John Deere Verification Warrant (Part Submission Warrant)
Part Number:
Decision No:
Revision Level:
Part Name / Description:
Product Application:
Originator:
Phone:
Email:
Supplier Name:
Supplier ID Code:
Supplier Contact:
Email:
Phone:
Reason For Submission:
*Attach documentation as needed
☐ Initial Submission
☐*Other – Please Specify:
☐ Correction of Discrepancy (Resubmission)
Submission Information:
(* Reference Table 1 in JDS-G223 Supplier Quality Manual)
☐ Design FMEA *4
☐ Process Flow Diagram *5
☐ Process FMEA *6
☐ Control Plan *7
☐ Gage R&R *8
☐ Initial Sample Inspection Report (ISIR) *9
☐ Material/Metallurgical Test Results *10
☐ Capability Study (Cpk) *11
☐ Appearance Approval Report *13
☐ Functional & Performance Test Results *16
☐ Sample Parts *17
☐ Master Sample *18
☐ Component Performance & Reliability Assurance
☐ JDM H31 Declaration
☐ Weight/piece:
Kg.
Special Notes:
Submission Results
These results meet all drawing and specification requirements: ☐Yes
☐ No (If No, explanation required)
All substances in product are within thresholds (limits) listed in the John Deere Restricted Material List? ☐ Yes ☐ No (If No, explanation required) :
I affirm that the samples, data and information represented by this submission are representative of our parts and have been made to the
applicable John Deere Drawings and specifications and are made from specified materials on regular production tooling at production rate
with no operations other that the regular production process. I have noted any deviations below:
Production material, tooling, and processes used? ☐ Yes
☐ No (If No, explanation required)
Name (printed):
Title:
Supplier Authorized Signature:
Phone:
Date:
FOR JOHN DEERE USE ONLY
☐ Approve
☐ Deviation / Follow-up
☐ Reject
(For Deviation / Follow-up only)
Conditions:
Signatures:
Quality Engineer:
Date:
Supply Management:
Date:
Design Engineer:
(for supplier initiated design changes only)
Date:
Materials Engineer:
(for supplier initiated material and/or special process changes)
Date:
Other:
Date:
SQM Verification Warrant Form 3 March 2016
Print Date: 03/22/16
This approval is advisory and does not change the Supplier's responsibility for ensuring that all characteristics meet their specifications. The Supplier is still responsible for the
changes. If the changes result in deficiencies not found in these approved items, the Supplier will reimburse Deere for the expenses needed to correct the deficiencies. This
reimbursement for deficiencies may be defined in Warrant Agreements or specific contracts.