Sample - BABA Compliant Form.docx

DOCX document 14 KB Posted

Attached to
LED Modules
Solicitation number
RFB 605 2700000067 7
Issued by
Elliott County, Kentucky

About this file

This is a Build America, Buy America (BABA) Act compliance certification form used by contractors and material suppliers to certify adherence to federal requirements mandated 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 products and materials provided to a government project comply fully with BABA Act requirements. The form includes designated spaces for listing specific items, products, and materials subject to certification and requires identification of the location where the compliant process took place. The certifying company commits to immediately notify both the prime contractor and project engineer of any changes to the compliance status during the project delivery period.

This certification form serves as documentation of compliance with federal domestic preference requirements applicable to infrastructure projects funded through the IIJA. The form is designed as a template that contractors and suppliers complete on company letterhead and submit as part of project documentation. There are no specific pricing terms, set-asides, or contract award dates associated with this form itself, as it functions as a compliance verification tool rather than a procurement solicitation. The form's primary purpose is to establish an audit trail demonstrating that materials and products meet the domestic content and manufacturing standards required for federally funded 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 .