5-Appendix J-b - Contractor Certificate of Compliance - BABA.pdf

FORM AML-003

Page 1 of 2 Revised 2/2024

CONTRACTOR CERTIFICATE OF COMPLIANCE

WITH BUILD AMERICA, BUY AMERICA PROVISIONS

FOR FEDERALLY ASSISTED CONTRACTS

Prime Contractors and subcontractors should complete and sign a copy of this form and submit with each payment request to the Division of Abandoned Mine Lands. Prime contractors must also attach receipts and/or other documentation with this form showing evidence of Buy America compliance.

CONTRACTOR NAME

CONTRACTOR ADDRESS

PROJECT NAME

INVOICE PERIOD TO

CONTRACT NUMBER

CONTRACT AMOUNT

This certification is to be utilized by prime contractors and subcontractors who have been awarded contracts funded through Abandoned Mine Lands Program Grant Funds and subject to the Buy America provisions of the Infrastructure Investment and Jobs Act (Pub. L. No 117-27). Buy America provisions state:

(1) All iron and steel used in the project are produced in the United States. This means all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States;

(2) All manufactured products used in the project are produced in the United States. This means the manufactured product was manufactured in the United States, and the cost of the components of the manufactured product that are mined, produced, or manufactured in the United States is greater than 55 percent of the total cost of all components of the manufactured product, unless another standard that meets or exceeds this standard has been established under applicable law or regulation for determining the minimum amount of domestic content of the manufactured product;

and

(3) All construction materials are manufactured in the United States. This means that all manufacturing processes for the construction material occurred in the United States.

MATERIALS/MANUFACTURED GOOD(S) BEING USED FOR PROJECT (Please List)

TYPE OF GOOD MAKE & MODEL MANUFACTURING LOCATION

FORM AML-003

Page 2 of 2 Revised 2/2024

CERTIFICATE OF COMPLIANCE WITH BUY AMERICA

I hereby certify that all of the iron and steel, manufactured products, and construction materials supplied or provided by our company for use on this project was manufactured in the United State of America, unless an applicable waiver applies.

or

I am relying on the following Buy America waiver(s) (check all that apply):

De Minimis Waiver Iron and steel, manufactured products, and construction materials supplied/provided by our company equal no more than 5 percent of the total applicable project costs of the iron and steel, manufactured products, and construction materials used in and incorporated into this project.

Small Grants Waiver The total award amount does not exceed the Simplified Acquisition Threshold of currently $250,000.00 and is not anticipated to exceed the Simplified Acquisition Threshold for the life of the award and is not subject to the provisions of Buy America.

Representative Name Title

Representative Signature Date

FORM AML-003 - CERTIFICATE OF COMPLIANCE BABA