25._CUF_Certification_(CCHCS-MC-345).pdf

Bid Number: SD23-00080

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