19._Small_Business_Subcon-Supplier_(CCHCS-MC-393).pdf
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- Attached to
- SD23-00088 Ocular Prosthetic Services (Region 4)
- Solicitation number
- 0000032627
- Issued by
- San Bernardino County, California
About this file
This document is a Small Business Subcontractor/Supplier Acknowledgement form related to Bid Number SD23-00088 CCHCS-MC-393 for the California Department of Corrections and Rehabilitation/California Correctional Health Care Services. The form confirms that the identified small business or microbusiness subcontractor/supplier has committed to perform or provide services/labor or supplies equal to a percentage of the total bid/cost proposal submitted by the prime contractor. The subcontractor agrees to provide the described commercially useful functions under the resulting contract if the prime contractor is awarded the contract.
The document outlines the responsibilities of the subcontractor, including confirming the contract award, and the obligations of the prime contractor to use the identified subcontractor unless a substitution is requested after contract execution. The form also includes certification that the information provided is true and accurate, and allows the State to confirm the information if deemed necessary.
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Text version
Bid Number: SD23-00088
CCHCS-MC-393 – Small Business Subcontractor/Supplier Acknowledgement Rev. 04/05/2018
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
File details come from the government source that posted it. Updated .