<SEC-DOCUMENT>0001341004-18-000317.txt : 20180518
<SEC-HEADER>0001341004-18-000317.hdr.sgml : 20180518
<ACCEPTANCE-DATETIME>20180518115133
ACCESSION NUMBER:		0001341004-18-000317
CONFORMED SUBMISSION TYPE:	SD
PUBLIC DOCUMENT COUNT:		1
<RULE>
<RULE-NAME>13p-1
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<ITEM-NUMBER>1.01
<ITEM-PERIOD>20171231
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FILED AS OF DATE:		20180518
DATE AS OF CHANGE:		20180518

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			CHICAGO RIVET & MACHINE CO
		CENTRAL INDEX KEY:			0000019871
		STANDARD INDUSTRIAL CLASSIFICATION:	METALWORKING MACHINERY & EQUIPMENT [3540]
		IRS NUMBER:				360904920
		STATE OF INCORPORATION:			IL
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		SD
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	000-01227
		FILM NUMBER:		18845656

	BUSINESS ADDRESS:	
		STREET 1:		901 FRONTENAC RD
		STREET 2:		P O BOX 3061
		CITY:			NAPERVILLE
		STATE:			IL
		ZIP:			60566
		BUSINESS PHONE:		6303578500

	MAIL ADDRESS:	
		STREET 1:		901 FRONTENAC RD
		STREET 2:		P O BOX 3061
		CITY:			NAPERVILLE
		STATE:			IL
		ZIP:			60566
</SEC-HEADER>
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<div style="FONT-SIZE: 12pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">UNITED STATES</div>

<div style="FONT-SIZE: 12pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">SECURITIES AND EXCHANGE COMMISSION</div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">WASHINGTON, D.C.&#160; 20549</div>

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<div style="FONT-SIZE: 12pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">FORM SD</div>

<div style="FONT-SIZE: 12pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">Specialized Disclosure Report</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center"><u>Chicago Rivet &amp; Machine Co.</u></div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">(Exact name of registrant as specified in its charter)</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">(State or other jurisdiction</div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">of incorporation)</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">(IRS Employer</div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">Identification No.)</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center">901 Frontenac Road</div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center"><u>Naperville, Illinois&#160; 60563</u></div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: center"><u>Michael Bourg, (630) 357-8500</u></div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: center">(Name and telephone number, including area code, of the person to contact in connection with this report.)<br>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">&#160;</div>

<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">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:</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left"><font style="FONT-SIZE: 10pt; FONT-FAMILY: 'Wingdings 2', serif">T</font>&#160; Rule 13p-1 under the Securities Exchange Act (17 CFR 240.13p-1) for the reporting period from January 1 to December 31, 2017.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Section 1 &#8211; Conflict Minerals Disclosure</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Item 1.01&#160; Conflict Minerals Disclosure and Report</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">This report for the year ended December 31, 2017 has been prepared by management of Chicago Rivet &amp; Machine Co. (the &#8220;Company,&#8221; &#8220;we,&#8221; &#8220;us,&#8221; and &#8220;our&#8221;) to comply with Section 13(p) of the Securities Exchange Act of 1934, as amended, and Rule 13p-1 (the &#8220;Rule&#8221;) promulgated thereunder.&#160; The Rule was adopted by the Securities and Exchange Commission (&#8220;SEC&#8221;) as required by the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010 and imposes certain reporting obligations on SEC registrants whose manufactured products contain so-called &#8220;conflict minerals&#8221; that are necessary to the functionality or production of those products.&#160; As used in this report, the term &#8220;conflict minerals&#8221; includes columbite-tantalite, cassiterite, gold, wolframite, and their derivatives tantalum, tin and tungsten.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">A copy of this report is made available on our website at www.chicagorivet.com, under the heading &#8220;Investor Relations&#8221;.&#160; <font style="FONT-SIZE: 10pt; FONT-FAMILY: inherit, 'Times New Roman', serif">The website and the information accessible through it are not incorporated into this specialized disclosure report.</font></div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Company Overview</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">The Company operates in two segments of the fastener industry: fasteners and assembly equipment.&#160; The fastener segment consists of the manufacture and sale of rivets, cold-formed fasteners and parts and screw machine products.&#160; The assembly equipment segment consists primarily of the manufacture of automatic rivet setting machines, automatic assembly equipment and parts and tools for such machines.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">For the year ended December 31, 2017, we determined that the plating of certain products in the fastener segment contained tin and that our rivet setting machines include electronic components that also may contain conflict minerals.&#160; As required by the Rule, we conducted a reasonable country of origin inquiry to determine whether those conflict minerals originated in the Democratic Republic of the Congo or an adjoining country (collectively, &#8220;Covered Countries&#8221;).</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: justify">Reasonable Country of Origin Inquiry</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">Because there are multiple tiers between us and the mines from which conflict minerals are sourced, we rely on the information provided by our direct suppliers to determine the origin of the conflict minerals contained in the components and materials supplied to us, including the conflict minerals provided to our suppliers from sub-tier suppliers.&#160; Accordingly, the methods we used to determine the origin of those conflict minerals included the following:</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif">Sending letters to our direct suppliers, explaining the Rule and referring the suppliers to online training materials and instructions available on the Conflict Free Sourcing Initiative&#8217;s website (www.conflictfreesourcing.org).</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif">Soliciting survey responses from our direct suppliers, using the standard Conflict Minerals Reporting Template designed by the Electronic Industry Citizenship Coalition (EICC) and the Global e-Sustainability Initiative (GeSI).&#160; This template has been widely adopted to assist companies in their due diligence processes related to conflict minerals.&#160; The template was developed to facilitate disclosure and communication of information regarding smelters that provide material to a company&#8217;s supply chain.&#160; It includes questions regarding a company&#8217;s conflict-free policy, engagement with its direct suppliers, and a listing of the smelters the company and its suppliers use.&#160; In addition, the template contains questions about the origin of conflict minerals included in suppliers&#8217; products, as well as supplier due diligence.</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif">Reviewing responses that we received from our suppliers and following up on inconsistent, incomplete and vague responses.</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif">Sending reminders to suppliers who did not respond to our surveys, encouraging them to respond.</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Results</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left; TEXT-INDENT: 18pt">All of our suppliers of tin included in our fastener products responded to our surveys and indicated that such tin did not originate in the Covered Countries.&#160; While we did not receive survey responses from all of our suppliers of the electronic components included in our rivet setting machines, none of the supplier responses received to date have indicated that the conflict minerals contained in those components originated in the Covered Countries.&#160; Accordingly, based on our reasonable country of origin inquiry, we have concluded that we have no reason to believe that the conflict minerals contained in our products may have originated in the Covered Countries.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: inherit, 'Times New Roman', serif; TEXT-ALIGN: left">Not required.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: inherit, 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Section 2 &#8211; Exhibits</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: inherit, 'Times New Roman', serif; FONT-WEIGHT: bold; TEXT-ALIGN: left">Item 2.01 Exhibits</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">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.</div>

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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">CHICAGO RIVET &amp; MACHINE CO.</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">/s/ Michael J. Bourg</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">Date:&#160; May 15, 2018</div>
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<div style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman', serif; TEXT-ALIGN: left">Michael J. Bourg</div>
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