Conflict Minerals Reporting Template (CMRT)  
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English   Revision 6.3
May 5, 2023
 
  The purpose of this document is to collect sourcing information on tin, tantalum, tungsten and gold used in products Link to Terms & Conditions  
A  
  Mandatory fields are noted with an asterisk (*).  Consult the instructions tab for guidance on how to answer each question.  
  Company Information  
  Company Name (*):   Metal Surfaces International, LLC.   
  Declaration Scope or Class (*):   A. Company        
  Description of Scope:   Company-wide  
     
  Company Unique ID:   DUNS 00-835-8145  
  Company Unique ID Authority:      
  Address:   6060 Shull St, Bell Gardens, CA 90201 USA  
  Contact Name (*):   Sam Bell  
  Email – Contact (*):   sbell@metalsurfaces.com  
  Phone – Contact (*):   562-927-1331  
  Authorizer (*):   Sam Bell  
  Title - Authorizer:   Environmental Compliance Manager  
  Email - Authorizer (*):   sbell@metalsurfaces.com  
  Phone - Authorizer:   562-927-1331  
  Effective Date (*):   16-May-2023    
   
  Answer the following questions 1 - 8 based on the declaration scope indicated above  
  1) Is any 3TG intentionally added or used in the product(s) or in the production process? (*) Answer Comments        
  Tantalum     No    
  Tin  (*)   Yes    
  Gold  (*)   Yes    
  Tungsten     No    
           
  2) Does any 3TG remain in the product(s)? (*) Answer Comments        
  Tantalum        
  Tin  (*) Yes    
  Gold  (*) Yes    
  Tungsten        
   
  3) Do any of the smelters in your supply chain source the 3TG from the covered countries? (SEC term, see definitions tab) (*) Answer Comments    
  Tantalum        
  Tin  (*) Yes Four of our reporting Tin suppliers have stated that smelters in their supply chain have obtained Tin from affected areas but are required to comply with Dodd Frank and RMI requirements.  
  Gold  (*) No    
  Tungsten        
   
  4) Do any of the smelters in your supply chain source the 3TG from conflict-affected and high-risk areas? (*) Answer Comments        
  Tantalum        
  Tin  (*) Yes Four of our reporting Tin suppliers have stated that smelters in their supply chain have obtained Tin from affected areas but are required to comply with Dodd Frank and RMI requirements.  
  Gold  (*) No    
  Tungsten        
   
  5) Does 100 percent of the 3TG (necessary to the functionality or production of your products) originate from recycled or scrap sources?  (*) Answer Comments        
  Tantalum        
  Tin  (*) No    
  Gold  (*) No    
  Tungsten        
   
  6) What percentage of relevant suppliers have provided a response to your supply chain survey?  (*) Answer Comments        
  Tantalum          
  Tin  (*)   Greater than 90%    
  Gold  (*)   100%    
  Tungsten          
                 
  7) Have you identified all of the smelters supplying the 3TG to your supply chain?  (*) Answer Comments    
  Tantalum        
  Tin  (*) Yes    
  Gold  (*) Yes    
  Tungsten        
   
  8) Has all applicable smelter information received by your company been reported in this declaration?  (*) Answer Comments  
  Tantalum          
  Tin  (*)   Yes    
  Gold  (*)   Yes    
  Tungsten            
   
  Answer the Following Questions at a Company Level  
  Question   Answer   Comments    
  A. Have you established a responsible minerals sourcing policy? (*)   Yes      
           
  B. Is your responsible minerals sourcing policy publicly available on your website? (Note – If yes, the user shall specify the URL in the comment field.) (*)   Yes      
                 
  C. Do you require your direct suppliers to source the 3TG from smelters whose due diligence practices have been validated by an independent third party audit program? (*)   Yes      
                 
  D. Have you implemented due diligence measures for responsible sourcing? (*)   Yes      
                 
  E. Does your company conduct Conflict Minerals survey(s) of your relevant supplier(s)? (*)   Yes, in conformance with IPC1755 (e.g., CMRT)      
   
  F. Do you review due diligence information received from your suppliers against your company’s expectations? (*)   Yes      
           
  G. Does your review process include corrective action management? (*)   Yes      
           
  H. Is your company required to file an annual conflict minerals disclosure? (*)   No      
   
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