Appendix A: Sample Review Certifications

As required by Title 49 of the CFR, Part 663 – Subpart B, __________________________________________
_____________________(the recipient) is satisfied that the buses to be purchased, _____________________
(number and description of buses) from __________________________________________________________
_____________________(the manufacturer), meet the requirements of Section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended. The recipient o , or its appointed analyst o ____________
________________________________________________________________________________________
(the analyst – not the manufacturer or its agent), has reviewed documentation provided by the manufacturer, which lists (1) the proposed component and subcomponent parts of the buses identified by manufacturer, country of origin, and cost; and (2) the proposed location of the final assembly point for the buses, including a description of the activities that will take place at the final assembly point and the cost of final assembly.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart B, ______________________________________
_________________(the recipient) certifies that there is a letter from FTA that grants a waiver to the buses to be purchased, _____________________________________________________________________________
______________________________________________________________________________________
(number and description of buses), from the Buy America requirements under Section 165(b)(1), (b)(2), or (b)(4) of the Surface Transportation Assistance Act of 1982, as amended.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart B, _________________________________________
_____________________(the recipient) certifies that the buses to be purchased, ________________________
_____________________(number and description of buses) from ___________________________________
_____________________(the manufacturer), are the same product described in the recipient’s solicitation specification and that the proposed manufacturer is a responsible manufacturer with the capability to produce a bus that meets the specifications.

Date: _____________________

Signature:_____________________ Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart D, _____________________
_____________(the recipient) certifies that it received, at the pre-award stage, a copy of_____________________
_____________’s (the manufacturer) self-certification information stating that the buses, _____________________
(number and description of buses), will comply with the relevant Federal Motor Vehicle Safety Standards issued by the National Highway Traffic Safety Administration in Title 49 of the Code of Federal Regulations, Part 571.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart D, _________________________________________
_________(the recipient) certifies that it received at the pre-award stage, a statement from _________________
_____________________’s (the manufacturer) indicating that the buses, ______________________________
(number and description of buses), will not be subject to the Federal Motor Vehicle Safety Standards issued by the National Highway Traffic Safety Administration in Title 49 Code of Federal Regulations, Part 571.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart C, __________________________________________
__________________(the recipient) certifies that it is satisfied that the buses received, _____________________
(number and description of buses) from _________________________________________________________
_____________________(the manufacturer), meet the requirements of Section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended. The recipient o , or its appointed analyst o  ___________
_______________________________________________________________________________________
(the analyst – not the manufacturer or its agent), has reviewed documentation provided by the manufacturer, which lists (1) the actual component and subcomponent parts of the buses identified by the manufacturer, country of origin, and cost; and (2) the actual location of the final assembly point for the buses, including a description of the activities that took place at the final assembly point and the cost of final assembly.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart C, __________________________________________
_____________________(the recipient) certifies that there is a letter from FTA, which grants a waiver to the buses received, ________________________________________________________________________________
________________________________________________________________________________________
(manufacturer, number and description of buses), from the Buy America requirements under Section 165(b)(1), (b)(2), or (b)(4) of the Surface Transportation Assistance Act of 1982, as amended.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart C, ___________________________________________
_____________________(the recipient) certifies that a resident inspector, _______________________________
(the resident inspector – not an agent or employee of the manufacturer), was at___________________________ ‘s
(the manufacturer) manufacturing site during the period of manufacture of the buses, _____________________
(number and description of buses). The inspector monitored manufacturing and completed a report on the manufacture of the buses providing accurate records of all bus construction activities. The report addresses how the construction and operation of the buses fulfill the contract specifications. After reviewing the report, visually inspecting the buses, and road testing the buses, the recipient certifies that the buses meet the contract specifications.

Date: _____________________

Signature: __________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart C, after visually inspecting and road testing the contract buses,
(the recipient) certifies that the buses, ___________________________________________________________
________________________________________________________________________________________
(number and description of buses) from __________________________________________________________
_____________________(the manufacturer), meet the contract specifications.

Date: _____________________

Signature: _____________________Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart D, _____________________
________________(the recipient) certifies that it received, at the post-delivery stage, a copy of _______________
’s (the manufacturer) self-certification information stating that the buses, _____________________
_____________________(number and description of buses), comply with the relevant Federal Motor Vehicle Safety Standards issued by the National Highway Traffic Safety Administration in Title 49 Code of Federal Regulations, Part 571.

Date: _____________________

Signature:_____________________ Title: _____________________

As required by Title 49 of the CFR, Part 663 – Subpart D,________________________________________
_________(the recipient) certifies that it received, at the post-delivery stage, a statement from ______________
’s (the manufacturer) indicating that the buses, _______________________ __________________________
(number and description of buses), are not subject to the Federal Motor Vehicle Safety Standards issued by the National Highway Traffic Safety Administration in Title 49 Code of Federal Regulations, Part 571.

Date: _____________________

Signature: _____________________Title: _____________________