7._Bidder_Declaration_-_GSPD-05-105.pdf

State of California-Department of General Services, Procurement Division

GSPD-05-105 (REV 08/09)

BIDDER DECLARATION

1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form}:

Solicitation Number 23BS0013

a. Identify current California certification(s) (MB, SB, NVSA, DVBE}: _____ or None 0_ (If "None'; go to Item #2)

b. Will subcontractors be used for this contract? Yes D No D (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary.

c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes D No D

(2) If the contract includes equipment rental,does[f co any own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/AO

2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB, SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?

CER TIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.

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