916MATERIALS CERTIFICATIONS

916.01General

Materials certifications will be required for certain materials in accordance with various sections of these specifications and other contract documents. Unless otherwise specified or directed, one copy of each certification shall be submitted prior to use of the material. All certifications shall be signed by a person having legal authority to bind the company preparing the certification.

The contract number, name of the Contractor, destination to which the material 10 covered by the certification is consigned, and name and quantity of material represented shall be shown on all copies of the certification. Identifying information such as alloy, grade, type, class, or other similar designation shall also be shown when applicable.

Any material received on the project for which certifi cation has been furnished may be sampled and tested. If the results of the tests are in disagreement with the certification, the test results shall prevail and further acceptance by certification from the manufacturer of the material concerned may be suspended.

916.02Types of Certifications

Certifications shall be Type A, Type B, Type C, Type D, Buy America, or as required under other types. When specified, the type of certification provided for a material shall be in accordance with the Frequency Manual except as otherwise specified. Specific information and test results required in Type A, Type B, and other 916.01

types of certifications will be listed in the material specifications. Sample forms for Type A, Type B, Type C, Type D, and Buy America certifications are shown in 916.03. Sample forms for other type certifications are shown in ITM 804.

Type A certification shall be prepared by the manufacturer. It shall consist of a certified copy of a laboratory report which lists results of the specified tests and shall certify that the materials furnished comply with the specifications. The applicable specification shall be referred to in the certification. The tests may be conducted in the laboratory of the manufacturer or in another qualified laboratory. Such tests shall have been conducted on samples obtained from the lot or lots of material in the shipment.

Type B certification shall be prepared by the manufacturer. It shall show the limits of test values for the specified tests and shall certify that the materials furnished 40 comply with the specifications. The applicable specification shall be referred to in the certification. The tests may be conducted in the laboratory of the manufacturer or in another qualified laboratory.

( c ) T y p e C Type C certification shall be prepared by the manufacturer and shall certify that the materials furnished are in accordance with the specifications. The applicable specification shall be referred to in the certification.

Type D certification shall be prepared by the Contractor and shall certify that the materials furnished are in accordance wi th the specifications . The applicable specification shall be referred to in the certification. A Type D certification shall be used for product identification. It may be required to certify that the material is in accordance with minimum trade standards.

All steel and iron materials and products used in the contract shall be certified to be in accordance with 106.01(c).

Types of certifications other than type A, B, C, and D are specified for selected materials. The requirements for a certification, other are described in the respective material’s specification. Samples are shown in ITM 804.

Where circumstances warrant, as determined by the Department, and previously acceptable material is not available, small quantities may be accepted either by a Type D certification or by an affidavit from the supplier stating that the material offered is equal to that specified. 70

916.02

916.03Sample Forms

INDIANA DEPARTMENT OF TRANSPORTATION

TYPE A CERTIFICATION OF COMPLIANCE

This is to certify that for the co ntract described above, the materials 90 supplied are as follows:

** Material Name Quantity ____________________ _____________________ ____________________ _____________________

*** Conform to: ______________________________________________

The materials listed above comply with the following Test Methods and are within the acceptable limits of said Test Methods: 100

TEST METHOD LIMITS OF TEST VALUE ACTUAL TEST RESULTS _____________ ______________________ _______________________ _____________ ______________________ _______________________ _____________ ______________________ _______________________

____________________ _____________________ Date Company of Manufacture _____________________ * Signature of Company Official/Title 110

* This Certification shall be prep ared by the manufacturer of the material being supplied for this contract. ** Identifying information such as Alloy, Grade, Type, Class, or other similar designation shall also be shown when appropriate. *** Applicable material specification reference shall be listed.

916.03

INDIANA DEPARTMENT OF TRANSPORTATION 120

TYPE B CERTIFICATE OF COMPLIANCE

This is to certify that for the cont ract described above, the materials supplied are as follows:

** Material Name Quantity ____________________ _____________________ ____________________ _____________________

*** Conform to: ______________________________________________

The materials listed above comply with the following Test Methods and are within the acceptable limits of said Test Methods.

TEST METHOD LIMITS OF TEST VALUE __________________ _______________________ __________________ _______________________ __________________ _______________________ 150

____________________ _____________________ Date Company of Manufacture _____________________ * Signature of Company Official/Title

* This Certification shall be prepared by the manufacturer of the material being supplied for this contract. ** Identifying information such as Alloy, Grade, Type, Class, or other similar designation shall also be shown when appropriate. 160 *** Applicable material specification reference shall be listed.

916.03

This is to certify that for the contract described above, the materials supplied are as follows:

**Material Name Quantity ____________________ _____________________ ____________________ _____________________ 180

*** Conform to: ______________________________________________

____________________ _____________________ Date Company of Manufacture _____________________ * Signature of Company Official/Title

* This Certification shall be prepared by the manufacturer of the 190 material being supplied for this contract. ** Identifying information such as Alloy, Grade, Type, Class, or other similar designation shall also be shown when appropriate. *** Applicable material specification reference shall be listed.

This is to certify that for the co ntract described above, the materials supplied are as follows:

**Material Name Quantity ____________________ _____________________ ____________________ _____________________ 916.03

*** Is in accordance with: _______________________________________

____________________ _____________________ Date Contractor ______________________ * Signature of Contractor Official/Title

* This Certification shall be prepared by the Contractor. ** Identifying information such as Alloy, Grade, Type, Class, or other similar designation shall also be shown when appropriate. 220 *** Applicable material specification reference shall be listed. Otherwise, a statement shall be provided that the material supplied is in accordance with minimum trade standards.

BUY AMERICA CERTIFICATION

This Certification shall be prepared by the manufacturer of the product and material being supplied for this contract. 230

In accordance with 106.01(c)1, I hereby certify that all steel and iron materials and products listed below were produced and manufactured in the United States of America or territories subject to its jurisdiction.

* Material Name Quantity (Units) Company of Manufacture _____________ ______________________ _______________________ _____________ ______________________ _______________________ 250 _____________ ______________________ _______________________ * Identifying information such as Alloy, Grade, Type, Class, or other similar designation shall also be shown when appropriate.

________________________ _____________ Signature of Company Official Title 916.03

Date: ___________

_________________________ _____________ 260 Signature of Contractor Official Title

Date: ___________

916.04Sample Asbestos Exclusion Letter

Prior to acceptance of work and final paym ent, the Contractor shall submit to the Engineer for each building or bridge, on the Contractor’s letterhead, a signed and dated copy of the following letter. The Engineer will be responsible for the distribution of the letter.

ASBESTOS EXCLUSION LETTER

____________ Date

_____________________________________________________ work address of Engineer for Indiana Department of Transportation

ATT: ______________________________ Name, Project Engineer/Supervisor 280

Re: Asbestos Exclusion Location/Description ___________ Contract Number ___________ Bridge Structure Number ___________ Contractor’s Name ___________

Dear Engineer:

I hereby certify that to the best of my knowledge no asbestos containing material 290 was used as a building material in this project.

Very truly yours, ________________________________ Signature of Contractor official

________________________________ Title of Contractor official

cc: District Bridge Inspection Engineer 300 Environmental Services Director Project File

916.03