Appendix F - Affirmation and Certification of Subcontract Terms and Conditions.pdf
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- Solicitation number
- RFP-SC-25-658
- Issued by
-
Department of Energy Ames Laboratory
About this file
This is an Environment, Safety and Health (ESH) Affirmation and Certification form (Form 48300) for subcontract SC-24-658 related to the Legacy Card Reader Project at Ames National Laboratory. The form requires subcontractors to affirm their understanding of and compliance with ESH requirements dated October 30, 2023.
The form requires subcontractors to initial three key clauses: Laws, Regulations, and DOE Directives; Conduct of Employees; and Environment, Safety and Health. Subcontractors must certify they have communicated these requirements to all sub-subcontractors, sub-suppliers, and manufacturing entities. The form is to be signed by an authorized representative who can make legally binding commitments, with Andrew Saxton serving as the Procurement Agent and Jacob Hahn as the Technical Representative for Ames National Laboratory. The form is part of a larger solicitation (RFP SC-25-658) for a Legacy Card Reader Upgrade project at the Department of Energy's Ames Laboratory facility in Iowa.
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Text version
AFFIRMATION AND CERTIFICATION
OF ENVIRONMENT, SAFETY AND HEALTH (ESH)
REQUIREMENTS
Form 48300.
Revision 0, 04/16/2024
Ames National Laboratory is operated by Iowa State University for the U.S. Department of Energy.
Subcontract No. SC-24-658 Project: Legacy Card Reader Project
SUBCONTRACTOR NAME:
Address:
City, State, Zip:
POC:
Phone:
Email:
AMES NATIONAL LABORATORY’S REPRESENTATIVES:
Andrew Saxton, Procurement Agent
Phone: 515-294-4191 Email: saxton@ameslab.gov
Jacob Hahn, Technical Representative Phone:
Email:
A. Affirmation with respect to Ames National Laboratory Environment, Safety and Health Requirements, dated October 30, 2023, and agrees to comply with all the terms and conditions under subcontract SC-24-622. Subcontractor AFFIRMS that it has reviewed and understands the terms and conditions set forth in these applicable documents to the subcontract by placing its initials in the following space:
B. Subcontractor further acknowledges and affirms that it has diligently reviewed and comprehended the clauses set forth below. Furthermore, it confirms having effectively communicated these clauses to all sub-subcontractors, sub-suppliers, manufacturing entities, and other resources to be contracted by the Subcontractor, if applicable, who are carrying out work under this subcontract. Subcontractor shall provide copies of this documentation to the Laboratory Technical Representative and Laboratory Procurement Agent immediately upon request.
Initials Clauses:
LAWS, REGULATIONS, AND DOE DIRECTIVES (based on DEAR 970.5204-2 DEC 2000)
CONDUCT OF EMPLOYEES (AMES LAB MAY 2019)
ENVIRONMENT, SAFETY AND HEALTH (AMES LAB JAN 2019)
CERTIFICATION
A PERSON AUTHORIZED TO MAKE LEGALLY BINDING COMMITMENTS ON BEHALF OF THE SUBCONTRACTOR MUST SIGN BELOW. BY SIGNING BELOW, THE SUBCONTRACTOR CERTIFIES, UNDER PERJURY OF LAW, THAT
THESE AFFIRMATIONS AND CERTIFICATIONS ARE ACCURATE, CURRENT, AND COMPLETE.
Company Name: Click or tap here to enter text.
Signature:
Signer’s Name (Printed): Click or tap here to enter text.
Title: Click or tap here to enter text.
Date: Click or tap to enter a date.
Telephone Number: Click or tap here to enter text.
Email Address: Click or tap here to enter text.
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