Compliance Statement Energy/Water Conservation Standards for Appliances

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Product Type:

Showerheads

Version 3.0

Overall Status

No Data

Manufacturer:

Type manufacturer name in the box above
If Applicable: Third Party Representative
If applicable, enter the name of the third party representative in the box above
Compliance Statement - (Appendix A to Subpart F of 10 CFR Part 430)
This compliance statement and all certification reports submitted are in accordance with 10 CFR Part 430 (Energy or Water Conservation Program for Consumer Products) and
the Energy Policy and Conservation Act, as amended. The compliance statement is signed by a responsible official of the above named company. The basic model(s) listed in
certification reports comply with the applicable energy conservation standard or water (in the case of faucets, showerheads, water closets, and urinals) conservation standard. All
testing on which the certification reports are based was conducted in conformance with applicable test requirements prescribed in 10 CFR Part 430 subpart B. All information
reported in the certification report(s) is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act, the regulations thereunder, and
is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.

ŽType your full name in the box to signify compliance
 Enter your email address

Must enter name
Must enter email address

Certification Report

· Please enter your data in the columns shaded in gray below, using a separate line for each model.
· Click on the column heading or any cell for instructions on how to complete that cell.
· Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue with the entry.
· If the "Status" for a row is "Error," you can see an
explanation in the columns to the right of the Status column.
· Reports submitted with errors cannot be processed and will be returned for resubmission.
· To review the effective dates of current standards for consumer products and certain commercial and industrial equipment
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Instructions for CCMS Reporting Templates

Use your mouse, the "Tab" key and arrows on your keyboard to navigate through the fillable fields in the template. If all fields have been completed correctly the "Overall Status" indicator
on the top right corner of the template will show "ok." If this indicator reads "Error," look for incomplete/incorrect field entry explanations by comparing the mirrored cells on the right of your
template screen with your report entries. Call 505-663-1302 ext 101 for additional assistance.

Step 1

Œ

Enter the manufacturer's name

Type manufacturer name in the box above

Step 2

Enter the full name of the third party representative if "applicable" in the cell above "If applicable, enter the name of the third party representative in the box above"

If Applicable: Third Party Representative
If applicable, enter the name of the third party representative in the box above


Step 3

Enter your full name in the cell above "Must enter name." Be certain that your are aware of the provisions contained in 18 U.S.C. 1001 before entering your name.

Type your full name in the box to signify compliance

Ž

Must enter name

Awareness Statement

Step 4



Enter your email address

Step 5



Enter your contact email address to the left of "Must enter email address."

Must enter email address

Starting on line No. 1, begin entering applicable data in each field. When you have chosen a field, an instruction box will display. Each template has
different product type standards. Although all product template instructions are similar, your product template may display different data entry
fields from the examples below. If the status at the end of the line reads "Error," review your data to verify entries and check the explanation table to
the right of the data entry table for an error description. Lines with an "ok" status have been completed correctly.

z

Step 6

Save the template to a local drive for safekeeping. You will upload this template later to DOE via the CCMS application.