SUPPLIER WARRANT OF MATERIAL FOR PROTOTYPE BUILDS

Part Name / Part Number
Engineering Design Record Change Level / Dated
Checking Aid No. / Checking Aid Eng. Change Level / Dated
Application/Vehicle / Order No. / Record Individual Part Weight Below

SUPPLIER MANUFACTURING INFORMATION

Supplier Name / Supplier Code
Street Address

REASON FOR SUBMISSION

/ Initial Submission / Correction of Discrepancy / Color Change Only
(Dimensionally Production Approved)
/ Engineering Change(s) / Additional Quantities

SUBMISSION REQUIREMENTS(Suppliers not informed of the submission requirement should follow submission level B.)

Parts shipped directly to Receiving Location.

Level A / Parts shipped directly to designated Receiving Location. Warrant and Corrective Action Plan (if necessary) should be in the box with the parts unless otherwise directed by Isuzu.
Level B / Parts shipped directly to designated Receiving Location. The completed Warrant and Corrective Action Plan (if necessary), Design Record, and Inspection Results. Completed documentation should be in the box with the parts.

Parts evaluated by Prototype Department prior to shipment to Receiving Location.

Level C / The completed Warrant and Corrective Action Plan (if necessary), Design Record (drawing used in inspection), Inspection Results, Complete documentation should be directed to the location designated by Isuzu.
Level D / Parts with Complete Documentation and Inspection/Test Device (if requested). (This level is usually required for on site/joint inspection).

SUBMISSION INFORMATION Corrective Action Plan required if answer "No" to Questions #1, #2, #3, #4 or #5.

Serial No: / Part Weight:
kg
1. / Does Part meet dimensional requirements on the design record? / Yes / No / kg
2. / Does Part meet functional requirements on the design record? / Yes / No / kg
3. / Was Part produced with specified materials? / Yes / No / kg
4. / Are inspection results enclosed? / Yes / No / kg
5. / Is the Design Record enclosed? / Yes / No / kg
6. / Have Important Qualities been identified? / Yes / No / kg
7. / What was the Checking Process used to check Part? / CMM / Fixture / Open Set-up / kg
8. / Did Isuzu define the Checking Process? / Yes / No / kg
9. / Is Checking Fixture included with shipment? / Yes / No / kg
Explanation of "NO" answer or comment here:
Supplier Name (please print) / Title / Phone No.
Supplier Authorized Signature / Dated:
Isuzu Name (please print) / Phone No.
Isuzu Authorized Signature / Dated:

CORRECTIVE ACTION PLAN

Part Number / DO #

NONCONFORMANCE TYPE:

Check the nonconformance type
that applies. / Dimensional
per Design Record / Functional
per Design Record

NONCONFORMANCE DESCRIPTION:

Quantity Suspected with Nonconformance:

IMMEDIATE FIX:

ROOT CAUSE: What is causing the nonconformance?

CORRECTIVE ACTION: What steps will be taken to assure that this nonconformance will not reoccur?

Corrected Part promise date:
Midpoint progress date:
Is this Part usable for prototype?
Supplier Engineer Name (Please print): / Phone No.
Supplier Authorized Signature / Dated:
Isuzu Name (Please print): / Phone No.
Isuzu Authorized Signature: / Date: / Code:

PTD02.doc Warrant-1 rev. 17APR03