United States–Mexico–Canada Agreement (USMCA) Certification of Origin Exporter Name Exporter Address Valid From: Valid To: July 1, 2020 December 31, 2020 Contact Email Address Producer Name Producer Address “Available upon request by the importing authorities” (1) Medtronic Part Number Part Description HTS Code (3 )M C EX A N -U (T S-M EC ) Contact Email Address (2) Country of Origin Preference Criteria ELC06-0022 VIBRATORY FEEDER ELECTROMAGNETIC COIL 8479.89 US Bii US Free Trade Agreements US (4) COMPANY CERTIFYING: x EXPORTER PRODUCER I certify that the goods described in this document qualify as originating and the information contained in this document is true and accurate. I assume responsibility for proving such representations and agree to maintain and present upon request or to make available during a verification visit, documentation necessary to support this certification. If information becomes available to me that changes the provided information, I will immediately notify rs.originverification@medtronic.com of those changes. Signature: Date: Name: Street Address: Title: General Manager Email Address j City: State: CA Zip Code: Country: USA
