Attach additional sheets that list the Buy America location and domestic content by component to this document package. This will be provided to you by the vendor. Supplier Signature: Date: Print Name: Title: Phone: Email: For each component supplied for the Contract, the Supplier attests that (CHECK ONE BOX): The required percentage of subcomponents, by cost, are of U.S. origin/manufacture, and is manufactured in the U.S. The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated See 49 CFR 661.11(g). Less than the required percentage of the subcomponents, by cost, are of U.S. origin/manufacture, and the component is manufactured in the U.S. (in such case, the cost of U.S. subcomponents is eligible for inclusion towards domestic content calculations). The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated in the attached documents. See 49 CFR 661.11(l). The component contains subcomponents of domestic origin, however, the component is NOT manufactured in the U.S. (in such case, the cost of U.S. subcomponents is eligible for inclusion towards domestic content calculations only if the U.S. subcomponent(s) received a tariff exemption). The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated by the attached documents. See 49 CFR 661.11(j). ROLLING STOCK VEHICLE PROCUREMENT Post-Delivery Audit Report Use the following template to complete the Post Delivery Audit report. Complete all sections highlighted in yellow. Additional comments and sheets may be added. GRANTEE DELIVERY DATE The following information can be obtained from the WisDOT Procurement or will supplied by the vehicle vendor. WisDOT Procurement Line Item Number Cycle/Year: Vehicle Type: Vendor:
Attach additional sheets that list the Buy America location and domestic content by component to this document package. This will be provided to you by the vendor. Supplier Signature: Date: Print Name: Title: Phone: Email: For each component supplied for the Contract, the Supplier attests that (CHECK ONE BOX): The required percentage of subcomponents, by cost, are of U.S. origin/manufacture, and is manufactured in the U.S. The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated See 49 CFR 661.11(g). Less than the required percentage of the subcomponents, by cost, are of U.S. origin/manufacture, and the component is manufactured in the U.S. (in such case, the cost of U.S. subcomponents is eligible for inclusion towards domestic content calculations). The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated in the attached documents. See 49 CFR 661.11(l). The component contains subcomponents of domestic origin, however, the component is NOT manufactured in the U.S. (in such case, the cost of U.S. subcomponents is eligible for inclusion towards domestic content calculations only if the U.S. subcomponent(s) received a tariff exemption). The Supplier attests that the U.S. content of subcomponents, by cost, is as indicated by the attached documents. See 49 CFR 661.11(j). ROLLING STOCK VEHICLE PROCUREMENT Post-Delivery Audit Report Use the following template to complete the Post Delivery Audit report. Complete all sections highlighted in yellow. Additional comments and sheets may be added. GRANTEE DELIVERY DATE The following information can be obtained from the WisDOT Procurement or will supplied by the vehicle vendor. WisDOT Procurement Line Item Number Cycle/Year: Vehicle Type: Vendor:
deliv-docs.docx