16._CCHCS-MC-345-_CUFCertification_Form.pdf
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- Attached to
- On-Site Dialysis Request for Proposal SD23-00097
- Solicitation number
- 0000032853
About this file
This document is a Commercially Useful Function (CUF) Certification Form for a government contract opportunity, Proposal Number SD23-00097. The form requires certified Small Businesses (SB), Microbusinesses, and/or Disabled Veteran Business Enterprises (DVBE) to certify that they will perform a commercially useful function when fulfilling the contract. The form asks the contractor to answer a series of questions to demonstrate they are responsible for the execution of a distinct element of the work, will carry out their obligations by performing, managing, or supervising the work, and will be responsible for negotiating price, quality, quantity, ordering, and making payment for the required products, materials, and supplies.
The form requires the owner or authorized officer of the certified business to sign the document under penalty of perjury, attesting that the information provided is truthful and accurate. No other details about the contract opportunity, such as the scope of work, pricing terms, set asides, incumbent information, or funding sources, are provided in this document.
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Text version
Proposal Number: SD23-00097
Attachment 16
CCHCS-MC-345 – Commercially Useful Function (CUF) Certification Form Rev. 11/27/2017
Commercially Useful Function (CUF) Certification Form
Complete the entire form with an original signature.
1. CONTRACTOR NAME
“DOING BUSINESS AS” (DBA) NAME
OSDS REF # (CURRENTLY CERTIFIED FIRMS ONLY)
2. COMMERCIALLY USEFUL FUNCTIONS (CUF)
All certified Small Business (SB), Microbusiness, and/or Disabled Veteran Business Enterprise (DVBE) contractors, subcontractors, or suppliers must meet the commercially useful function requirements under Government Code, Section 14837(d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for
DVBE).
Answer the following questions as they apply to the contractor when fulfilling a contract or purchase order.
Is the contractor responsible for the execution of a distinct element of the work of the contract?
Yes No
Will the contractor carry out its obligation on a contract by actually performing, managing, or supervising the work involved?
Yes No
Will the contractor perform work on a contract that is normal for its business services and functions?
Yes No
Is the contractor responsible, with respect to products, inventories, materials, and supplies required for the contract, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment?
Yes No
Does the contractor perform the work themselves, rather than further subcontracting a portion of the work that is greater than would be expected by normal industry practices?
Yes No
Does the contractor add value by performing the work themselves, rather than being a subcontractor or supplier whose role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation?
Yes No
AUTHORIZING SIGNATURE (REQUIRED)
The signatory of this document must be the certified business owner (or officer in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.
OWNER’S/OFFICER’S SIGNATURE
DATE
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