Appendix G - Affirmation and Certification of Subcontract Terms and Conditions.pdf
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- Solicitation number
- RFP-SC-25-665
- 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 with Ames National Laboratory. The form is associated with the MD 150 Remodel project (Subcontract No. SC-25-665), operated by Iowa State University for the U.S. Department of Energy. The document requires a subcontractor to review and affirm compliance with specific environmental, safety, and health requirements, including laws, regulations, and DOE directives. The subcontractor must initial and sign the form, certifying under penalty of perjury that they have comprehensively reviewed and communicated the clausal requirements to all associated sub-subcontractors, suppliers, and manufacturing entities involved in the project.
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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-25-665 Project: MD 150 Remodel
SUBCONTRACTOR NAME:
Address:
City, State, Zip:
POC:
Phone:
Email:
AMES NATIONAL LABORATORY’S REPRESENTATIVES:
Nicole Howe, Procurement Agent Phone: 515-294-1985 Email: nhowe@ameslab.gov Leigh Wiand, 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-25-665. 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.
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Date: Click or tap to enter a date.
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