01_RFP-26-801_Att_01_Contractor_Status_Form_ada.docx

ATTACHMENT 1

CONTRACTOR STATUS FORM

This document provides the Energy Commission with basic information about the Bidder.

· Each Bidder must complete, sign and include this attachment in its Proposal.

1. Bidder Information Full Legal Name of Bidder

Business Address

(street number and name)

E-mail

2. Type of Entity or Business Organization Organization Tax ID Number How long under current ownership _______ Nature of Business Activity _____________________________________________________

Number of employees _________ Year established _______ Legal form of organization (check one):

3. Small Business Preference Claim Is your organization certified as a small business by the State of California, or have you applied for certification?

|_| No |_| Yes If yes, list your OSDS Number _________________________ |_| Date certified |_| Application submitted to Office of Small Business Certification and Resources on: (date) 4.

Disabled Veteran Business Participation Acknowledgement I certify that I have read and understand the requirements of DVBE participation and understand my obligations in regard to DVBE. I also understand that failure to meet the requirements of the DVBE will cause my Proposal to be rejected before evaluation.

DVBE Participation Amount must be documented on Attachment 4 Bidder Declaration.

5. Proposal Contents Check to indicate the Proposal material you are submitting (CO to customize)

|_| Administrative Response, Section 1 |_| Technical and Cost Proposal, Section 2 |_| Confidential Information, Section 3 |_| CD ROM or USB memory stick

6. Authorization and Certification I hereby authorize the California Energy Commission to make any inquiries necessary to verify the information I have presented in my Application.

I hereby authorize the California Energy Commission to obtain business credit reports and make any inquiries necessary to verify and evaluate the financial condition of the applicant.

I hereby certify that this application does not contain any confidential or proprietary information.

I hereby certify to the best of my knowledge and belief that I have read, understand, and do hereby accept the terms and conditions contained in this solicitation, including the provisions of the Agreement Terms and Conditions and, further, I am willing to enter into an agreement with the Commission to conduct the proposed project according to the terms and conditions without negotiation.

I hereby certify to the best of my knowledge, and under penalty of perjury, that the information contained in this Application is correct and complete.

I hereby certify that I am authorized to complete and sign this form on behalf of the applicant.

Signature of Authorized Representative Date

Typed Name Title

Assistance