Certificate of Conformance (Category A)



C of C & Certified Listing (Mechanical Assemblies, FAI Req’d.)

*The following is to be filled in by the part manufacturer’s or distributor’s authorized representative

Serialized assembly data. All items are required. A separate Certified Listing is Req’d. for each Serialized Assy.

LMC Purchase Order Number: _________________________________________

Assembly P.O. Part Number: __________________________________________

Assembly Nomenclature: _____________________________________________

Assembly Serial Number:_____________________________________________

Use the following table or attach a listing documenting this information for all piece parts.

Cage

Part Number Manufacturer Code Production Lot Qty

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

_______________ _______________ _______ ____________ ____

( Certificate of Compliance: Attach a certificate of compliance for all materials, finishes, coatings, surface treatments and special processes as defined by the engineering dwg’s & subtier dwg’s as applicable.

The undersigned states that “The articles furnished to Lockheed Martin are in conformance with the purchase order requirements, engineering drawings and specifications”.

The following is to be filled in by the part manufacturer’s or distributor’s authorized representative.

Supplier Name: _______________________________________________________________________

Cage Code: __________________________________________________________________________

Supplier Address: _____________________________________________________________________

Name (Print):_____________________________________________________

Title:____________________________________________________________

Signature:________________________________________ Date____________

Rev. 4 - Cat. D

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