Cs 4171-2026

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The document is a Certificate of Compliance form (CS-4171) used for shipping materials to construction projects, specifically for the Pennsylvania Department of Transportation (PennDOT). It outlines instructions for completing the form, including details about the manufacturer or producer, material specifications, and certification requirements. The form must be filled out by the party shipping approved materials and includes sections for listing the material's lot number, quantity, and description. It also emphasizes compliance with U.S. manufacturing standards and requires retention of records for inspection.

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Click ‘Get Form’ to open the cs 4171 document in the editor.
Begin by filling in the COUNTY, LR/SR, SEC/SEG, and ECMS# fields. This information should be completed by the party shipping the material; if not applicable, leave it blank.
In the NAME OF MANUFACTURER section, check all relevant boxes for operations performed (manufactured, fabricated, etc.) and provide the supplier code.
Complete the SHIPPED TO section with the name of the company receiving the material.
Fill in LOT NUMBER, QUANTITY, and DESCRIPTION OF MATERIAL as required for your shipment.
If applicable, check the block indicating if your product contains iron or steel.
Select your VENDOR CLASSIFICATION by checking only one box that applies to your status as a Manufacturer or Distributor.
Finally, complete the CERTIFICATION REQUIREMENTS section with your name, title, date, company name, and signature to validate compliance.

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