Exhibit 5 - Buy American Form.pdf

MO 300-1102N (1-16)

EXHIBIT 5

DOMESTIC PRODUCTS PROCUREMENT ACT (BUY AMERICAN) PREFERENCE

In accordance with sections 34.350-34.359, RSMo, the offeror is instructed to provide information regarding the point of manufacture for each of the products being proposed so that the product’s eligibility for the Domestic Products Procurement Act (Buy American) Preference can be determined.

This information is requested for the finished product only, not for components of the finished product. The offeror may be required to provide supporting documentation indicating proof of compliance.

Qualifying for the Domestic Products Preference:

A product qualifies for the preference if one of the following circumstances exist:

• if manufactured or produced in the U.S.; or

• if the product is imported into the U.S. but is covered by an existing international trade treaty, law, agreement, or regulation that affords the specific product the same status as a product manufactured or produced in the U.S.; or

• if only one line of products is manufactured or produced in the U.S.

Non-Domestic Product:

If the product is not manufactured or produced in the U.S. and does not otherwise qualify as domestic, then it will be considered non-domestic and not eligible for the preference.

THE OFFEROR MUST COMPLETE THE FOLLOWING APPLICABLE TABLES TO CERTIFY WHETHER:

(Table 1) ALL products proposed are manufactured or produced in the U.S. and qualify for the Domestic Products Procurement Act Preference;

OR

(Table 2) ALL products proposed are manufactured or produced outside the U.S. and do not otherwise qualify for the Domestic Products

Procurement Act Preference; OR

(Tables 3-6) Not all products proposed fall into the prior two categories so an item-by-item certification is necessary.

The offeror is responsible for certifying the information provided on the exhibit is accurate by signing where indicated at the end of the exhibit.

TABLE 1 – ALL PRODUCTS MANUFACTURED OR PRODUCED IN U.S. (eligible for preference)

Check the box to the right if ALL products proposed are MANUFACTURED OR PRODUCED IN THE U.S.:

TABLE 2 – ALL PRODUCTS MANUFACTURED OR PRODUCED OUTSIDE U.S. AND DON’T QUALIFY FOR PREFERENCE

(ineligible for preference)

Check the box to the right if ALL products proposed are MANUFACTURED OR PRODUCED OUTSIDE THE U.S. and DO NOT

OTHERWISE QUALIFY for the Domestic Products Procurement Act Preference:

TABLES 3 THROUGH 6 – ITEM BY ITEM CERTIFICATION (NOT ALL PRODUCTS PROPOSED FALL INTO PRIOR TWO

TABLES)

• For those line items for which a U.S.-manufactured or produced product is proposed, complete Table 3.

• For those line items which are manufactured or produced outside the U.S. that do not qualify for the Domestic Products Procurement Act

Preference, complete Table 4.

• For those line items which are not manufactured or produced in the U.S., but for which there is a U.S. trade treaty, law, agreement, or regulation in compliance with section 34.359, RSMo, complete Table 5.

• For those line items which are not manufactured or produced in the U.S., but for which there is only one U.S. Manufacturer of that product or line of products, complete Table 6.

TABLE 3 – U.S.-MANUFACTURED OR PRODUCED PRODUCTS (Eligible for Preference)

• List item numbers of products proposed that are U.S.-manufactured or produced and therefore qualify for the Domestic Products Procurement

Act Preference.

• List U.S. city and state where products proposed are manufactured or produced.

Item # U.S. City/State Where Manufactured/Produced Item # U.S. City/State Where Manufactured/Produced

TABLE 4 -- FOREIGN-MANUFACTURED OR PRODUCED PRODUCTS (Not Eligible for Preference)

• List item numbers of products proposed that are foreign manufactured or produced and do not otherwise qualify for the Domestic Products

Procurement Act Preference.

• List country where product proposed is manufactured or produced.

Item # Country Where Manufactured/Produced Item # Country Where Manufactured/Produced

(Exhibit continues on next page)

MO 300-1102N (1-16)

EXHIBIT 5, continued: DOMESTIC PRODUCTS PROCUREMENT ACT (BUY AMERICAN) PREFERENCE

TABLE 5 -- FOREIGN-MANUFACTURED OR PRODUCED PRODUCTS BUT U.S. TRADE TREATY, LAW, AGREEMENT, OR

REGULATION APPLIES (Eligible for Preference)

• List item numbers of products proposed that are foreign manufactured or produced but qualify for the Domestic Products Procurement Act

Preference because a U.S. Trade Treaty, Law, Agreement, or Regulation applies.

• Identify country where proposed foreign-made product is manufactured or produced.

• Identify name of applicable U.S. Trade Treaty, Law, Agreement, or Regulation that allows product to be brought into the U.S. duty/tariff-free.

• Identify website URL for the U.S. Trade Treaty, Law, Agreement, or Regulation.

• NOTE: As an imported product, if an import tariff is applied to the item, it does not qualify for the preference. In addition, “Most Favored

Nation” status does not allow application of the preference unless the product enters the U.S. duty/tariff-free.

Item # Country Where Proposed Foreign-Made Product is

Manufactured/Produced

Name of Applicable U.S.

Trade Treaty, Law, Agreement, or Regulation

Official Website URL for the U.S.

Treaty, Law, Agreement, or Regulation

TABLE 6 -- FOREIGN-MANUFACTURED OR PRODUCED PRODUCTS BUT ONLY ONE US MANUFACTURER PRODUCES

PRODUCT OR LINE OF PARTICULAR GOOD (Eligible for Preference)

• List item numbers of products proposed that are foreign manufactured or produced but qualify for the Domestic Products Procurement Act

Preference because only one US Manufacturer produces the product or line of a particular good.

• Identify country where proposed foreign-made product is manufactured or produced.

• Identify sole US manufacturer name.

• Identify name of sole US manufactured product/line of particular good.

Item # Country Where Proposed Foreign-Made Product is

Manufactured/Produced

Sole US Manufacturer

Name

Name of Sole U.S. Manufactured

Product or Line of Particular Good

The offeror is responsible for certifying the information provided on this exhibit is accurate by signing below:

I hereby certify that the information provided herein is true and correct, and complies with all provisions of sections 34.350 to 34.359, RSMo. I understand that any misrepresentation herein constitutes the commission of a class A misdemeanor.

SIGNATURE (If submitting proposal electronically, scanned or typed signature is acceptable)

COMPANY NAME