ATTACHMENT M - Form C-76B - CONTRACTOR’S CERTIFICATE OF COMPLIANCE.pdf
PDF 195 KB Posted
- Attached to
- IFB 160941 JS Ferry Surry Shipyard Package
- Solicitation number
- IFB-126120
- Issued by
- Southampton County, Virginia
About this file
Form C-76B is a Contractor's Certificate of Compliance for Manufactured Products used by the Virginia Department of Transportation (VDOT) and compliant with Federal Highway Administration (FHWA) regulations under 23 CFR 635.410. This form serves as documentation that manufactured products incorporated into VDOT projects meet Buy America requirements and are produced in the United States. Contractors must submit this certificate at the time of delivery of any manufactured product to the project site. The form requires identification of the manufacturer/supplier, the prime contractor, the project location, and detailed information about each manufactured product including bid item number, bid item description, product description, quantity, and unit of measurement (linear feet, square yards, cubic yards, tons, etc.). The form accommodates multiple bid items across multiple pages to allow comprehensive documentation of all manufactured products used on a project.
Supporting documentation demonstrating compliance with Made in the USA requirements must be organized by Manufactured Products Submittal Number and maintained by the contractor from the date of delivery until three years after project acceptance. This documentation may include off-site test reports and other material quality reports required at the time of delivery. The Prime Contractor's Project Superintendent must certify compliance by signing and dating the form, confirming that all listed manufactured products were produced in the United States and meet all requirements set forth in the project plans and specifications.
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Text version
Form C-76B Rev. 10-1-25
CONTRACTOR’S CERTIFICATE OF COMPLIANCE
FOR MANUFACTURED PRODUCTS
With Buy America Requirements 23 CFR § 635.410
Contract ID No.: Page 1 of ______
VDOT Project No.:
FHWA Project No.:
Manufactured Products Submittal No.:
Project Location & Description
The (Name of Manufacturer/Supplier) has furnished to
(Street Address) (City, State) (Phone)
(Name of Contractor) (Street Address) (City, State) (Phone) the following manufactured products used and permanently incorporated 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,
TONS, etc.)
Submit this form to VDOT at the time of delivery of any manufactured product to the project.
Supporting documentation to demonstrate compliance with the Made in the USA requirements shall be organized by Manufactured Products 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 Certification of Compliance I, the undersigned, hereby certify that the manufactured products listed above and on any additional pages attached to this form were produced in the United States, and that the manufactured products meet all other requirements as set forth in the plans and specifications.
By (Name of Prime Contractor’s Project Superintendent, Typed or Printed)
Title
(Signature of Prime Contractor’s Project Superintendent) Date
Form C-76B Rev. 10-1-25
CONTRACTOR’S CERTIFICATE OF COMPLIANCE
FOR MANUFACTURED PRODUCTS
With Buy America Requirements 23 CFR § 635.410 Contract ID No.: Page 2 of ______
VDOT Project No.:
FHWA Project No.:
Manufactured Products Submittal No.:
Bid Item No. Bid Item Description Product Description (if only a portion of the Bid Item) Quantity
Unit
(LF,YD², YD³,
TONS, etc.)
(Initials of Prime Contractor’s Project Superintendent)
| Contract ID No: |
| Page 1 of: |
| VDOT Project No: |
| FHWA Project No: |
| Submittal No: |
| Project Location Description: |
| The: |
| has furnished to: |
| Bid Item NoRow1: |
| Bid Item DescriptionRow1: |
| Product Description if only a portion of the Bid ItemRow1: |
| QuantityRow1: |
| Unit LFYD² YD³ TONS etcRow1: |
| Bid Item NoRow2: |
| Bid Item DescriptionRow2: |
| Product Description if only a portion of the Bid ItemRow2: |
| QuantityRow2: |
| Unit LFYD² YD³ TONS etcRow2: |
| Bid Item NoRow3: |
| Bid Item DescriptionRow3: |
| Product Description if only a portion of the Bid ItemRow3: |
| QuantityRow3: |
| Unit LFYD² YD³ TONS etcRow3: |
| Bid Item NoRow4: |
| Bid Item DescriptionRow4: |
| Product Description if only a portion of the Bid ItemRow4: |
| QuantityRow4: |
| Unit LFYD² YD³ TONS etcRow4: |
| By 1: |
| Title: |
| Date: |
| Contract ID No_2: |
| Page 2 of: |
| VDOT Project No_2: |
| FHWA Project No_2: |
| Submittal No_2: |
| Bid Item NoRow1_2: |
| Bid Item DescriptionRow1_2: |
| Product Description if only a portion of the Bid ItemRow1_2: |
| QuantityRow1_2: |
| Unit LFYD² YD³ TONS 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 TONS 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 TONS 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 TONS etcRow4_2: |
| Bid Item NoRow5: |
| Bid Item DescriptionRow5: |
| Product Description if only a portion of the Bid ItemRow5: |
| QuantityRow5: |
| Unit LFYD² YD³ TONS etcRow5: |
| Bid Item NoRow6: |
| Bid Item DescriptionRow6: |
| Product Description if only a portion of the Bid ItemRow6: |
| QuantityRow6: |
| Unit LFYD² YD³ TONS etcRow6: |
| Bid Item NoRow7: |
| Bid Item DescriptionRow7: |
| Product Description if only a portion of the Bid ItemRow7: |
| QuantityRow7: |
| Unit LFYD² YD³ TONS etcRow7: |
| Bid Item NoRow8: |
| Bid Item DescriptionRow8: |
| Product Description if only a portion of the Bid ItemRow8: |
| QuantityRow8: |
| Unit LFYD² YD³ TONS etcRow8: |
| Bid Item NoRow9: |
| Bid Item DescriptionRow9: |
| Product Description if only a portion of the Bid ItemRow9: |
| QuantityRow9: |
| Unit LFYD² YD³ TONS etcRow9: |
| Bid Item NoRow10: |
| Bid Item DescriptionRow10: |
| Product Description if only a portion of the Bid ItemRow10: |
| QuantityRow10: |
| Unit LFYD² YD³ TONS etcRow10: |
| Bid Item NoRow11: |
| Bid Item DescriptionRow11: |
| Product Description if only a portion of the Bid ItemRow11: |
| QuantityRow11: |
| Unit LFYD² YD³ TONS etcRow11: |
| Bid Item NoRow12: |
| Bid Item DescriptionRow12: |
| Product Description if only a portion of the Bid ItemRow12: |
| QuantityRow12: |
| Unit LFYD² YD³ TONS etcRow12: |
| Bid Item NoRow13: |
| Bid Item DescriptionRow13: |
| Product Description if only a portion of the Bid ItemRow13: |
| QuantityRow13: |
| Unit LFYD² YD³ TONS etcRow13: |
| Bid Item NoRow14: |
| Bid Item DescriptionRow14: |
| Product Description if only a portion of the Bid ItemRow14: |
| QuantityRow14: |
| Unit LFYD² YD³ TONS etcRow14: |
| Bid Item NoRow15: |
| Bid Item DescriptionRow15: |
| Product Description if only a portion of the Bid ItemRow15: |
| QuantityRow15: |
| Unit LFYD² YD³ TONS etcRow15: |
| Bid Item NoRow16: |
| Bid Item DescriptionRow16: |
| Product Description if only a portion of the Bid ItemRow16: |
| QuantityRow16: |
| Unit LFYD² YD³ TONS etcRow16: |
| Initials of Prime Contractors: |
| Signature2_es_:signer:signature: |
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