D.3 Statement of FAR 52.222-41 Statement of DoL WD Compliance.docx
FAR Clause DOCX document 15 KB Posted
- Attached to
- 7195--Moving, Storage, Inventory, and Installation Services | Base Plus 4 | VA Ann Arbor Healthcare System
- Solicitation number
- 36C25026Q0717
About this file
This is a Statement of Department of Labor Wage Determination Compliance form (FAR 52.222-41) that contractors must complete and submit as part of their offer for solicitation 36C25026Q0717. The form requires company leadership—specifically the Owner, CEO, and COO—to certify under oath that all employees performing services under the resulting contract will be paid at hourly rates equal to or greater than the current Department of Labor Wage Determinations specified in the Performance Requirements Summary section of the Performance Work Statement. The wage determinations are applicable by labor category for the county in which the VA medical center being supported is located.
This compliance certification is a mandatory submission requirement for the moving, storage, inventory, and installation services contract supporting the VA Ann Arbor Healthcare System in Washtenaw County, Michigan. The form must be signed by authorized company representatives and includes reference to the applicable wage determination document (WD 2015-4833 Rev 31, effective July 20, 2026). This requirement applies to all labor categories and positions supporting the contract performance.
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Other versions and copies of FAR 52.222-41
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Who attaches FAR 52.222-41
Other files
| File | Type | Posted |
|---|---|---|
| D.4 Past Performance Questionnaire.docx | DOCX document | |
| D.2 WD 2015-4833 Rev 31 Washtenaw 20 Jul 2026.txt | TXT text file | |
| 36C25026Q0717_2.docx | DOCX document | |
| D.1 36C25026Q0717.docx | DOCX document |
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Text version
D.2 52.222-41 (Addendum B) – Statement of Department of Labor Wage Determination Compliance
MEMORANDUM FOR RECORD
07/20/2026
REFERENCE: 36C25026Q0717
TO: Elizabeth Koses (Contracting Officer), NCO-10
FROM: ________
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 in the Performance Requirements Summary (PRS) section of the Performance Work Statement (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:
• (WD, Labor Occupation #, 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: ______________
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