to view our Flexsteel Domestic Supplier Agreement

FLEXSTEEL INDUSTRIES INC.
COMPLIANCE VERIFICATION LETTER
On behalf of “Supplier Name”,
We hereby confirm that our manufacturing facility & operations governing all employees within are
in full compliance with Flexsteel's Supplier Code of Conduct, Social Responsibility Statement,
Environmental Policy, and US Safety & Environmental Regulations.
We certify that our factory was in compliance prior to ‘date’ and has either made no changes or
made the following changes:
Check all that apply for 2012 & send supporting documentation as requested:
CPSIA (CFR1303 Lead Base Paint Regulation)
o Did you change finish/ vinyl suppliers or did your current supplier change materials
on existing Flexsteel product?
o If yes, did you retest per the requirements of CFR1303 and submit new test
certificates to Flexsteel? Yes/ No
No Polybrominated Diphenylethers (PBDE)
o Did you start upholstery or fabric for Flexsteel in 2012? Yes/ No
o Did you change fabric or poly fill/ cushion core suppliers? Yes/ No
o If yes, did you have them complete a ‘No PBDE’ statement and submit to Flexsteel?
Yes/ No
o Please provide style effected (if all, state ‘all’), new supplier, testing agency, and
statement
Low VOC/ HAP Coatings
o Did you make any changes to your finishing, gluing, touch-up, cleaning, or work
practices in 2012? Yes/ No
o If yes, please send a new Low VOC/ HAP Coatings Statement
CARB & Chain of Custody or Equivalent Certified Renewal Wood Statement
o Did you change wood suppliers or genus/ species of wood used on current Flexsteel
styles in 2012? Yes/ No
o If yes, are they CARB compliant? Did you send a CARB letter?
o If yes, did you send a revised Lacey Act Declaration Product Template?
o If yes, did you send a Chain of Custody or Supplemental Chain of Custody Statement
verifying the wood was from a renewable source?
Did you make any changes to your environmental policy?
o If yes, please list.
Supplier:
Printed Name:
Signature:
Title:
8 Doc Version
12/2012