MES Add 2 Att 3 CDBG Materials Certification Form.pdf

PDF 115 KB Posted

Attached to
Town of Morris - East Street Housing Site Infrastructure Project
Solicitation number
34935
Issued by
Middlesex County, Connecticut

About this file

This is a Build America Buy America Materials Certification Form designed for the Town of Morris, Connecticut, in connection with the East Street Housing Site Infrastructure Project, a Community Development Block Grant (CDBG)-funded construction and site development project. The form serves as a compliance document requiring contractors to certify that materials used in the project—including steel, iron, manufactured goods, and construction materials—were produced in the United States of America. The certification form includes spaces for the grantee, contract number, contractor name, and invoice period, along with a detailed inventory section accommodating up to fifteen line items for material documentation. Each material entry requires specification of the material type category, product description, manufacturer name, and product location of origin. Contractors must sign and print their names along with their company information to attest that all listed materials meet the domestic sourcing requirements mandated by federal funding regulations. The form structure allows for comprehensive tracking of materials across multiple invoice periods to ensure ongoing compliance with Buy America provisions throughout project execution.

The certification form is a mandatory compliance document rather than a pricing or contractual instrument, reflecting the increasing emphasis on domestic procurement requirements for federally-funded infrastructure projects. As a CDBG-funded project, the East Street Housing Site Infrastructure Project is subject to Build America Buy America compliance, which requires that all steel, iron, and manufactured products used in the project originate from United States manufacturers. The form does not establish pricing terms, set-asides, or contract amounts; rather, it functions as an administrative verification tool to document material sourcing compliance. Contractors must complete and submit this certification with invoices to demonstrate adherence to federal funding requirements. The extensive line-item capacity indicates anticipation of a complex project with numerous material inputs requiring individual certification, consistent with the project's scope involving site clearing, grading, stormwater systems, septic installation, electrical work, and paving operations across the affordable housing development site.

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Text version

Build America Buy America Materials Certification

Grantee: __________________________________ Contract Number: _______________________

Contractor: ________________________________ Invoice Period: _________________________

Material Type (Steel, Iron, Manufactured

Goods, Construction Materials) Description Name of Manufacturer Location of Product

By signing, I certify that the statements made above are true to the best of my ability and knowledge and that the listed materials for use in this project funded by federal dollars were produced in the United States of America.

Contractor Signature:

Print Contractor Name:

Contractor Company:

Attachment 4-17

Grantee:
Contract Number:
Contractor:
Invoice Period:
Material Type SteelIron ManufacturedGoods ConstructionMaterials:
Description:
Name of Manufacturer:
Location of Product:
Description1:
Name of Manufacturer1:
Location of Product1:
Material Type SteelIron ManufacturedGoods ConstructionMaterials2:
Name of Manufacturer2:
Location of Product2:
Material Type SteelIron ManufacturedGoods ConstructionMaterials3:
Name of Manufacturer3:
Location of Product3:
Material Type SteelIron ManufacturedGoods ConstructionMaterials4:
Name of Manufacturer4:
Location of Product4:
Material Type SteelIron ManufacturedGoods ConstructionMaterials5:
Name of Manufacturer5:
Location of Product5:
Material Type SteelIron ManufacturedGoods ConstructionMaterials6:
Name of Manufacturer6:
Location of Product6:
Material Type SteelIron ManufacturedGoods ConstructionMaterials7:
Name of Manufacturer7:
Location of Product7:
Material Type SteelIron ManufacturedGoods ConstructionMaterials8:
Name of Manufacturer8:
Location of Product8:
Material Type SteelIron ManufacturedGoods ConstructionMaterials9:
Name of Manufacturer9:
Location of Product9:
Material Type SteelIron ManufacturedGoods ConstructionMaterials10:
Name of Manufacturer10:
Location of Product10:
Material Type SteelIron ManufacturedGoods ConstructionMaterials11:
Name of Manufacturer11:
Location of Product11:
Material Type SteelIron ManufacturedGoods ConstructionMaterials12:
Name of Manufacturer12:
Location of Product12:
Material Type SteelIron ManufacturedGoods ConstructionMaterials13:
Name of Manufacturer13:
Location of Product13:
Material Type SteelIron ManufacturedGoods ConstructionMaterials14:
Name of Manufacturer14:
Location of Product14:
Material Type SteelIron ManufacturedGoods ConstructionMaterials15:
Name of Manufacturer15:
Location of Product15:
Print Contractor Name:
Contractor Company:
Material Type SteelIron ManufacturedGoods ConstructionMaterials1:
Description0:
Description2:
Description3:
Description4:
Description5:
Description6:
Description7:
Description8:
Description9:
Description10:
Description11:
Description12:
Description13:
Description14:

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