ST-1 STEEL ORIGIN CERTIFICATION: PRIME CONTRACTOR
This form must be executed by the Prime Contractor and 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 an ST form. A completed form is required for each type of steel product (e.g., beams,
columns, stairways, etc.), from each supplier but not for each piece of steel product.
A. TO BE COMPLETED BY THE PRIME CONTRACTOR:
1. Name of Contractor's firm:___________________________________________________________
2. Firm's address:______________________________________________________________________
3. Firm's phone number: _____________________ 4. Date submitted:_______________________
5. Contract No.________________________ 6. Contract Title:_______________________________
7. Steel Product Certified:__________________________________ 8. GSC-23:____________________
9. Name & Address of Supplier:__________________________________________________________
TYPE OF STEEL PRODUCT (Check and complete one (1) applicable category):
10. _____ Identifiable steel product: 100% of the steel in the product is identifiably
marked as manufactured in the United States.
a. Other documentation required: NONE
b. Manner in which steel product is identifiable:
(1) ______ Stamped "Made in U.S.A."
(2) ______ Stamped "Made in _____________________."
(3) ______ Other. Explain:_____________________________
11. _____ Non-identifiable structural steel: Less than 100% of the steel contained in
the product is identifiable as provided above. 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, structural
lintels, pipes, etc.)
a. Other documentation required: Bills of lading, invoices and mill
certificates that certify that the steel contained in the product was
melted and/or manufactured in the United States.
12. ______ Non-identifiable non-structural steel: all other steel products including door
and window frames, machines, equipment, etc.
a. Other documentation required: Executed Form ST-2
CERTIFICATION: I, the undersigned officer of the Contractor, do certify that, to the best of my knowledge, the steel
product listed above complies with the provisions of the Steel Products Procurement Act (73 P.S. § 1881, et seq., as
amended). I understand that by signing this document I certify that the facts contained herein are true. I further
understand that this document is subject to the provisions of the Unsworn Falsification to Authorities (18 P.S. § 4904)
and the Steel Products Procurement Act, which provides penalties including, but not limited to, debarment from
bidding on any Commonwealth of Pennsylvania public works project for a period of five years. 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)
