Conflict Minerals Reporting Template (CMRT)  
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English   Revision 5.01
June 21, 2017
  The purpose of this document is to collect sourcing information on tin, tantalum, tungsten and gold used in products Link to Terms & Conditions  
  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, Inc.  
  Declaration Scope or Class (*):   A. Company         A. Company[2] B. Product (or List of Products) C. User defined [Specify in 'Description of scope']    
  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 (*):   Teresa Bell  
  Email – Contact (*):  
  Phone – Contact (*):   562-927-1331  
  Authorizer (*):   Teresa Bell  
  Title - Authorizer:   Purchasing Manager  
  Email - Authorizer (*):  
  Phone - Authorizer (*):   562-927-1331  
  Effective Date (*):   15-Aug-2017    
  Answer the following questions 1 - 7 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        [3]
  Tin  (*)   Yes       (*)
  Gold  (*)   Yes       (*)
  Tungsten     No        
  2) Does any 3TG remain in the product(s)? (*) Answer Comments        
2  (*)[4]
  Tantalum           (*)[5]
  Tin  (*) Yes Plating     (*)
  Gold  (*) Yes Plating     (*)
  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    
2  (*)[6]
  Tin  (*) No       (*)
  Gold  (*) No       (*)
  4) Does 100 percent of the 3TG (necessary to the functionality or production of your products) originate from recycled or scrap sources?  (*) Answer Comments        
  Tin  (*) No      
  Gold  (*) No      
  5) What percentage of relevant suppliers have provided a response to your supply chain survey?  (*) Answer Comments        
  Tin  (*)   100%      
  Gold  (*)   100%      
  6) Have you identified all of the smelters supplying the 3TG to your supply chain?  (*) Answer Comments    

  Tin  (*) Yes      
  Gold  (*) Yes      
  7) Has all applicable smelter information received by your company been reported in this declaration?  (*) Answer Comments  

  Tin  (*)   Yes      
  Gold  (*)   Yes      
  Answer the Following Questions at a Company Level  
  Question   Answer   Comments      
  A. Have you established a conflict minerals sourcing policy? (*)   Yes      
  B. Is your conflict 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 be DRC conflict-free? (*)   Yes      
  D. 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      

  E. Have you implemented due diligence measures for conflict-free sourcing? (*)   Yes      
  F. Does your company conduct Conflict Minerals survey(s) of your relevant supplier(s)? (*)   Yes, in conformance with IPC1755 (e.g., CMRT)   Some have CMRT's , others send info on their smelters.  
  G. Do you review due diligence information received from your suppliers against your company’s expectations? (*)   Yes      

  H. Does your review process include corrective action management? (*)   Yes      
  I. Is your company required to file an annual conflict minerals disclosure with the SEC? (*)   No      
© 2017 Conflict-Free Sourcing Initiative. All rights reserved.  
Greater than 90%
Greater than 75%
Greater than 50%
50% or less
Yes, in conformance with IPC1755 (e.g., CMRT)
Yes, using other format (describe)

location number in language list
list for Validation in D9
condition for answer Q3 and later
condition for answer
condition for answer Q3 and later
condition for answer