St-2 Steel Origin Certification: Non-Identifiable, Non-Structural Steel Form - Commonwealth Of Pennsylvania
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1ST-2 STEEL ORIGIN CERTIFICATION:
NON-IDENTIFIABLE, NON-STRUCTURAL STEEL
This form must be executed by the Purchaser and the Fabricator of any item containing steel that is not
structural steel. This form must be submitted to the CIS within 30 days from the date the Professional
approves a GSC-23 listing a "steel product". No steel product may be delivered on-site unless DGS has
received the ST form. Structural steel is defined as steel products used as a basic structural element of a
project (i.e., steel beams, columns, decking stairways, reinforcing bars, pipes, etc.). Purchasers of structural
steel products (contractors or subcontractors) must provide bills of lading, invoices and mill certifications that
the steel was manufactured in the United States instead of this form. The Fabricator shall be herein defined as
the firm that assembles the component parts of the product to be purchased. The Department of General
Services will accept the certification of firms that are earlier in the chain of purchase (i.e., manufacturers of
components, steel suppliers) in lieu of the Fabricator.
A. TO BE COMPLETED BY THE PURCHASER:
1.
Name of purchasing firm:_____________________________________________________________
2.
Firm's address:________________________________________________________________________
3.
Firm's phone number:____________________ 4. Date submitted to Fabricator:____/____/___
5.
Contract No. DGS ______________________
6. Contract title:___________________________
7.
Steel Product Certified:________________________________________ 8. GSC-23#___________
Model: ___________________________________________
B. TO BE COMPLETED BY THE FABRICATOR/MANUFACTURER:
9.
Name of firm:________________________________________________________________________
10.
Address of firm:_____________________________________________________________________
11.
Firm's phone number:_____________________________ 12. Date received:_____/______/___
13.
Federal Employer ID. No.:_____________________________________________
CERTIFICATION:
I, the undersigned officer of the Fabricator/Manufacturer, do certify that our firm
assembled/fabricated the components to the steel products listed in Section A, Item 7, and that all steel
components therein are comprised of steel that is melted and/or manufactured in the United States.
I
understand that, by signing this document, I certify that I have received assurances from the
suppliers/manufacturers of the components that said components do not contain foreign manufactured steel. I
further understand that this document is subject to the provision of the Unsworn Falsification to Authorities Act
(18 P.S. § 4904). I also understand that I am subject to the provisions of the Steel Products Procurement Act
(73 P.S. § 1881, et seq.) which provides penalties including, but not limited to, debarment from supplying any
products for Commonwealth of Pennsylvania public works projects for a period of five (5) years for violations
therein. I agree to provide documentation supporting these facts if requested by the Commonwealth. The
Commonwealth reserves the right to pursue any action deemed necessary to protect the Commonwealth's
interest and ensure compliance with the laws of the Commonwealth.
WITNESS:
__________________________________
_____________________________________(Seal)
Name:
Name:
Secretary or Treasurer
President or Vice President
(Rev. 6/1/99)
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