Appendix G - Affirmation and Certification of Subcontract Terms and Conditions.pdf
PDF 577 KB Posted
- Solicitation number
- RFP-SC-25-672
- Issued by
-
Department of Energy Ames Laboratory
About this file
This document is an Affirmation and Certification of Environment, Safety and Health (ESH) Requirements form for a subcontract at Ames National Laboratory. The form is associated with Subcontract No. SC-25-672 for the MD160A Magnet Test Bed Phase 2 project, operated by Iowa State University for the U.S. Department of Energy. The form requires a subcontractor to review and affirm compliance with specific environmental, safety, and health requirements, including laws, regulations, and DOE directives. A legally authorized representative must sign the document, certifying under penalty of perjury that the affirmations and certifications are accurate, current, and complete, with key contact representatives from Ames National Laboratory being Andrew Saxton (Procurement Agent) and Mitch Amundson (Technical Representative).
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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-25-672 Project: MD160A Magnet Test Bed Phase 2
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 Mitch Amundson, Technical Representative Phone: 515-294-3614 Email: mitcha92@ameslab.gov
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.
File details come from the government source that posted it. Updated .