ATTACHMENT L - Form C-76A - CONTRACTOR’S CERTIFICATE OF COMPLIANCE.pdf
PDF 685 KB Posted
- Attached to
- IFB 160941 JS Ferry Surry Shipyard Package
- Solicitation number
- IFB-126120
- Issued by
- Southampton County, Virginia
About this file
This is a Contractor's Certificate of Compliance form (Form C-76A) issued by the Virginia Department of Transportation (VDOT) for compliance with the Build America, Buy America Act under Public Law 117-58. The form serves as a mandatory documentation requirement for contractors delivering construction materials to VDOT projects. Contractors must submit this form at the time of delivery for any construction materials used for permanent installation on the project. The form requires contractors to identify the manufacturer/supplier, list specific bid items and products being supplied with corresponding quantities and units of measure (linear feet, square yards, cubic yards, etc.), and include the VDOT Project Number, FHWA Project Number, Contract ID, and submittal number for tracking purposes.
The form includes a contractor's certification statement in which the Prime Contractor's Project Superintendent attests that all listed construction materials were produced in the United States and that all manufacturing processes required for fabrication occurred within the United States, with materials meeting all plans and specifications requirements. Supporting documentation demonstrating compliance—such as manufacturer and supplier certifications—must be organized by submittal number and retained by the contractor from the date of material delivery through three years following project acceptance. The form accommodates multiple pages to accommodate projects with numerous bid items, with designated fields for contractor and manufacturer information, signatures, dates, and page numbering.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
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
Form C-76A
Rev. 12-9-22
CONTRACTOR’S CERTIFICATE OF COMPLIANCE
FOR CONSTRUCTION MATERIALS
For Compliance with “Build America, Buy America Act” Public Law, No. 117-58, §§ 70901-70953
Contract ID No.: Page 1 of ______
VDOT Project No.:
Build America Buy America
FHWA Project No.: Submittal No.:
Project Location & Description
The (Name of Manufacturer/Supplier) (Street Address) (City, State) (Phone) has furnished to (Name of Contractor) (Street Address) (City, State) (Phone) the following Construction Materials for permanent use in the above referenced project:
Bid Item No. Bid Item Description Product Description
(if only a portion of the Bid Item)
Quantity
Unit
(LF,YD²,
YD³, etc.)
Submit this form to VDOT at the time of delivery of any Construction Materials to the project. Supporting documentation to demonstrate compliance with Build America Buy America Act provisions (such as manufacturer/supplier certifications, etc.) shall be organized by Submittal Number and maintained by the contractor from the date of delivery until three years after project acceptance. (Note that documentation such as off-site test reports, etc., when also required for other material quality purposes, is still required at time of delivery.)
Contractor’s Statement of Certification
I hereby certify that the Construction Materials listed above and on any additional pages attached to this form were produced in the United States, and that all manufacturing processes required for the manufacture of the Construction Materials occurred in the United States, and that the Contraction
Materials meet all other requirements as set forth in the plans and specifications.
By Title (Name of Prime Contractor’s Project Superintendent, Typed or Printed)
Date (Signature of Prime Contractor’s Project Superintendent)
Form C-76A
Rev. 12-9-22
CONTRACTOR’S CERTIFICATE OF COMPLIANCE
FOR CONSTRUCTION MATERIALS
For Compliance with “Build America, Buy America Act” Public Law, No. 117-58, §§ 70901-70953
Contract ID No.: Page ______ of ______
VDOT Project No.:
Build America Buy America
FHWA Project No.: Submittal No.:
Bid Item No. Bid Item Description Product Description
(if only a portion of the Bid Item) Quantity
Unit (LF,YD², YD³, etc.)
(Initials of Prime Contractor’s Project Superintendent)
| Page 1 of: |
| Project Location Description: |
| Bid Item NoRow1: |
| Bid Item DescriptionRow1: |
| Product Description if only a portion of the Bid ItemRow1: |
| QuantityRow1: |
| Unit LFYD² YD³ etcRow1: |
| Bid Item NoRow2: |
| Bid Item DescriptionRow2: |
| Product Description if only a portion of the Bid ItemRow2: |
| QuantityRow2: |
| Unit LFYD² YD³ etcRow2: |
| Bid Item NoRow3: |
| Bid Item DescriptionRow3: |
| Product Description if only a portion of the Bid ItemRow3: |
| QuantityRow3: |
| Unit LFYD² YD³ etcRow3: |
| Bid Item NoRow4: |
| Bid Item DescriptionRow4: |
| Product Description if only a portion of the Bid ItemRow4: |
| QuantityRow4: |
| Unit LFYD² YD³ etcRow4: |
| Title: |
| Date: |
| Page: |
| of: |
| Bid Item NoRow1_2: |
| Bid Item DescriptionRow1_2: |
| Product Description if only a portion of the Bid ItemRow1_2: |
| QuantityRow1_2: |
| Unit LFYD² YD³ etcRow1_2: |
| Bid Item NoRow2_2: |
| Bid Item DescriptionRow2_2: |
| Product Description if only a portion of the Bid ItemRow2_2: |
| QuantityRow2_2: |
| Unit LFYD² YD³ etcRow2_2: |
| Bid Item NoRow3_2: |
| Bid Item DescriptionRow3_2: |
| Product Description if only a portion of the Bid ItemRow3_2: |
| QuantityRow3_2: |
| Unit LFYD² YD³ etcRow3_2: |
| Bid Item NoRow4_2: |
| Bid Item DescriptionRow4_2: |
| Product Description if only a portion of the Bid ItemRow4_2: |
| QuantityRow4_2: |
| Unit LFYD² YD³ etcRow4_2: |
| Bid Item NoRow5: |
| Bid Item DescriptionRow5: |
| Product Description if only a portion of the Bid ItemRow5: |
| QuantityRow5: |
| Unit LFYD² YD³ etcRow5: |
| Bid Item NoRow6: |
| Bid Item DescriptionRow6: |
| Product Description if only a portion of the Bid ItemRow6: |
| QuantityRow6: |
| Unit LFYD² YD³ etcRow6: |
| Bid Item NoRow7: |
| Bid Item DescriptionRow7: |
| Product Description if only a portion of the Bid ItemRow7: |
| QuantityRow7: |
| Unit LFYD² YD³ etcRow7: |
| Bid Item NoRow8: |
| Bid Item DescriptionRow8: |
| Product Description if only a portion of the Bid ItemRow8: |
| QuantityRow8: |
| Unit LFYD² YD³ etcRow8: |
| Bid Item NoRow9: |
| Bid Item DescriptionRow9: |
| Product Description if only a portion of the Bid ItemRow9: |
| QuantityRow9: |
| Unit LFYD² YD³ etcRow9: |
| Bid Item NoRow10: |
| Bid Item DescriptionRow10: |
| Product Description if only a portion of the Bid ItemRow10: |
| QuantityRow10: |
| Unit LFYD² YD³ etcRow10: |
| Bid Item NoRow11: |
| Bid Item DescriptionRow11: |
| Product Description if only a portion of the Bid ItemRow11: |
| QuantityRow11: |
| Unit LFYD² YD³ etcRow11: |
| Bid Item NoRow12: |
| Bid Item DescriptionRow12: |
| Product Description if only a portion of the Bid ItemRow12: |
| QuantityRow12: |
| Unit LFYD² YD³ etcRow12: |
| Bid Item NoRow13: |
| Bid Item DescriptionRow13: |
| Product Description if only a portion of the Bid ItemRow13: |
| QuantityRow13: |
| Unit LFYD² YD³ etcRow13: |
| Bid Item NoRow14: |
| Bid Item DescriptionRow14: |
| Product Description if only a portion of the Bid ItemRow14: |
| QuantityRow14: |
| Unit LFYD² YD³ etcRow14: |
| Bid Item NoRow15: |
| Bid Item DescriptionRow15: |
| Product Description if only a portion of the Bid ItemRow15: |
| QuantityRow15: |
| Unit LFYD² YD³ etcRow15: |
| Bid Item NoRow16: |
| Bid Item DescriptionRow16: |
| Product Description if only a portion of the Bid ItemRow16: |
| QuantityRow16: |
| Unit LFYD² YD³ etcRow16: |
| Bid Item NoRow17: |
| Bid Item DescriptionRow17: |
| Product Description if only a portion of the Bid ItemRow17: |
| QuantityRow17: |
| Unit LFYD² YD³ etcRow17: |
| Initials of Prime Contractors Project: |
| Name Of Manufacturer - Supplier: |
| Street Address: |
| City, State: |
| Phone Number: |
| Name of Contractor: |
| Street Address2: |
| City, State2: |
| Phone Number2: |
| Name Of Prime Contractor's Superintendent: |
| Contract ID No: |
| VDOT Project No: |
| FHWA Project No: |
| Submittal No: |
File details come from the government source that posted it. Updated .