19._Small_Bus._Subcon-Supplier_(CCHCS-MC-393).pdf
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- Solicitation number
- 0000035871
- Issued by
- California
About this file
This document is a Small Business Subcontractor/Supplier Acknowledgement form for the California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CCHCS), associated with Bid Number SD24-00021. The form is designed to document and confirm a small business or microbusiness subcontractor's commitment to provide services, labor, or supplies as part of a potential contract bid. The form requires the subcontractor to specify their proposed participation percentage of the total bid/cost proposal and outline the commercially useful functions they will provide if the prime contractor is awarded the contract.
The document emphasizes the subcontractor's responsibilities, including the obligation to verify contract award status with the prime contractor and understand that if the bid is awarded based on small business subcontractor preferences, the prime contractor must use the identified small/microbusiness subcontractors unless a formal substitution is requested through specific legal procedures (Public Contract Code Section 4107 and California Code of Regulations, Title 2, Section 1896.10). The form requires the subcontractor to certify the accuracy of the information provided and allows the State to verify the details if necessary.
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Text version
CCHCS-MC-393 – Small Business Subcontractor/Supplier Acknowledgement Rev. 04/05/2018
Bid Number: SD24-00021
Small Business Subcontractor/Supplier Acknowledgement
Name of Bidding Firm/Prime Contractor
Total Dollar Value of Subcontractor Use
This document confirms and acknowledges that the firm named below agreed to be identified by a bidding firm as a proposed small business or microbusiness subcontractor or supplier for a California Department of Corrections and Rehabilitation/California Correctional Health Care Services agreement.
Subcontractor acknowledgements:
a. The subcontracting firm named herein has committed to perform or provide services/labor or supplies equal to a percentage of the total bid/cost proposal price submitted by the bidding firm named above.
b. The subcontracting firm named herein acknowledges the total dollar value of claimed participation identified above.
c. The subcontracting firm named herein agrees to provide the following subcontracted services/labor or supplies under the resulting contract if the bidding firm named above receives the contract award:
Below and/or continued on an attachment is a brief description of the commercially useful function(s) that the subcontractor/supplier identified herein will provide or supply:
The subcontracting firm named herein understands it is its sole responsibility to contact the bidding firm named above to learn if the proposer was awarded the contract pursuant to the referenced bid number and to confirm its subcontract agreement. If the bidding firm named above receives an award based in part on non-small business subcontractor preference, the bidding firm/contractor is obligated to use each small and/or microbusiness subcontractor or supplier identified in its proposal unless a subcontractor substitution is requested after contract execution pursuant to Public Contract Code Section 4107 and California Code of Regulations, Title 2, Section 1896.10.
The person signing below certifies the information supplied on this form is true and accurate to the best of their knowledge and agrees to allow the State to confirm this information, if deemed necessary.
Name of Proposed Subcontractor/Supplier Date Signed
Signature of Subcontractor/Supplier Representative
Telephone Number Email Address (if applicable)
Printed/Typed Name Title
For State Use Only
Information Verified by Date
| Name of Bidding FirmPrime Contractor: |
| Total Dollar Value of Subcontractor Use: |
| Name of Proposed SubcontractorSupplier: |
| Date Signed: |
| Email Address if applicable: |
| PrintedTyped Name: |
| Title: |
| Information Verified by: |
| Date: |
| Text1: |
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