3._Bidder_Certification_(CCHCS-MC-333).pdf
PDF 34 KB Posted
- 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 Bidder Certification form for Bid Number 23-00088 CCHCS-MC-333 issued by the California Department of Corrections and Rehabilitation (CDCR). The form must be submitted with the bidder's response and certifies the business status of the bidder as either a DGS certified Small Business Enterprise, a DGS certified Microbusiness Enterprise, or a large business seeking the Non-Small Business Subcontractor Preference. The bidder must provide their certification number if certified as a small or micro business. The form also requires the bidder to provide company information such as name, address, tax status, and the name and signature of an authorized representative.
The document does not provide details on the products or services being procured, project overviews, quantities, response dates, award dates, or contract term. It focuses solely on the bidder certification requirements for this solicitation.
View the file
Other files
Show all 32
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Bid Number: 23-00088
CCHCS-MC-333 Rev. 08/17/2017
BIDDER CERTIFICATION
This form must be submitted with your bid. Failure to do so may be cause for your bid to be disqualified. If you have obtained certification status as a Small/Micro Business Enterprise from the Department of General Services (DGS) and fail to complete this section, your business may be classified as a large business, which will preclude your bid from receiving the five percent (5%) Small/Micro Business Preference.
BUSINESS STATUS:
I am a DGS certified Small Business Enterprise. My Certification number is: ___________________.
I am a DGS certified Microbusiness Enterprise. My Certification number is: ___________________.
I am a large business seeking the Non-Small Business Subcontractor Preference.
I am a large business.
By virtue of submitting this form, the undersigned is certifying under penalty of perjury that they are the duly authorized representative accepting the terms and conditions expressed in this solicitation.
COMPANY NAME:
STREET ADDRESS: P.O. BOX:
CITY, STATE AND ZIP CODE: CITY, STATE AND ZIP CODE:
TELEPHONE NUMBER: FAX NUMBER:
FEDERAL ID or SOCIAL SECURITY NUMBER: EMAIL ADDRESS: (Address to be used on the matrix)
TAX STATUS: [ ] Individual/Sole Proprietor [ ] Estate or Trust [ ] Partnership
[ ] Corporation (State in which incorporated _____) [ ] Other: ___________________________
PRINT NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:
SIGNATURE OF AUTHORIZED REPRESENTATIVE: DATE:
File details come from the government source that posted it. Updated .