01. BAA_Certification_08.29.2023_(D5) (1).pdf
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- PXle Module
- Solicitation number
- SLAC_367517_PXleModule
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Department of Energy Office of Science
About this file
This is a Buy American Act Certification form required from bidders and offerors in federal contract solicitations. The document is used to certify compliance with domestic product sourcing requirements under the Buy American Act.
The form requires bidders to certify whether each end product qualifies as a U.S. domestic commercial product by selecting Yes or No. If Yes is selected, the bidder proceeds directly to Section C for signature. If No is selected, the bidder must complete Sections A, B, and C. Section A requires identification of any excluded end products per FAR Part 25.104. Section B requires certification that all end products, except those listed, are domestic source end products with no components of unknown origin mined, produced, or manufactured outside the United States. Bidders must also estimate the percentage of foreign content as a percentage of the total purchase order or subcontract award price, with accuracy within plus or minus 5 percent acceptable, and identify the country of origin. Section C requires the offeror's signature, date, printed name, title, and company name, making these representations and certifications part of their quotation. The form is revision 08.29.2023 and is issued by SLAC National Accelerator Laboratory's Supply Chain Management department.
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Text version
BUY AMERICA ACT CERTIFICATION (REV. 08.29.2023) Page 1 of 1
SUPPLY CHAIN MANAGEMENT
BUY AMERICAN ACT CERTIFICATION
Solicitation Number
The bidder/offeror hereby certifies that each end product qualifies as a U.S. domestic commercial product.
Yes No
If the answer above is Yes, skip to Section (C). If the answer above is No, fill out Sections (A), (B) and
(C) Below:
A. Excluded end products, in accordance with FAR Part 25.104. (Mark "N/A" if not-applicable)
B. The bidder/offeror hereby certifies that each end product, except the end products listed below, is a domestic source end product (as defined in the Buy American Act provisions); and that NO components of unknown origin have been mined, produced, or manufactured outside the United States.
The bidder/offeror will represent (as an estimate), herein, before the award of a purchase order or subcontract, the percent of the foreign content of the item or service being procured expressed as a percent of the total purchase order/subcontract award price (accuracy within plus or minus 5 percent is acceptable).
Percent (%) of Foreign Content:
Country of Origin:
c. THE OFFEROR’S SIGNATURE MAKE THE ABOVE REPRESENTATIONS AND
CERTIFICATIONS PART OF THEIR QUOTATION
Offeror’s Signature: Date:
Printed Name:
Title:
Company Name:
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