Sample - BABA Compliant Form.docx

DOCX document 14 KB Posted

Attached to
LED Modules
Solicitation number
RFB 605 2700000067 4
Issued by
Elliott County, Kentucky

About this file

This is a Build America, Buy America (BABA) Act compliance certification form template designed for use by companies providing products and materials to state and local infrastructure projects funded under the Infrastructure Investment and Jobs Act (IIJA), Public Law 117-58. The form requires a company representative to certify that specified manufacturing or fabrication processes—including melting, bending, coating, galvanizing, cutting, and similar operations—for listed products and materials comply with BABA Act requirements. The certifying company must identify the specific items, products, and materials being provided for the project and document the geographic location where the manufacturing or fabrication processes took place. The form includes a commitment to immediately notify the prime contractor and project engineer of any changes to compliance status during the material supply period.

The certification form contains no pricing terms, set-asides, incumbent information, or other financial details. Instead, it functions as a compliance documentation tool required for project eligibility under federal infrastructure funding. Companies must complete the form with specific product descriptions and manufacturing locations to demonstrate adherence to domestic content requirements mandated by the IIJA legislation. The template is provided as a standardized reference document for contractors and subcontractors involved in state and local infrastructure projects.

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Text version

Company letterhead

Date

Company Name Company Address City, State Zip

Subject: Build America, Buy America Act Step Certification for Project (XXXXXXXXXX)

I, (company representative), certify the (melting, bending, coating, galvanizing, cutting, etc.) process for (manufacturing or fabricating) the following products and/or materials shipped or provided for the subject project is in full compliance with the Build America, Buy America (BABA) Act requirement as mandated in the Infrastructure Investment and Jobs Act (IIJA) Pub. L. No. 117-58, §§ 70901-27.

Item, Products and/or Materials:

1. XXXX

2. XXXX

3. XXXX

Such process took place at the following location: .

If any of the above compliance statements change while providing material to this project, we will immediately notify the prime contractor and the engineer.

Signed by company representative

File details come from the government source that posted it. Updated .