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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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