General Certificate of Conformity - Kroger



The Kroger Co.

General Certificate of Conformity

Product Details Vendor Name:

|Product Description | | Item/Style No.: | |

|Manufacturer | |P.O. No | |

|Address | |SKU No. | |

| | |UPC No. | |

| | |Date of Manufacture | |

|Phone No | |Place of Manufacture | |

|Contact Person | |Bank Reference number | |

Testing Details

The above product was tested independently by a third party laboratory*, please indicate below.

*Children’s items must be tested by a CPSC Accepted Laboratory, using samples representative of production lot

|( |( Other : |

|Testing Laboratory Name and full address | |

| |*TESTING IS NOW A MANDATORY REQUIREMENT!* |

| |PLEASE INCLUDE TEST RESULTS WITH DOCUMENTS |

|Tel. number | |

|Test Report No. | |Test Report Date | |

|Test Sample selection |Date Sample Qty | Test samples are representative of |Yes No |

| | |production lot | |

Based upon a reasonable test program, this product complies with all Rules, Bans, Standards, or Regulations applicable to the product.

Standards and regulations applicable to Children’s product must also be submitted on the appropriate separate Children’s Product Certificate form as required by the CPSC for CPSIA. (List separately) all rules, bans and standards.

|( CPSIA 101 – Lead in substrate of children’s product |( CPSIA 106, ASTM F963-11-Toy Safety |( 16 CFR 1505 – Electrically operated toys & children’s|

| |Specification |article |

|( CPSIA 101.314, 16 CFR 1303 – Lead in paint & surface |( 16 CFR 1500.19 – CPSA Labeling (Small Parts) |( CA Proposition 65, Lead & Phthalate limitations |

|coatings | | |

|( 16 CFR 1500.18(a) (17) – Balls |( 16 CFR 1500.44 – Flammability |( CPSC Guidance – Lead in art materials |

|( CPSIA 108 – Phthalates in Children’s products |( 16 CFR 1500.48 & 49 – Sharp edges and points |( 16 CFR 1610 = Flammability on clothing textiles |

|( 16 CFR 1500.14(b) (8) – Art Materials |( 16 CFR 1501 – small parts |( 16 CFR 1500.14 – Lhama |

|( 16 CFR 1210 - Multipurpose Lighters |( CPSA 1202 - Matchbooks |( 16 CFR 1203 - Bicycle Helmets |

|( 16 CFR 1204 - CB Antennas |( 16 CFR 1205 - Power Mowers |( CPSA 1207 - Swimming Pool Slides |

|( 16 CFR 1209 - Cellulose Insulation |( 16 CFR 1210 - Cigarette Lighters |( 16 CFR 1211 - Garage Door Openers |

|( CPSA1201 - Architectural Glazing Materials |( CPSA 1213, FHSA 1500.18 (A)(18) - Bunk |( CPSC 1240 (2); ASTM F963-11; Magnet Sets |

| |Beds; Furniture | |

|( FFA 1611 - Vinyl Plastic Film |( CPSA 1305 - Artificial Emberizing Materials |( CPSA 1304 - Consumer Patching Compound |

|( CPSA 1306, FHSA 1500. 18(a)(4) - Lawn Darts |( CPSA 1420; 15 U.S.C. - ATV’s |( CPSA1450; ANSI/APSP-16 Pool & Spa |

| |(All-Terrain Vehicle) |drain Covers |

|( FHSA 1500.12(a)(29); 1500.17 (a)(13) - Metal Candle |( 16 CFR 1507 and CFR 1500 and Fireworks |( CPSC 1240 (2); ASTM F963-11; Magnet Sets |

|Wicks | | |

|( FHSA 1500.83(a)(14); P.L. 110-278; ASTM F2517-05 - |( P.L. 112-266; ASTM C1396-14a - Drywall |( CPSC 1750 - Refrigerator Doors |

|Portable Gas Containers | | |

|( Small Batch Manufacturer -2012 |( Another Party’s finished product |( UL 859 and 1727 – Hand Supported Hair Dryers |

|CPSC Registration number |testing/certification (not applicable to | |

|_____________________ |children’s products ) | |

|( UL 588 – Seasonal and Decorative Lighting |( Flammability of Carpets & Rugs 16 CFR 1630 |( Component Part Testing/Certification-2012 |

| |and 1631 | |

|( WA 70.240 RCW Children’s safe products |( Flammability of Mattresses and Mattress |( 16 CFR Part 1512; FHSA 1500. 18(a)(12) Requirements |

| |Pads 16 CFR 1632 & 1633 |for Bicycles |

|( PPPA 1700 - Special Packaging |( UL 817 – Extension Cords |( Inaccessible Component Parts -2012 |

|( CPSIA 103, Tracking labels |( CPSA 1301 - Refuse Bins |( Other |

|( Other |( Other |( Other |

| |

Kroger Requirements

**Include all UL or ETL standards not listed above

|( UL # _____________________ |( ETL # _____________________ |

|( UL # _____________________ |( ETL # _____________________ |

|( UL # _____________________ |( ETL # _____________________ |

|( UL # _____________________ |( ETL # _____________________ |

|( UL # _____________________ |( ETL # _____________________ |

|( Other |( Other |

Importer Details

Importer Fred Meyer, Inc. dba Kroger Private Label

Address 3800 SE 22nd Ave. Address Same

Portland, OR 97202

USA

Contact Tel. 503-797-3323

Contact Person Megan Liu, MS 23C

Email: megan.liu@

This Certificate was completed by

_________________________________

Signed by with company chop

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