D.3 Statement of FAR 52.222-41 - Statement of DoL WD Compliance.docx

DOCX document 15 KB Posted

Attached to
Research Biosafety Cabinet, Laboratory Equipment Certification & Service
Solicitation number
36C25026Q0900
Issued by

About this file

This is a Statement of Department of Labor Wage Determination Compliance certification template required for federal contracting under FAR 52.222-41. The document serves as a memorandum for record in which a contractor certifies that all employees performing services under a resultant contract will be compensated at hourly rates equal to or greater than the current Department of Labor Wage Determination rates applicable to the county where the supporting VA Medical Center is located. The template requires signature certification from the Company Owner, CEO, and COO, along with their printed names and dates. The document references solicitation number 36C25026Q2655 and is directed to Robert Bolcavage, Contracting Specialist at NCO-10, with space provided for the contractor to list relevant occupational codes and titles subject to wage determination requirements.

This compliance statement applies to the Cincinnati VA Medical Center's Research & Development Department contract for Biosafety Cabinet, Laboratory Equipment Certification & Service (Solicitation 36C25026Q0900). The underlying contract opportunity involves certification, calibration, decontamination, and maintenance services for laboratory equipment including Biosafety Cabinets, fume hoods, centrifuges, pipettes, and a Nikon AXR Confocal Microscope to ensure compliance with regulatory standards and maintain a safe research environment. The certifying contractor must confirm adherence to prevailing wage requirements for all service personnel assigned to this Department of Veterans Affairs Veterans Health Administration work.

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Other files

File Type Posted
D.1 36C25026Q0900 RFQ.docx DOCX document
D.5 Past Performance Questionnaire.docx DOCX document
D.2 Memorandum to Confirm Operational Date.docx DOCX document
36C25026Q0900.docx DOCX document
D.4 WD 2015-4719 Rev 34 Cincinnati 12 August 2026.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

REFERENCE: 36C25026Q2655

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 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: ______________

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