25CS0058_-_Darfur_Contracting_Act_Certification_Form.pdf
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- Solicitation number
- 0000037322
- Issued by
- Imperial County, Los Angeles County, Orange County, Riverside County, San Bernardino County, San Diego County, Orange Cove City, Imperial City, East Los Angeles CDP, Lake Los Angeles CDP, Los Angeles City, Orange City, Lake Riverside CDP, Riverside City, Orangevale CDP, San Bernardino City, Imperial Beach City, Rancho San Diego CDP, San Diego City, San Diego Country Estates CDP, Orange Blossom CDP, California
About this file
This is a Darfur Contracting Act Certification Form for the State of California, Department of General Services, related to contract opportunity 25CS0058 for Window and Window Screen Repair and Replacement Services at the Veterans Home of California in Chula Vista. The form applies to companies with business activities or operations outside the United States within the previous three years and establishes compliance requirements for bidding on state contracts. The solicitation is restricted to certified Small Business (SB) and Minority Business (MB) firms only. Prospective bidders must submit questions by email according to the timeline specified in the Notice to Prospective Bidders, with specific scope of work details provided in Exhibits A-E.
The certification form requires bidders to declare either that they are not a scrutinized company as defined under Public Contract Code Section 10476, or to provide written permission from the Department of General Services if they are a scrutinized company. Bidders must complete the appropriate certification option (Option #1 or Option #2) with their company name, Federal ID Number, authorized signature, and printed name and title of the signing official. The form serves as a prerequisite to bid submission and confirms compliance with California's contracting regulations regarding international business activities and Sudan-related restrictions under the Darfur Contracting Act.
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Text version
Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.
If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.
OPTION #1 - CERTIFICATION
If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.
Company/Vendor Name (Printed) Federal ID Number
By (Authorized Signature)
Printed Name and Title of Person Signing
OPTION #2 – WRITTEN PERMISSION FROM DGS
Pursuant to Public Contract Code Section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.
STATE OF CALIFORNIA
DARFUR CONTRACTING ACT CERTIFICATION
DGS PD 1 (Rev. 12/19)
Date
Agreement Number: 25CS0058
We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477(b). A copy of the written permission from DGS is included with our bid or proposal.
Company/Vendor Name (Printed) Federal ID Number
By (Authorized Signature)
Printed Name and Title of Person Signing
Date
| OPTION #1 - CERTIFICATION |
| OPTION #2 – WRITTEN PERMISSION FROM DGS |
| Federal ID Number: |
| Printed Name and Title of Person Signing: |
| CompanyVendor Name Printed_2: |
| Federal ID Number_2: |
| Printed Name and Title of Person Initialing: |
| CompanyVendor Name: |
| ADA Instructions: |
| Date of signature: |
| Date of signature 2: |
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