Quonset_Hut_BABA_form.pdf

210 KB Posted

Attached to
Conservation/WL/D1-Quonset Hut Wiring
Solicitation number
SRC0000027914
Issued by
Limestone County, Alabama

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This is a Vendor Certificate of Compliance form for the Build America, Buy America Act issued by the Alabama Department of Conservation and Natural Resources (DCNR) for the Quonset Hut Wiring project located at 21453 Harris Station Road in Tanner, Alabama. The project involves purchasing electrical components including a w2P60A circuit breaker, w2P30A circuit breaker for the water heater, and associated materials such as conduit, wiring, circuit breaker, and receptacle for a 30A 240V heater.

The form requires vendors to certify whether the steel, manufactured products, and construction materials meet the Build America, Buy America Act requirements, specifically confirming if items are produced or manufactured in the United States as defined by the Infrastructure and Investment Jobs Act (Public Law 117-58). The certificate provides two options for vendors: a compliance certification affirming U.S. origin of materials, or a non-compliance certification indicating the materials do not meet the specified requirements. No specific pricing, funding sources, or contract term details are provided in this compliance document.

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SRC27914._specs_for_Quonset_wiring.pdf PDF
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VENDOR CERTIFICATE of COMPLIANCE with BUILD AMERICA, BUY AMERICA ACT Procurement of Steel, Iron, or Manufactured Products, and Construction Materials

1) To be completed by the Alabama Department of Conservation and Natural Resources (DCNR). Instructions: DCNR representative/employee must submit this completed form with Purchase Order Requests and Materials Receipts.

FOR DCNR USE ONLY:

TITLE OF INFRASTRUCTURE PROJECT: _________________________________________________________

GRANT AWARD (FAIN) NUMBER: ______________________________________________________ _____

LOCATION OF INFRASTRUCTURE PROJECT: ____________________________________________________

ITEMS REQUESTED FOR PURCHASE: __________________________________________________________

2) To be completed by the VENDOR. Instructions: VENDOR shall complete the information below and submit it to DCNR representative/employee.

Items Supplied for Purchase by Vendor Under This Certificate

Item Description Quantity

Steel

Manufactured Product

Construction Material

Certificate of Compliance with Build America, Buy America Requirements I hereby certify that, to the best of my knowledge, the iron, steel, manufactured products, and/or construction materials itemized above to be furnished to the Alabama Department of Conservation and Natural Resources for the construction of the above referenced infrastructure project are compliant with the Build America Buy America Act as having been produced or manufactured in the United States of America as defined by §70912 “Definitions” of the Infrastructure and Investment Jobs Act (IIJA) (Public Law 117-58 - Nov.

15, 2021) and applicable laws and policies pursuant to: “Buy America” - DOI Financial Assistance.

Signature________________________________________________________________ Date:___________________

Company________________________________________________________________ ________________________

Name___________________________________________________________________ ________________________

Title____________________________________________________________________ ________________________

Certificate of Non-Compliance with Build America, Buy America Requirements

I hereby certify that, to the best of my knowledge, the iron, steel, manufactured products, and/or construction materials itemized above to be furnished to the Alabama Department of Conservation and Natural Resources for the construction of the above referenced infrastructure project ARE NOT compliant with the requirements of Public Law 117-58 and applicable laws and policies pursuant to:

“Buy America” - DOI Financial Assistance.

Signature_______________________________________________________________ Date:____________________

Company_______________________________________________________________ ________________________

Name__________________________________________________________________ ________________________

Title___________________________________________________________________ ________________________

TITLE OF INFRASTRUCTURE PROJECT: Quonset Hut Wiring @ D1 Office
LOCATION OF INFRASTRUCTURE PROJECT: 21453 HARRIS STATION RD TANNER Alabama 35671
ITEMS REQUESTED FOR PURCHASE 1: w 2P60A circuit breaker, w 2P30A circuit breaker for the water heater.
ITEMS REQUESTED FOR PURCHASE 2: conduit, wiring, circuit breaker, and receptacle for a 30A 240V heater
Items Supplied for Purchase by Vendor Under This Certificate:
Item DescriptionSteel:
QuantitySteel:
Item DescriptionManufactured Product:
QuantityManufactured Product:
Item DescriptionConstruction Material:
QuantityConstruction Material:
Company:
Name:
Title:
Date 1:
Date 2:
Date 3:
Date 4:
Company_2:
Name_2:
Title_2:
Date 1_2:
Date 2_2:
Date 3_2:
Date 4_2:

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