GENERAL CONFORMITY CERTIFICATE
Product Description (include fabric / material content):
Style Number:
Date of Manufacture:
Product Manufacturer and Location
Name:
Address:
Weight of Fabric:
Date Weighted:
Date of Testing :
Testing Facility:
Address:
Telephone:
Testing Records Maintained By:
Name of Individual:
Company:
Address:
Telephone:
Telephone:
Purchase Order Number:
The following safety rules enforceable by the U.S. Consumer Product Safety Commission are applicable to
the above-noted product (check all that apply):
Flammability for Textiles (16 CFR 1610)
check box if flammability test was performed
In compliance with Section 102 of the Consumer Product Safety Improvement Act (CPSIA), I
hereby certify that, pursuant to the attached test results, the above-noted product conforms to the
safety rule checked above.
Exempt from testing Flammability for Textiles (16 CFR 1610)
check box if flammability test is not required; above- noted product is exempt
Prop 65 (California Proposition)
check box if Prop 65 testing was performed undergoing appropriate tests listed in Vendor Handbook
In compliance with Proposition 65 requirements, I hereby certify that, pursuant to the attached test
results, the above-noted product conforms to the safety rule checked above.
Vendor Company Name: ____________________________________________________________
Date GCC was completed: __________________________________________________________
CHI 57,522,664v1