Form C-76 Rev. 10-1-25

CONTRACTOR’S CERTIFICATE OF COMPLIANCE

FOR IRON OR STEEL ITEMS

For Compliance with “Buy America” 23 CFR 635.410 Contract ID No.: Page 1 of

VDOT Project No.:

FHWA Project No.:

Iron or Steel Submittal No.:

Project Location & Description

The (Name of Manufacturer/Supplier) (Street Address) (City, State) (Phone) has furnished to (Name of Contractor) (Street Address) (City, State) (Phone) the following items containing iron or steel for permanent use in the above referenced project:

Bid Item No. Bid Item Description Product Description (if only a portion of the Bid Item) Quantity

Unit

(LF,YD²,

YD³, etc.)

Total Cost of Non-Domestic Steel and Iron in this Item

Submit this form to VDOT at the time of delivery of any items containing Iron or Steel to the project. Supporting documentation to demonstrate compliance with the Made in the USA requirements (such as mill test reports manufacturer/supplier certifications, etc.) shall be organized by Iron or Steel Submittal Number and maintained by the contractor from the date of delivery until three years after project acceptance. (Note that documentation such as off-site test reports, etc., when also required for other material quality purposes, is still required at time of delivery.)

Contractor’s Statement of Certification Domestic Material. I hereby certify that all iron or steel manufacturing processes (including melting, mixing, extruding, rolling, bending, casting, forging, etc., and the application of any coating, as applicable), occurred in the United States for the above listed materials and that those materials do meet all other requirements as set forth in the plans and specifications.

Non-Domestic Material. Although the above listed materials do meet all other requirements as set forth in the plans and specifications, all or part of the steel or iron manufacturing process may have occurred outside the United States, so the material is considered non-domestic. The cost of the steel and iron in this material, as delivered to the project, is $ and will be tracked to ensure the total non-domestic ferrous material does not exceed the maximum allowable.

By Title (Name of Prime Contractor’s Project Superintendent, Typed or Printed)

Date (Signature of Prime Contractor’s Project Superintendent)

Form C-76 Rev. 10-1-25

CONTRACTOR’S CERTIFICATE OF COMPLIANCE

FOR IRON OR STEEL ITEMS

For Compliance with “Buy America” 23 CFR 635.410 Contract ID No.: Page 2 of

VDOT Project No.:

FHWA Project No.:

Iron or Steel Submittal No.:

Bid Item No. Bid Item Description Product Description (if only a portion of the Bid Item) Quantity

Unit

(LF,YD²,

YD³, etc.)

Total Cost of Non-Domestic Steel and Iron in this Item

(Initials of Prime Contractor’s Project Superintendent)

Submit this form to VDOT at the time of delivery of any items containing Iron or Steel to the project. Supporting documentation to demonstrate compliance with the Made in the USA requirements (such as mill test reports manufacturer/supplier certificat...