Sample - BABA Compliant Form.docx

This is a Build America, Buy America (BABA) Act compliance certification form template for the state of Kentucky related to an LED Modules contract opportunity. The form serves as a declaration by a company representative certifying that the manufacturing or fabrication processes—including melting, bending, coating, galvanizing, cutting, and related operations—for products and materials supplied to the project comply fully with BABA Act requirements as mandated under the Infrastructure Investment and Jobs Act (IIJA), Public Law No. 117-58, sections 70901-27. The document requires the supplier to list specific items, products, and materials being provided and identify the geographic location where the applicable manufacturing or fabrication processes occurred.

The certification form includes a commitment that the supplying company will immediately notify both the prime contractor and the engineer of any changes to compliance status during the material provision phase. This template establishes a standardized approach for documenting supply chain compliance with federal domestic content requirements for the LED Modules procurement in Kentucky. The form must be signed by an authorized company representative and submitted as part of the contract documentation to verify adherence to Buy America provisions.