Manufacturer'S Certificates Of Compliance

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TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR
DATE
TRANSMITTAL NO.
MANUFACTURER'S CERTIFICATES OF COMPLIANCE
(Read instruction on the reverse side prior to initiating this form)
SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)
TO:
FROM:
CONTRACT NO.
CHECK ONE:
THIS IS A NEW TRANSMITTAL
THIS IS A RESUBMITTAL OF
TRANSMITTAL ___________
SPECIFICATION SEC. NO.
PROJECT TITLE AND LOCATION
(Cover only one section
with each transmital)
NO. OF
ITEM
DESCRIPTION OF ITEM SUBMITTED
MFG OR CONTR.
CONTRACT REFERENCE
FOR
VARIATION
FOR
COPIES
NO.
(Type size, model number/etc.)
CAT., CURVE
DOCUMENT
CONTRACTOR
(See
CE
instruction No.
DRAWING OR
USE CODE
USE
SPEC.
DRAWING
6)
BROCHURE NO.
CODE
PARA. NO.
SHEET NO.
(See instruction no. 8)
a.
b.
c.
d.
e.
f.
g.
h.
I.
REMARKS
I certify that the above submitted items have been reviewed in
detail and are correct and in strict conformance with the contract
drawings and specifications except as other wise stated.
NAME AND SIGNATURE OF CONTRACTOR
SECTION II - APPROVAL ACTION
ENCLOSURES RETURNED (List by Item No.)
NAME, TITLE AND SIGNATURE OF APPROVING AUTHORITY
DATE
ENG FORM 4025, OCT 99
(ER 415-1-10)
EDITION OF AUG 89 IS OBSOLETE
SHEET _____ OF _____
(Proponent: CEMP-CE)

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