Attachment 3 Vendor Country of Origin and Place of Manufacture Declaration Solicitation 1232SA26Q0707.pdf

This is a Vendor Country of Origin & Place of Manufacture Declaration form for federal procurement solicitation 1232SA26Q0707 regarding the Citation 5 Cell Imaging Multi-Mode Reader. The form requires vendors to disclose comprehensive information about the products they are offering, including the manufacturer name, specific place of manufacture by city, state/province, and country, and the country of origin. Vendors must also provide the Harmonized Tariff Schedule code if known.

The declaration requires complete vendor and offeror information including company name, address, contact person, phone number, and email. The form includes a product information table with one line item (0001) for the Citation 5 Cell Imaging Multi-Mode Reader, with blank fields for the manufacturer name, place of manufacture, country of origin, and tariff schedule. An authorized representative must certify under penalty of perjury that all information provided is true, complete, and accurate, and that the products comply with applicable U.S. procurement regulations regarding country of origin. The authorized representative must provide their name, title, and signature.