Cs 4171-2026

The document is a Certificate of Compliance (CS-4171) used for certifying that materials shipped to a project meet specific requirements set by PennDOT. It includes sections for detailing the manufacturer, type of material, compliance with specifications, and vendor classification. The form must be completed by the shipping party and includes checks for steel content and supporting documentation requirements. It emphasizes the importance of maintaining records for inspection purposes.

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Click ‘Get Form’ to open the cs 4171 document in the editor.
Begin by filling in the project information, including County, LR/SR, SEC/SEG, and ECMS# if known. If not, leave these fields blank for the Project Contractor to complete.
In the section for Manufacturer, Fabricator, Coater, Precaster or Producer, check all applicable boxes (Manufactured, Fabricated, Coated, Precasted) and provide the name and supplier code.
List the specifications that confirm your material meets requirements under Publication 408. This is crucial for compliance.
Indicate where the material is being shipped by entering the company name in the designated field.
Fill in Lot Number and Quantity of materials being shipped along with a description as per PennDOT Bulletin #15.
If your product contains iron or steel, check the appropriate box and specify whether it is 100% US steel or contains minimal foreign steel.
Complete vendor classification by checking either block #1 or block #2 based on your status as a manufacturer or distributor.
Finally, enter your name, title, company name, sign and date the form. Ensure all required information is accurate before submission.

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