manufacturing location notification

Document Name:	NIJ CTP Manufacturing Location	Approval Date:	dd mmm yyyy
Revision:	20 Jun 2012	Implementation Date:	dd mmm yyyy
OMB Number:	1121-0321	Expires:	dd mmm yyyy

National Institute of Justice Compliance Testing Program
Manufacturing Location Notification

In accordance with the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number. The OMB number for this collection is 1121-0321. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information.

This information is being requested pursuant to 6 U.S.C. 162(b)(4) and 6 U.S.C. 162(b)(6)(B). The disclosure is voluntary. The information provided on this form will be used by the National Institute of Justice to administer a product conformity assessment program for products used by law enforcement and correctional officers. This information and the associated products are voluntarily submitted under the Compliance Testing Program.

PRIVACY ACT NOTICE: The information provided in this document is not considered Confidential Commercial Information and may be released without limitations or restrictions.

This National Institute of Justice Compliance Testing Program Authorized Representatives Notification pertains to all applicants seeking to voluntarily participate in the National Institute of Justice Compliance Testing Program (hereafter, the NIJ CTP). Any reference to the NIJ CTP as an organization includes elements of both National Institute of Justice (NIJ) and the National Law Enforcement and Corrections Technology Center-National (NLECTC-National).

Model Designation:

Date of Notification:

Please provide business headquarters information below.

Applicant Name:

Applicant Address:

Telephone:

Model Designation:

The Applicant hereby expressly acknowledges and agrees as follows:

1. General

The body armor model identified on the previous page shall be manufactured only at the locations identified here. All of these locations use the same quality management system and report to a single corporate management system.

Any additions to (New) manufacturing locations shall be communicated to the NIJ CTP prior to implementation.

Any other changes to (Withdrawn) manufacturing locations shall be communicated to the NIJ CTP as soon as possible.

Failure of the applicant to provide current and accurate information concerning manufacturing locations could result in unnecessary costs to the applicant in the form of unnecessary surveillance (Follow-up Inspection and Testing, or FIT) charges.

The point of contact (and alternate) for each location should be available on site and prepared to escort the inspection representative.

2. Access to Manufacturing Locations for Surveillance Activities (Follow-up Inspection and Testing)

The Applicant expressly acknowledges and agrees that full, safe and secure access shall be provided to NIJ CTP staff, representatives, their agents or designees, either announced or unannounced, for all manufacturing facilities and/or storage facilities, records and personnel used in the manufacture of models of equipment identified in this document. This includes the selection and removal of production samples from manufacturing facilities at the Applicant’s expense for the purposes of surveillance (FIT).

Applicant is free to verify NIJ CTP staff, representatives, their agents or designees meet any U.S. Persons requirements (citizenship, Green Card Status) applied to its own employees prior to their entry. It is the applicant’s responsibility to communicate the manufacturing locations requirements to the NIJ CTP prior to the first inspection in order to avoid unnecessary costs to the applicant in the form of an incomplete or canceled inspection

3. Subcontracting

The Applicant agrees that the NIJ CTP may subcontract surveillance activities to third parties. The Applicant authorizes the NIJ CTP to disclose to the subcontractor any information necessary for such performance of the inspection by the subcontractor. The NIJ CTP shall provide as a term of any such subcontract that the subcontractor shall meet the NIJ CTP's current qualification requirements for accreditation, conflicts of interest and ethical standards.

The relationship between an NIJ CTP designated subcontractor and the Applicant may be governed by a separate agreement. Failure to execute an agreement required by an NIJ CTP-designated subcontractor shall be viewed as a failure of the Applicant to satisfactorily participate in the NIJ CTP and could result in the removal of the Applicant from the program.

It is the applicant’s responsibility to ensure that any direct interaction with subcontractors is addressed with acceptable agreements.Model Designation:

Manufacturing Location # 1:

Address:

Point of Contact: Alternate Point of Contact:

Name

Title

Phone

E-mail

□ Current □ New (Beginning) □ Withdrawn (Last)

Beginning/Last Date:

Beginning/Last Serial Number:

Beginning/Last Lot Number:

Manufacturing Location # 2:

Address:

Point of Contact: Alternate Point of Contact:

Name

Title

Phone

E-mail

□ Current □ New (Beginning) □ Withdrawn (Last)

Beginning/Last Date:

Beginning/Last Serial Number:

Beginning/Last Lot Number:

Model Designation:

Applicant Signatory

(an officer or representative of the Applicant who has the authority to bind it)

(Name/Title):

Telephone Number:

E-mail:

□ additional pages have been attached (each page initialed and dated) to indicate additional manufacturing locations.

The Applicant agrees to the terms of this agreement and warrants that it has made no alterations to its text. The undersigned represents and warrants that he/she is authorized to execute this agreement on behalf of the Applicant.

Applicant Signatory Date

NLECTC-National Representative Acknowledgement:

Signature Date

Name (Please print/type)

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