Attachment 3 Place of Manufacture Request Solicitation 1232SA26Q1189.docx
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- Solicitation number
- 1232SA26Q1189
About this file
This is a Place of Manufacture Certification form required for Solicitation Number 1232SA26Q1189, issued by the Department of Agriculture Agricultural Research Service for a High-Speed Optical Coherence Tomography (OCT) System for Analysis of Poultry Tissue. Offerors must complete this attachment to disclose manufacturing location details and certify the origin of the end product. The form requires offerors to provide their company information, identify the specific item/line item being quoted, and document the manufacturer name and complete manufacturing plant address. Offerors must select one of three sourcing options: that the offeror itself manufactures the product in the United States, that the offeror does not manufacture but the item is manufactured within the United States, or that the end product is manufactured outside the United States with specification of the country of origin.
For items manufactured in the United States, offerors must certify whether the cost of components mined, produced, or manufactured in the U.S. meets the applicable FAR Buy American domestic content threshold by selecting yes or no. The certification must be signed by an authorized representative who attests that the information is accurate and acknowledges that this certification constitutes a material representation upon which the Government will rely during evaluation and award. This RFQ is unrestricted and open to all responsible sources; it is not set-aside for small business concerns, with a small business size standard of 1,000 employees under NAICS Code 334516.
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Attachment 3
PLACE OF MANUFACTURE CERTIFICATION
| Solicitation Number: | 1232SA26Q1189 |
| Description: | High-Speed Optical Coherence Tomography (OCT) System for Analysis of Poultry Tissue. |
1. Offeror Info:
- Offeror Name:
- UEI (Unique Entity ID):
2. Product & Manufacturing Details:
(Complete a separate section or attached spreadsheet for each unique item)
- Item Name / Line Item (CLIN):
- Manufacturer Name:
- Manufacturing Plant Street Address:
- City, State/Province, Zip Code:
- Country of Manufacture:
3. Vendor Sourcing Check (Check one):
[ ] The offeror itself MANUFACTURES the end product in the United States.
[ ] The offeror does not manufacture the item, but the place of manufacture is WITHIN the United States.
[ ] The end product is manufactured OUTSIDE the United States.
If outside, specify country of origin:
4. Domestic Content Threshold Certification (For U.S. manufactured items):
Does the cost of components mined, produced, or manufactured in the U.S. exceed the applicable FAR Buy American domestic content threshold?
[ ] Yes [ ] No
AUTHORIZED REPRESENTATIVE SIGNATURE
By signing below, the offeror certifies that the information provided is accurate and acknowledges that this certification forms a material representation upon which the Government will rely during the evaluation and award process.
Name & Title:
Signature:
Date:
Email & Phone:
File details come from the government source that posted it. Updated .