specs

Appendix B
REGIONALLY MANUFACTURED INFORMATION FORM
Date_____________ SUBMITTAL NUMBER_______________
Project Name:
The undersigned Contractor certifies to the best of the Contractor's knowledge, information, and belief the information contained herein is true
and accurate.
Contractor Name / Address Legibly Printed Name
Contact Email Title
Telephone Fax Date
Signature
Product Description
CSI Section Number
(Required for all
Products)
Manufacturer and
Product Trade Name
Total Product
Cost ($)
Distance Between
project and
Manufacturer
(in miles)
Percentage Of
Material
Manufactured
Regionally
Distance
between
Project and
Extraction
Site (in
Miles)
Percentage
of Material
Extracted /
Harvested
Regionally
Regional
Content /
Extracted
Content
Information
Source