D5-BAA_Certification - 369233.pdf
PDF 112 KB Posted
- Solicitation number
- Req-369233
- 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 (document number 369233, dated 10/28/2025). The form is a template requiring bidders and offerors to certify whether all end products qualify as U.S. domestic commercial products in accordance with federal procurement regulations.
The certification requires respondents to answer either "Yes" or "No" to whether each end product qualifies as a U.S. domestic commercial product. If the answer is "Yes," the bidder may skip to Section C and provide signature attestation. If the answer is "No," the bidder must complete Sections A, B, and C, which require identification of excluded end products per FAR Part 25.104, certification that all remaining end products are domestic source end products with no components of unknown foreign origin, and an estimate of the total foreign content as a percentage of the purchase order or subcontract award price (with accuracy within plus or minus 5 percent acceptable). The form includes a table for line item numbers, country of origin, and foreign content percentages. Section C requires the offeror's signature, printed name, title, company name, and date, certifying that the representations and certifications become part of their quotation.
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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: 369233 |
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