Conflict Minerals Reporting Template (CMRT)  
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English   Revision 5.01
June 21, 2017
  1[1]
  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, 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 (*):   tbell@metalsurfaces.com  
  Phone – Contact (*):   562-927-1331  
  Authorizer (*):   Teresa Bell  
  Title - Authorizer:   Purchasing Manager  
  Email - Authorizer (*):   tbell@metalsurfaces.com  
  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]
  Tantalum            
  Tin  (*) No       (*)
  Gold  (*) No       (*)
  Tungsten            
     
  4) 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          
     
  5) What percentage of relevant suppliers have provided a response to your supply chain survey?  (*) Answer Comments        
  Tantalum            
  Tin  (*)   100%      
  Gold  (*)   100%      
  Tungsten            
                   
  6) Have you identified all of the smelters supplying the 3TG to your supply chain?  (*) Answer Comments    

  Tantalum          
  Tin  (*) Yes      
  Gold  (*) Yes      
  Tungsten          
     
  7) 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 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   www.metalsurfaces.com  
                   
  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.  
Yes
No
Unknown
100%
Greater than 90%
Greater than 75%
Greater than 50%
50% or less
None
Yes, in conformance with IPC1755 (e.g., CMRT)
Yes, using other format (describe)
No

[1]
location number in language list
[2]
list for Validation in D9
[3]
condition for answer Q3 and later
[4]
condition for answer
[5]
condition for answer Q3 and later
[6]
condition for answer