01. BAA_Certification_08.29.2023_(D5) (1).pdf
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- Attached to
- Lift Truck
- Solicitation number
- SLAC_367782_LiftTruck
- Issued by
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Department of Energy Office of Science
About this file
Buy American Act Certification
This is a certification form required for federal contract solicitations that verifies compliance with Buy American Act requirements. The form is issued by SLAC National Accelerator Laboratory and is revision dated 08.29.2023.
The bidder/offeror must certify whether each end product qualifies as a U.S. domestic commercial product by selecting either "Yes" or "No." If answering "Yes," the offeror proceeds directly to Section C to execute the certification. If answering "No," the offeror must complete Sections A, B, and C. Section A requires listing any excluded end products per FAR Part 25.104. Section B requires the offeror to certify 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, and to provide an estimate of foreign content as a percentage of the total purchase order or subcontract award price (within plus or minus 5 percent accuracy). The offeror must also identify the country of origin. Section C requires the authorized representative to sign and date the form and provide their printed name, title, and company name, making these representations and certifications part of the quotation submission. This form serves as a template and does not address specific products, services, response dates, or pricing terms related to any particular solicitation.
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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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