BAA_Certification_10.28.2025_(D5) (1).pdf
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- Attached to
- Rockwell Automation PLC Software Licenses, Hardware Support, and TechConnect Support Renewal
- Solicitation number
- SLAC_368076_Rockwell_Automation_PLC_Software_Licenses
- Issued by
-
Department of Energy Office of Science
About this file
This is a Buy American Act Certification form used by the SLAC National Accelerator Laboratory for federal contract procurement compliance. The form requires bidders/offerors to certify whether each end product qualifies as a U.S. domestic commercial product. If all products are domestic, the offeror may skip to Section C and provide signature authorization. If non-domestic products are included, the offeror must complete Sections A, B, and C, identifying any excluded end products per FAR Part 25.104, certifying that remaining products are domestic source end products with no components of unknown origin manufactured outside the United States, and disclosing the estimated percentage of foreign content for each line item (with accuracy within plus or minus 5 percent acceptable). The certification must be signed by an authorized company representative with printed name, title, date, and company name, making the representations and certifications binding as part of the quotation submission.
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Text version
BUY AMERICAN ACT CERTIFICATION (10/28/2025) PAGE 1 OF 1
SUPPLY CHAIN MANAGEMENT
BUY AMERICAN ACT CERTIFICATION
Number _____________________________________
The bidder/offeror hereby certifies that each end product qualifies as a U.S. domestic commercial product.
Yes No
If the answer above is Yes, skip to Section (C). If the answer above is No, fill out Sections (A), (B) and
(C) Below:
A. Excluded end products, in accordance with FAR Part 25.104. (Mark "N/A" if not-applicable)
B. The bidder/offeror hereby certifies that each end product, except the end products listed below, is a domestic source end product (as defined in the Buy American Act provisions); and that NO components of unknown origin have been mined, produced, or manufactured outside the United States.
The bidder/offeror will represent (as an estimate), herein, before the award of a purchase order or subcontract, the percent of the foreign content of the item or service being procured expressed as a percent of the total purchase order/subcontract award price (accuracy within plus or minus 5 percent is acceptable).
Line Item No. Country of Origin Percent (%) of Foreign Content:
c. THE OFFEROR’S SIGNATURE MAKE THE ABOVE REPRESENTATIONS AND CERTIFICATIONS
PART OF THEIR QUOTATION
Offeror’s Signature: Date:
Printed Name:
Title:
Company Name:
| Line Item NoRow1: |
| Country of OriginRow1: |
| Percent of Foreign ContentRow1: |
| Line Item NoRow2: |
| Country of OriginRow2: |
| Percent of Foreign ContentRow2: |
| Line Item NoRow3: |
| Country of OriginRow3: |
| Percent of Foreign ContentRow3: |
| Printed Name: |
| Company Name: |
| Dropdown1: [Choose One.] |
| Check Box3: Off |
| Check Box4: Off |
| Section A: |
| Date5_af_date: |
| Title: |
| No: |
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