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EECBG BUY AMERICAN CERTIFICATION ND DEPARTMENT OF COMMERCE/DCS SFN 59473 (3/10)   

Recipient Name City

Address State

Zip Code

Primary Contact Name

Primary Telephone Number

Project Name

Project Location

Grant Award Number

Manufactured in USA1

Project Materials

1

Cost

Include copy of verification that product is manufactured in the USA.

Certification: I certify to the best of my knowledge and belief this information is correct and complete. Name

Title

Signature

Date


Buy American certification for EECBG