12-09-CR27005-26361490-VA40-0895-2.pdf
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- Solicitation number
- CR27005
- Issued by
- Utah
About this file
This is a Certification of Compliance form issued by the Department of Veterans Affairs for a State Cemetery Grant project managed by the State of Utah's Division of Facilities Construction and Management (DFCM). The document pertains to a Veterans Cemetery Columbarium Expansion project (Project #26361490) involving the addition of six new columbarium niche walls, associated concrete walkways, and landscape and irrigation improvements. The project is a Stage II invitation to bid restricted to contractors who have been prequalified under the respective DFCM Stage I Prequalification process and are currently listed on the DFCM Prequalified Contractors list as of the solicitation date. The construction cost estimate for this project is $3,000,000.00.
The form certifies compliance with the Davis-Bacon Act (40 U.S.C. 3141-3148), which requires that prevailing wage rates established by the U.S. Department of Labor be incorporated into construction contracts for federally funded projects. The certification must be completed by an authorized State, Tribal, or eligible County Government official and signed with the project's Federal Application Identifier (FAI) number and the date of execution. The statutory authority for this State Cemetery Grant is 38 U.S.C. 2408. The public reporting burden for completion of this certification is estimated at 15 minutes, with an OMB number of 2900-0559 valid through October 31, 2026.
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OMB NUMBER: 2900-0559
Expiration Date: Oct. 31, 2026 Respondent Burden: 15 minutes
CERTIFICATION OF COMPLIANCE
WITH PROVISIONS OF THE DAVIS-BACON ACT
(40 U.S.C. 3141 - 3148) Respondent Burden: Public reporting burden for this collection of information is estimated to average 15 minutes. Statutory authority for a State Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to ensure that State, Tribal or eligible County government pays the prevailing wage rates for this Federally funded project. VA may not conduct or sponsor and you are not required to respond to this collection of information unless it displays a valid OMB number. Respond to this collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to OIRA Desk Officer for VA, 725 17th St NW, Washington, DC 20503. SEND COMMENTS ONLY. Please do not send applications for a grant to this address.
CERTIFICATION STATEMENT: I certify that I have obtained the latest prevailing wage rates from the U.S. Department of Labor for the State, Tribal or eligible County Government Cemetery project and have incorporated them into the construction contract in compliance with the Davis-Bacon Act.
STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT CEMETERY
PROJECT LOCATED AT
PROJECT FAI (Federal Application Identifier) NO.
NAME OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT
OFFICIAL
TITLE OF AUTHORIZED STATE, TRIBAL OR ELIBIBLE COUNTY GOVERNMENT
OFFICIAL
SIGNATURE OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY
GOVERNMENT OFFICIAL
DATE SIGNED (mm/dd/yyyy)
VA FORM
SEP 2023 40-0895-2
OMB NUMBER: 2900-0559
Expiration Date: Oct. 31, 2026 Respondent Burden: 15 minutes
O M B NUMBER: 2 9 0 0-0 5 5 9
Expiration Date: Oct. 31, 2026 Respondent Burden: 15 minutes Department of Veterans Affairs logo
CERTIFICATION OF COMPLIANCE
WITH PROVISIONS OF THE DAVIS-BACON ACT
(40 U.S.C. 3141 - 3148)
CERTIFICATION OF COMPLIANCE
WITH PROVISIONS OF THE DAVIS-BACON ACT (40 U.S.C. 3141 - 3148)
Respondent Burden: Public reporting burden for this collection of information is estimated to average 15 minutes. Statutory authority for a State Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to ensure that State, Tribal or eligible County government pays the prevailing wage rates for this Federally funded project. VA may not conduct or sponsor and you are not required to respond to this collection of information unless it displays a valid OMB number. Respond to this collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to OIRA Desk Officer for VA, 725 17th St NW, Washington, DC 20503. SEND COMMENTS ONLY. Please do not send applications for a grant to this address.
Respondent Burden: Public reporting burden for this collection of information is estimated to average 15 minutes. Statutory authority for a State Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to ensure that State or Tribal government pays the prevailing wage rates for this Federally funded project. V A may not conduct or sponsor and you are not required to respond to this collection of information unless it displays a valid O M B number. Respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspects of this collection of information, including suggestions for reducing the burden to V A Clearance Officer (0 0 5 R 1 B), 8 1 0 Vermont Avenue Northwest, Washington, D.C. 2 0 4 2 0. SEND COMMENTS ONLY. Please do not send applications for a grant to this address.
CERTIFICATION STATEMENT: I certify that I have obtained the latest prevailing wage rates from the U.S. Department of Labor for the State, Tribal or eligible County Government Cemetery project and have incorporated them into the construction contract in compliance with the Davis-Bacon Act.
STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT CEMETERY
PROJECT LOCATED AT
PROJECT FAI (Federal Application Identifier) NO.
NAME OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT
OFFICIAL
TITLE OF AUTHORIZED STATE, TRIBAL OR ELIBIBLE COUNTY GOVERNMENT OFFICIAL
SIGNATURE OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY
GOVERNMENT OFFICIAL
SIGNATURE OF AUTHORIZED STATE OR TRIBAL GOVERNMENT OFFICIAL
DATE SIGNED (mm/dd/yyyy)
VA FORM
SEP 2023
V A Form 40-0 8 9 5 - 2, September 2023 40-0895-2
40-0895-2, CERTIFICATION, COMPLIANCE,
PROVISIONS, DAVIS-BACON, ACT
Missie Vaccaro-Palomaki VA Form 40-0895-2, CERTIFICATION OF COMPLIANCE
WITH PROVISIONS OF THE DAVIS-BACON ACT
(40 U.S.C. 3141 - 3148)
SEPTEMBER 2023
Brian Hurley October 2010 (40)
READ RESPONDENT BURDEN AND CERTIFICATION STATEMENT ABOVE
STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT CEMETERY
PROJECT LOCATED AT:
| PROJECT F A I (Federal Application Identifier) Number: |
| NAME OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT |
OFFICIAL:
| TITLE OF AUTHORIZED STATE, TRIBAL OR ELIBIBLE COUNTY GOVERNMENT OFFICIAL: |
| DATE SIGNED (mm/dd/yyyy): |
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