The Kroger Co.
General Certificate of Conformity
Product Details Vendor Name:
Product Description
/Item/Style No.:
Manufacturer
/P.O. No
Address
/SKU No.
UPC No.
Date of Manufacture
Phone No
/Place of Manufacture
Contact Person
/Bank Reference number
Testing Details
The above product was tested independently by a third partylaboratory*, please indicate below.
*Children’s items must be tested by a CPSC Accepted Laboratory, using samples representative of production lot
/ Other :Testing Laboratory Name and full address
Tel. number / *TESTING IS NOW A MANDATORY REQUIREMENT!*
PLEASE INCLUDE TEST RESULTS WITH DOCUMENTS
Test Report No. / Test Report Date
Test Sample selection / Date Sample Qty / Test samples are representative of production lot / Yes No
Based upon a reasonable test program, this product complies with all Rules, Bans, Standards, or Regulations applicable to the product.
Standards and regulations applicable to Children’s product must also be submitted on the appropriate separate Children’s Product Certificate form as required by the CPSC for CPSIA. (List separately) all rules, bans and standards.
CPSIA 101 – Lead in substrate of children’s product / CPSIA 106, ASTM F963-11-Toy Safety Specification / 16 CFR 1505 – Electrically operated toys & children’s article CPSIA 101.314, 16 CFR 1303 – Lead in paint & surface coatings / 16 CFR 1500.19 – CPSA Labeling (Small Parts) / CA Proposition 65, Lead & Phthalate limitations
16 CFR 1500.18(a) (17) – Balls / 16 CFR 1500.44 – Flammability / CPSC Guidance – Lead in art materials
CPSIA 108 – Phthalates in Children’s products / 16 CFR 1500.48 & 49 – Sharp edges and points / 16 CFR 1610 = Flammability on clothing textiles
16 CFR 1500.14(b) (8) – Art Materials / 16 CFR 1501 – small parts / 16 CFR 1500.14 – Lhama
16 CFR 1210 - Multipurpose Lighters / CPSA 1202 - Matchbooks / 16 CFR 1203 - Bicycle Helmets
16 CFR 1204 - CB Antennas / 16 CFR 1205 - Power Mowers / CPSA 1207 - Swimming Pool Slides
16 CFR 1209 - Cellulose Insulation / 16 CFR 1210 - Cigarette Lighters / 16 CFR 1211 - Garage Door Openers
CPSA1201 - Architectural Glazing Materials / CPSA 1213, FHSA 1500.18 (A)(18) - Bunk Beds;Furniture / CPSC1240 (2); ASTM F963-11; Magnet Sets
FFA 1611 - Vinyl Plastic Film / CPSA 1305 - Artificial Emberizing Materials / CPSA 1304 - Consumer Patching Compound
CPSA 1306, FHSA 1500. 18(a)(4) - Lawn Darts / CPSA 1420; 15 U.S.C. - ATV’s (All-Terrain Vehicle) / CPSA1450; ANSI/APSP-16 Pool & Spa drain Covers
FHSA 1500.12(a)(29); 1500.17 (a)(13) - Metal Candle Wicks / 16 CFR1507 andCFR 1500 and Fireworks / CPSC 1240 (2); ASTM F963-11; Magnet Sets
FHSA 1500.83(a)(14); P.L. 110-278; ASTM F2517-05 - Portable Gas Containers / P.L. 112-266; ASTM C1396-14a - Drywall / CPSC 1750 - Refrigerator Doors
Small Batch Manufacturer -2012
CPSC Registration number ______/ Another Party’s finished product testing/certification (not applicable to children’s products ) / UL 859 and 1727 – Hand Supported Hair Dryers
UL 588 – Seasonal and Decorative Lighting / Flammability of Carpets & Rugs 16 CFR 1630 and 1631 / Component Part Testing/Certification-2012
WA 70.240 RCW Children’s safe products / Flammability of Mattresses and Mattress Pads 16 CFR 1632 & 1633 / 16 CFR Part 1512; FHSA 1500. 18(a)(12) Requirements for Bicycles
PPPA 1700 - Special Packaging / UL 817 – Extension Cords / Inaccessible Component Parts -2012
CPSIA 103, Tracking labels / CPSA 1301 - Refuse Bins / Other
Other / Other / Other
Kroger Requirements
**Include all UL or ETL standards not listed above
UL # ______/ ETL # ______ UL # ______/ ETL # ______
UL # ______/ ETL # ______
UL # ______/ ETL # ______
UL # ______/ ETL # ______
Other / Other
Importer Details
ImporterFred Meyer, Inc. dba KrogerPrivate Label
Address3800 SE 22nd Ave.AddressSame
Portland, OR 97202
USA
Contact Tel. 503-797-3323
Contact PersonMegan Liu, MS 23C
Email:
This Certificate was completed by
______
Signed by with company chop