26FS0004_-_CUF_Certification_Form.pdf
PDF 179 KB Posted
- Solicitation number
- 0000038701
- Issued by
- Fresno County, Inyo County, Kings County, Madera County, Mariposa County, Merced County, Mono County, Monterey County, San Benito County, Tulare County, Fresno City, Kingsburg City, Inyokern CDP, Monterey Park City, Madera City, Madera Acres CDP, Madera Ranchos CDP, Corte Madera Town, Mariposa CDP, Merced City, University of California-Merced CDP, Mono City CDP, Monterey City, Kings Beach CDP, Monterey Park Tract CDP, East Tulare Villa CDP, Tulare City, Mono Vista CDP, California
About this file
Summary
This is a Commercially Useful Function (CUF) Certification Form issued by the State of California Department of Veterans Affairs in conjunction with solicitation 26FS0004, which is a DVBE-only exterior window cleaning services contract for the Veterans Home of California at Fresno. The form must be completed by all certified Small Business (SB), Micro Business (MB), and Disabled Veteran Business Enterprise (DVBE) firms that will perform any element of the work. The certification requires respondents to affirm through five questions whether their business will be responsible for executing a distinct element of work, will carry out contract obligations through actual performance or management, will perform work normal to their business functions, will not subcontract beyond normal industry practices, and will not serve merely as a pass-through entity for appearance of participation. Responses of "No" to questions 1-3 or "Yes" to question 4 will result in disqualification as non-responsive.
The form requires authorized representatives to provide a written statement detailing the specific role, services, and goods their company will provide to satisfy CUF requirements and to certify under penalty of perjury that all information submitted is truthful and accurate. The certification applies to prime contractors, subcontractors, and suppliers, and is governed by California Government Code Section 14837(d)(4) for SB firms and California Military and Veterans Code Section 999(b)(5)(B) for DVBE firms. The State reserves the right to request additional clarifying information prior to contract award.
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Text version
State of California Department of Veterans Affairs
COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM
CV 012 (REV. 08/2023) Page 1 of 2
Solicitation Number:
Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.
1. CONTRACTOR NAME (Completing Form) "DOING BUSINESS AS" (DBA) NAME: OSDS REF # (Currently certified firms only): Expiration Date:
2. COMMERCIALLY USEFUL FUNCTIONS (CUF)
All certified Small Business, Micro Business, and/or DVBE prime 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).
Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:
Mark all that apply: DVBE Small Business Micro Business
1 If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work? Yes No
2 If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved? Yes No
3 If awarded a contract, will you perform work that is normal for your business, service and functions? Yes No
4 If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices? Yes No
5 If awarded a contract, will your business role be 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
A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.
3. WRITTEN STATEMENT
Provide a written statement below detailing the role, services and goods your company will provide to meet the commercially useful function requirement. At the State's option prior to award, you may be required to submit additional clarifying information
State of California Department of Veterans Affairs
CV 012 (REV. 08/2023) Page 2 of 2
AUTHORIZING SIGNATURE (REQUIRED)
The signatory of this document must be the certified business owner (or authorized representative 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.
AUTHORIZED REPRESENTATIVE SIGNATURE: TITLE:
PRINTED NAME: DATE:
State of California Department of Veterans Affairs
CV 012 (REV. 08/2023) Page 1 of 2 Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.
1. CONTRACTOR NAME (Completing Form)
2. COMMERCIALLY USEFUL FUNCTIONS (CUF)
All certified Small Business, Micro Business, and/or DVBE prime 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).
Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:
Mark all that apply:
If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work?
If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved?
If awarded a contract, will you perform work that is normal for your business, service and functions?
If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices?
If awarded a contract, will your business role be 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?
A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.
3. WRITTEN STATEMENT
State of California Department of Veterans Affairs
COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM
CV 012 (REV. 08/2023) Page 2 of 2
AUTHORIZING SIGNATURE (REQUIRED)
The signatory of this document must be the certified business owner (or authorized representative 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.
9.0.0.2.20101008.1.734229
| SolicitationNumber: 26FS0004 |
| DoingBusinessAs: |
| OSDSRefNumber: |
| ExpirationDate: |
| : |
| Yes: |
| No: |
| ProvideAWrittenStatement: |
| AuthorizedRepresentative: |
| Title: |
| PrintedName: |
| Date: |
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