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Click ‘Get Form’ to open the CS 4171 Certificate of Compliance in our 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 the appropriate box indicating whether the material was manufactured, fabricated, coated, precasted, or produced. Enter the supplier code and name of the manufacturer.
Complete the SHIPPED TO section with the name of the company receiving the material. Then provide details for LOT NUMBER, QUANTITY, and DESCRIPTION OF MATERIAL.
If your product contains iron or steel, check the corresponding box. Next, select your VENDOR CLASSIFICATION by checking either block #1 or #2 based on your status.
Finally, fill in your NAME, TITLE, COMPANY NAME, and SIGNATURE in the CERTIFICATION REQUIREMENTS section. Ensure all information is accurate before saving.

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