DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protecction

NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN
19 CFR 181.11,181.22
2. BLANKET PERIOD
1.EXPORTER NAME,ADDRESS AND EMAIL
ROGERS MACHINERY COMPANY, INC. 14650 SW 72 ND AVENUE PORTLAND,OREGON 97224 usa, FROM (mm/dd/yyyy)
erick.mooore@roger-machinery.com
TO (mm/dd/yyyy)
3. PRODUCER NAME, ADDRES AND EMAIL. 4. IMPORTER NAME,ADDRESS AN
TAX IDENTIFICATION NUMBER: CIA990728KH0 COMPRIMIDO s.a de c.v. JOSE T.
MEXICO,MEXICO ciacsa3@yahoo

TAX IDENTIFICATION NUMBER: CIA990728KH0 TAX

6. HS TARIFF
5. DESCRIPTION OF GOOD (S) CLASSIFICATION
NUMBER
 I CERTIFY THAT:
THE INFORMATION ON THIS DOCUMENT IS TRUE AND ACCURATE AND I ASSUME THE RESPONSABILITY FOR PROVING SUCH REPRESENTATIONS. I UN
OMISSIONS MADE ON OR IN CONNECTION WITH THIS DOCUMENT;
I AGREE TO MAINTAIN AND PRESENT UPON REQUES, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATE, AND TO INFOR, IN WRITING, ALL
THAT COULD AFFCT THE ACCURACY OR VALODITY OF THIS CERTIFICATE;
THE GOODS ORIGINATED IN THE TERRITORY OF ONE MORE OF THE PARTIES, AND COMPLY WITH THE ORIGIN REQUIREMENTS SPECIFIED FOR THOSE
SPECIFICALLY EXEMPTED IN ARTICLE 411 OR ANNEX 401, THERE HAS BEEN NO FURTHER PRODUCTION OR ANY OTHER OPERATION OUTSIDE THE TER
THIS CERTIFICATE CONSSISTS OF PAGES, INCLUDING ALL ATTACHMENTS
11a AUTHORIZED SIGNATURE 11b. COMPANY
ROGERS MACHINERY COMPANY, INC
11c. NAME 11d.TITLE
11.
ERICK MOORE CORPORATE TRAFFIC MANAGER
11e. DATE (mm/dd/yyyy) 11F. TELEPHONE NUMBERS 11g.email
01-15-20189 (Voice) 5036031970 (facsimile) 503-6031973 ERIC.MOORE@ROGERS-MA
OMELAND SECURITY
Border Protecction
EE TRADE AGREEMENT
E OF ORIGIN
1.11,181.22
2. BLANKET PERIOD

FROM (mm/dd/yyyy)
TO (mm/dd/yyyy)
4. IMPORTER NAME,ADDRESS AND EMAIL, COMERCIALIZADORA INTERNACIONAL DE AIRE
COMPRIMIDO s.a de c.v. JOSE T. CUELLAR No. 27 Col. Obrera, Deleg. Cuautemoc C.P. 60803 CIUDAD DE
MEXICO,MEXICO ciacsa3@yahoo.com.mx

TAX IDENTIFICATION NUMBER: CIA990728KH0

6. HS TARIFF 7.PREFERENCE 10. COUNTRY OF
CLASSIFICATION 8.PRODUCER 9. NET COST
CRITERION ORIGIN
NUMBER
ROVING SUCH REPRESENTATIONS. I UNDERSTAND THAT I AM LIABLE FOR ANY FALSE STATEMENTS OR MATERIAL

CATE, AND TO INFOR, IN WRITING, ALL PERSONS TO WHOM THE CERTIFICATE WAS GIVEN OF ANY CHANGES

REQUIREMENTS SPECIFIED FOR THOSE GOODS IN THE NORTH AMERICAN FREE TRADE AREEMENT AND UNLESS
Y OTHER OPERATION OUTSIDE THE TERRITORIES OF THE PARTIES, AND

11b. COMPANY
ROGERS MACHINERY COMPANY, INC
11d.TITLE
CORPORATE TRAFFIC MANAGER
11g.email
ERIC.MOORE@ROGERS-MACHINERY.CO