Form EAC Form 001-VSTL EAC Form 001-VSTL Certification of Laboratory Conditions and Practices

CERTIFICATION OF LABORATORY CONDITIONS
AND PRACTICES

I, the undersigned, having investigated or caused to be investigated each matter,
below; certify, affirm and acknowledge that each of the following numbered
statements are true and otherwise accurately reflect the status, condition and
operations of ___________________________ (hereinafter “Laboratory”).
I
understand that by certifying the information below, I am making a statement or
representation to the U.S. Election Assistance Commission required for receiving a
Laboratory Accreditation under 42 U.S.C. §15371(b). I further understand, that to the
extent any of the below representations or certifications are found to be materially
false, the U.S. Election Assistance Commission may revoke any Accreditations
granted to the above named laboratory and that I may be subject to criminal
prosecution under 18 U.S.C. §1001.
1. Signing Official. I hereby certify that I am an officer, partner or other official
vested with the legal authority to speak for, contract on behalf of or otherwise
bind the above noted company, corporation, partnership or organization
(Laboratory).
2. Personnel. I certify, consistent with Section 2.6. of the EAC Voting System Test
Laboratory Accreditation Program Manual (hereinafter Laboratory Manual), that
the laboratory has written policies in place to ensure that it does not currently, and
will not in the future, employ any individuals in any capacity related to the testing
of voting systems who have been convicted of a felony offense or any criminal
offense involving fraud, misrepresentation, or deception under either Federal or
state law.
3. Conflicts of Interest and Prohibited Practices. I certify, consistent with
Section 2.5. of the Laboratory Manual, that the Laboratory maintains and enforces
written policies which:
a.

Prohibit conflicts of interest or the appearance of conflicts of interest
pursuant to Section 2.5.1. of the Laboratory Manual.

b. Prohibit practices such as participation in both the development and
testing of a voting system or the solicitation or acceptance of gifts from a
voting system manufacture pursuant to Section 2.5.2. of the Laboratory
Manual.
c. Provide clear mechanisms for enforcement of the prohibitions noted above
pursuant to Section 2.5.3. of the Laboratory Manual.
EAC Form 001-VSTL

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4. Financial Stability. I certify, consistent with Section 2.14. of the Laboratory
Manual, that the laboratory possess sufficient resources to enable it to properly
use and maintain its test equipment and facility, to satisfactorily perform all
required functions, and to adequately indemnify itself against financial liabilities
or penalties that may result from its operations.
5. Authority to do Business in the United States. I certify, consistent with
Section 2.12. of the Laboratory Manual, that the Laboratory is lawfully entitled or
otherwise not prohibited from doing business with the United States or its citizens
or operating in the United States.
6. Recordkeeping. I certify, consistent with Section 2.15. of the Laboratory
Manual, that the laboratory operates and manages a records system in which it
maintains all forms, reports, test records, observations, calculations and derived
data for all tests performed for a period of at least 5 years.

I, by signing my name below, certify, affirm and acknowledge, under penalty of Federal
law, that each of the above numbered paragraphs accurately represent the operations,
conditions and practices of _____________________________ (Laboratory).
Signed this day,_____________:

________________________________________(Signature)

_________________________________________(Name of Signing Official)

__________________________________________(Title of Signing Official)

EAC Form 001-VSTL

OMB Control No pending