0001079973-16-000996.txt : 20160531 0001079973-16-000996.hdr.sgml : 20160531 20160531111927 ACCESSION NUMBER: 0001079973-16-000996 CONFORMED SUBMISSION TYPE: SD PUBLIC DOCUMENT COUNT: 2 13p-1 1.01 20151231 FILED AS OF DATE: 20160531 DATE AS OF CHANGE: 20160531 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Lifeloc Technologies, Inc CENTRAL INDEX KEY: 0001493137 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826] IRS NUMBER: 841053680 STATE OF INCORPORATION: CO FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SD SEC ACT: 1934 Act SEC FILE NUMBER: 000-54319 FILM NUMBER: 161684448 BUSINESS ADDRESS: STREET 1: 12441 WEST 49TH AVE UNIT #4 CITY: WHEAT RIDGE STATE: CO ZIP: 80033 BUSINESS PHONE: 303-431-9500 MAIL ADDRESS: STREET 1: 12441 WEST 49TH AVE UNIT #4 CITY: WHEAT RIDGE STATE: CO ZIP: 80033 FORMER COMPANY: FORMER CONFORMED NAME: Lifeloc Technologies Inc DATE OF NAME CHANGE: 20100601 SD 1 lctc_sd.htm SPECIALIZED DISCLOSURE REPORT lctc_sd.htm
 
 
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
 
FORM SD
Specialized Disclosure Report
 
 
Lifeloc Technologies, Inc.
(Exact name of registrant as specified in its charter)
 
LIFELOC TECHNOLOGIES, INC.
 (Exact name of registrant as specified in its charter)

 
Colorado
000-54319
84-1053680
(State or other jurisdiction of incorporation or organization)
(Commission File Number)
(I.R.S. Employer Identification No.)

12441 W 49th Ave., Suite 4,
Wheat Ridge, Colorado
80033
(Address of principal executive offices)
(Zip Code)

Rene Mitchell
Director of Purchasing and Materials
303-431-9500
(Name and telephone number, including area code,
of the person to contact in connection with this report.)

 Check the appropriate box to indicate the rule pursuant to which this form is being filed, and provide the period to which the information in this form applies:
 
x
Rule 13p-1 under the Securities Exchange Act (17 CFR 240.13p-1) for the reporting period from January 1 to December 31, 2015.
 
 

 
 
Section 1 – Conflict Minerals Disclosure
 
Item 1.01 Conflict Minerals Disclosure and Report, Exhibit
 
A copy of Lifeloc Technologies, Inc.’s Conflict Minerals Report is filed as Exhibit 1.01 hereto.
 
Item 1.02 Exhibits
 
See Section 2.
 
Section 2 – Exhibits
 
Item 2.01 Exhibits
 
The following exhibit is filed as part of this report:
 
Exhibit 1.01 — Conflict Minerals Report as required by Items 1.01 and 1.02 of this Form.
 
 
 
 
SIGNATURES
 
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the duly authorized undersigned.
 
Lifeloc Technologies, Inc.
    
(Registrant)
 
    
/s/ Wayne R. Willkomm
  
May 31, 2016
By Wayne R. Willkomm, Ph.D., President and Chief Executive Officer
  
(Date)
 
 EX-1.01 2 ex1x01.htm EXHIBIT 1.01 ex1x02.htm
Exhibit 1.02
 
 
Conflict Minerals Report of Lifeloc Technologies, Inc.
in Accordance with Rule 13p-1 under the Securities Exchange Act of 1934
 
This is the Conflict Minerals Report of Lifeloc Technologies, Inc. (“Lifeloc”) for calendar year 2015 in accordance with Rule 13p-1 (“Rule 13p-1”) under the Securities Exchange Act of 1934 (the “1934 Act”). Please refer to Rule 13p-1, Form SD and the 1934 Act Release No. 34-67716 for definitions to the terms used in this Report, unless otherwise defined herein.
 
Due Diligence
 
Lifeloc undertook due diligence to determine the conflict minerals status of the necessary conflict minerals, specifically tantalum and tin, used in the manufacture of its breath alcohol testers. Lifeloc’s due diligence measures were based on the Electronic Industry Citizenship Coalition and Global e-Sustainability (“EICC/GeSI”) initiative with the smelters and refiners of conflict minerals who provide those conflict minerals to our suppliers. As a company in the breathalyzer business, Lifeloc is several levels removed from the actual mining of conflict minerals. Lifeloc does not make purchases of raw ore or unrefined conflict minerals and makes no purchases in the Covered Countries.
 
Lifeloc’s due diligence measures included conducting a supply-chain survey with direct suppliers of materials containing conflict minerals using the EICC/GeSI Conflict Minerals Reporting Template to identify the smelters and refiners. 
 
As a result of the due diligence measures described above, Lifeloc has determined in good faith that for calendar year 2015, the conflict minerals status for a portion of the tantalum and tin it uses to be “DRC conflict undeterminable” and for the remainder to be “DRC conflict free” (terms as defined in the 1934 Act). Lifeloc’s determination regarding the tantalum and tin that it has classified as “DRC conflict undeterminable” was due to a lack of information from its suppliers to conclude whether conflict minerals originated in the Covered Countries and, if so, whether the tantalum and tin were from recycle or scrap sources, were DRC conflict free or have not been found to be DRC conflict free.
 
Product Description
 
Lifeloc develops, manufactures and markets breath alcohol testers and related accessories, supplies and education.  We design, produce and sell fuel-cell based breath alcohol testing equipment, as well as a line of supplies, accessories, services, and training to support customers’ alcohol testing programs. Some of our breath alcohol testers, components of which are manufactured by third parties, contain small amounts of tantalum. In addition, the solder we use in our own manufacturing process contains small amounts of tin.
 
Based on the information obtained through the due diligence process, Lifeloc does not have sufficient information to determine the facilities used to produce the conflict minerals in its products, nor the mine or location of origin of conflict minerals in its products.
 
Conflict Minerals Policy

In connection with Rule 13p-1, we have adopted a policy with respect to our sourcing of conflict minerals (our "Policy"). Lifeloc has implemented a due diligence process across our supply chain to support the identification and avoidance of “Conflict Minerals.”  Through this process Lifeloc seeks to obtain assurance that metals within our supply chain are conflict-free
 
In accordance with the instructions to Form SD, this Report has not been audited by an independent private sector auditor.