26WS0010_-_Darfur_Contracting_Act_Certification.pdf
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- Solicitation number
- 0000039350
About this file
This is a Darfur Contracting Act Certification form required by the State of California for the solicitation 26WS0010, which pertains to Temporary/Relief Physician/Surgeon and Chief Medical Officer Services at the Veterans Home of California at West Los Angeles. The certification applies to any company that has conducted business activities or operations outside the United States within the previous three years. Companies meeting this criterion must certify their compliance status to be eligible to submit bids or proposals. The form provides two certification options: companies may certify that they are not a scrutinized company as defined under Public Contract Code Section 10476, or they may demonstrate that they have received written permission from the California Department of General Services to submit a proposal despite being classified as a scrutinized company.
Bidders must complete the appropriate certification option by providing their company name, Federal ID Number, and an authorized signature from a representative with legal authority to bind the company. The certification must be made under penalty of perjury in accordance with California law. Companies without business activities or operations outside the United States within the previous three years are exempt from this requirement. All questions regarding the solicitation must be submitted via email, and prospective bidders should consult the Notice to Prospective Bidders for the complete timeline, scope of work, and service specifications detailed in Exhibits A and A-1.
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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
Solicitation: 26WS0010
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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