Appendix A: Sample Review Certifications

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Exhibit A-1. Sample Pre-Award Buy America Compliance Certification

PRE-AWARD BUY AMERICA COMPLIANCE CERTIFICATION

As required by Title 49 of the CFR, Part 663 – Subpart B, __________________________________________
_____________________(the recipient) is satisfied that the rail vehicles to be purchased, _____________________
(number and description of rail vehicles) from __________________________________________________________
_____________________(the manufacturer), meet the requirements of Section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended. The recipient checkbox, or its appointed analyst checkbox____________
________________________________________________________________________________________
(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 rail vehicles identified by manufacturer, country of origin, and cost; and (2) the proposed location of the final assembly point for the rail vehicles, including a description of the activities that will take place at the final assembly point and the cost of final assembly.

Date: _____________________


Signature: _____________________Title: _____________________

Exhibit A-2. Sample Pre-Award Buy America Exemption Certification

PRE-AWARD BUY AMERICA EXEMPTION CERTIFICATION

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 rail vehicles to be purchased, _____________________________________________________________________________
______________________________________________________________________________________
(number and description of rail vehicles), 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: _____________________

Exhibit A-3. Sample Pre-Award Purchaser's Requirements Certification

PRE-AWARD PURCHASER’S REQUIREMENTS CERTIFICATION

As required by Title 49 of the CFR, Part 663 – Subpart B, _________________________________________
_____________________(the recipient) certifies that the rail vehicles to be purchased, ________________________
_____________________(number and description of rail vehicles) 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 rail vehicle that meets the specifications.

Date: _____________________


Signature:_____________________ Title: _____________________

Exhibit A-4. Sample Post-Delivery Buy America Compliance Certification

POST-DELIVERY BUY AMERICA COMPLIANCE CERTIFICATION

As required by Title 49 of the CFR, Part 663 – Subpart C, __________________________________________
__________________(the recipient) certifies that it is satisfied that the rail vehicles received, _____________________
(number and description of rail vehicles) from _________________________________________________________
_____________________(the manufacturer), meet the requirements of Section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended. The recipient checkbox, or its appointed analyst checkbox___________
_______________________________________________________________________________________
(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 rail vehicles identified by the manufacturer, country of origin, and cost; and (2) the actual location of the final assembly point for the rail vehicles, including a description of the activities that took place at the final assembly point and the cost of final assembly.

Date: _____________________


Signature: _____________________Title: _____________________

Exhibit A-5. Sample Post-Delivery Buy America Exemption Certification

POST-DELIVERY BUY AMERICA EXEMPTION CERTIFICATION

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 rail vehicles received, ___________________________________________________________________________
________________________________________________________________________________________
(manufacturer, number and description of rail vehicles), 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: _____________________

Exhibit A-6. Sample Post-Delivery Purchaser's Requirements Certification

POST-DELIVERY PURCHASER’S REQUIREMENTS CERTIFICATION

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 rail vehicles, _____________________
(number and description of rail vehicles). The inspector monitored manufacturing and completed a report on the manufacture of the rail vehicles providing accurate records of all vehicle construction activities. The report addresses how the construction and operation of the rail vehicles fulfill the contract specifications. After reviewing the report, visually inspecting the rail vehicles, the recipient certifies that the rail vehicles meet the contract specifications.

Date: _____________________


Signature: __________________Title: _____________________