Form Dr 0231 - Tobacco Product Manufacturer Certification (Page 5 of 10) in pdf

Form Dr 0231 - Tobacco Product Manufacturer Certification Page 5

Checklist For Completing Certificate Of Compliance Form

Pursuant to C.R.S. § 39-28-305(4), the Attorney General may require a tobacco product manufacturer to submit any

additional information necessary to enable the attorney general to determine whether a manufacturer is in compliance

with § § 39-28-201 to 39-28-307. All packing samples, FTC health warning rotations, CDC compliance letters, and

Jenkins Act reports should be mailed to the Office of the Attorney General only.

A. Check List for Participating Tobacco Product Manufacturers

Parts 1,2,3 and 6 must be completed in their entirety;

Brand families have been listed and “Cigarettes” or “RYO” is indicated;

Brands that are not being sold in the current year have been marked with an asterisk (*);

FTC Cigarette Health-Warning Rotation Plans, CDC Ingredient Approval letters, packaging samples on CD and

PACT Act information, are attached

Certificate of Compliance is signed by an authorized officer of the tobacco product manufacturer; and

Certificate of Compliance is notarized.

B. Check List for Non-Participating Manufacturers

All parts of Certificate of Compliance are completed;

Brand families have been listed and “Cigarettes” or “RYO” is indicated;

Brands that are not being sold in the current year have been marked with an asterisk (*);

FTC Cigarette Health-Warning Rotation Plans, CDC Ingredient Approval letter, packaging samples on CD and

PACT Act information are attached;

If registered agent has been appointed, letter from agent accepting appointment is attached;

Current escrow agreement and any attachments and amendments are attached;

Certificate of Compliance is signed by an authorized officer of the non-participating manufacturer; and

Certificate of Compliance is notarized.

Note: The state of Colorado will not process incomplete or illegible certifications.

Attach additional sheets as necessary to provide a complete response.

Form Dr 0231 - Tobacco Product Manufacturer Certification Page 5