D.3 Statement of FAR 52.222-41 - Statement of DoL WD Compliance.docx
DOCX document 15 KB Posted
- Attached to
- V225--Ambulance Service (Columbus)
- Solicitation number
- 36C25026Q7571
About this file
This is a Statement of Compliance document for Federal Acquisition Regulation (FAR) 52.222-41, addressing Department of Labor (DoL) Wage Determination compliance requirements for the ambulance service procurement. The document serves as a certification template requiring the contractor to acknowledge compliance with prevailing wage standards applicable to the Columbus, Ohio service area under Wage Determination 2015-4729 Rev 33 (effective May 13, 2026). The statement obligates the selected vendor to pay all employees engaged in the performance of this contract in accordance with the established prevailing wage rates for ambulance service workers in the specified geographic location, as determined by the Department of Labor.
This compliance statement is a mandatory submission for the Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside solicitation (36C25026Q7571) issued by the Department of Veterans Affairs Veterans Health Administration, Veterans Integrated Service Network 10 (VISN 10). Contractors must execute and return this compliance certification as part of their quotation package to demonstrate their commitment to meeting federal prevailing wage requirements for the V225 Ambulance Service contract opportunity in Columbus. Failure to certify compliance or subsequent non-compliance with the stated wage determination standards may result in contract default or suspension.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25026Q7571 0003.docx | DOCX document | |
| 36C25026Q7571 0004.docx | DOCX document | |
| D.1 36C25026Q7571 RFQ 7.7.2026.docx | DOCX document | |
| 36C25026Q7571_4.docx | DOCX document | |
| D.5 Past Performance Questionnaire updated 7.6.2026.docx | DOCX document | |
| 36C25026Q7571_3.docx | DOCX document | |
| 36C25026Q7571_2.docx | DOCX document | |
| D.7 Compliance Checklist updated 7.6.2026.docx | DOCX document | |
| 36C25026Q7571 0002.docx | DOCX document | |
| D.1 36C25026Q7571 RFQ 7.6.2026.docx | DOCX document | |
| D.6 Statement of Start Date Confirmation updated.docx | DOCX document | |
| 36C25026Q7571_1.docx | DOCX document | |
| D.4 Statement of FAR 52.219-14 Limitations on Subcontracting Compliance.docx | DOCX document | |
| D.5 Past Performance Questionnaire.docx | DOCX document | |
| D.6 Statement of Start Date Confirmation.docx | DOCX document | |
| D.1 36C25026Q7571 RFQ.docx | DOCX document | |
| D.2 WD 2015-4729 Rev 33 Columubs 13 May 2026.docx | DOCX document | |
| D.7 Required Compliance Checklist.docx | DOCX document | |
| 36C25026Q7571.docx | DOCX document |
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Text version
D.3 52.222-41– Statement of Department of Labor Wage Determination Compliance
MEMORANDUM FOR RECORD
5/21/2026
REFERENCE: 36C25026Q7571
TO: Robert Bolcavage (Contracting Specialist), NCO-10 FROM: Contractor Name Address City, State Zipcode
UEI / CAGE CODE
SUBJECT: Statement of Department of Labor Wage Determination Compliance I do hereby certify that the offer submitted by our company in response to the subject solicitation is fully compliant with the requirement that all employees performing services under the resultant contract (if awarded) shall be paid at an hourly rate that is equal to or greater than current Department of Labor Wage Determination (WD) as specified paragraph 8 "Wage Rates" since there is no PRS section in the PWS for all labor categories as appropriate for the county in which the VA medical center being support for this requirement resides to include but not limited to the following:
• Occupational Code (Occupational Title)
· Occupational Code (Occupational Title)
Company OWNER Full Legal Name (PRINT): ________________________________ Company OWNER Signature__________________________________ Date: ______________
Company CEO Full Legal Name (PRINT): ________________________________ Company CEO Signature: _________________________________ Date: ______________
Company COO Full Legal Name (PRINT): ________________________________ Company COO Signature: __________________________________ Date: ______________
File details come from the government source that posted it. Updated .