concessions noted in block # 5 above,
the products listed above conform in all respects to the Framework Agreement requirements.

Date:
Contractor Name and Title:
Contractor Signature:









Certificate of Conformity - Part II
1. Contractor CoC Serial No.

2. Contractor:

3. Contract Number:
4. Contract Modification Number:

5. Remarks or Comments:

6. Government Quality Assurance Representative Statement of GQA: Referring to the CoC indicated in block 1, this is to attest that Government Quality Assurance has been performed, within the provisions of STANAG 4107, AQAP 2070 and in accordance with the agreed RGQA No. …………/Rev………….


(the GQAR Statement of GQA above and the GQAR signature below do not mean acceptance on behalf of the Purchaser and/or Delegator of the supplies identified by the Contractor in Part I, do not necessary mean that the individual items have been inspected, nor do they mean that certification have been granted).

Date:
GQAR / Purchaser Representative Information:

Name:


Phone Number:


Email Address:
GQAR / Purchaser Representative Signature:




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