8._Bidder_Declaration.pdf

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Attached to
NCR-HQ-RFQ-26-E0006 Live Sacramento Perch
Solicitation number
0000040739
Issued by
California

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This is a Bidder Declaration form (DFW 1082, Revised 09/30/21) issued by the State of California Department of Fish and Wildlife for the contract opportunity NCR-HQ-RFQ-26-E0006 Live Sacramento Perch, which involves procuring Sacramento perch for fishing in the city. The form serves as a declaration document that bidders must complete and sign under penalty of perjury to certify the accuracy of information provided in their bid submission.

The form requires bidders to identify their California vendor name, current California certifications (Minority-Owned Business, Small Business, or Disabled Veteran Business Enterprise), and whether subcontractors will be utilized. If subcontractors are employed, bidders must list each subcontractor's name, contact person, phone number, email address, complete address, California certification number, description of work or goods provided, and the corresponding percentage of the bid price allocated to that subcontractor. The form includes space for multiple subcontractors and provides an example showing Fix It Now as a subcontractor performing office repairs for 25 percent of the bid price. An authorized representative must sign and date the certification statement to validate that all declared information is true and correct.

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State of California – Department of Fish and Wildlife

BIDDER DECLARATION

DFW 1082 (REV. 09/30/21)

1. Prime bidder information:

a. What is your California vendor name?

b. Identify your current California Certification(s) number(s):

(MB/SB/DVBE):_____________ or None (If “None”, proceed to number 2)

c. Will subcontractors be used for this contract? YES NO (If yes, indicate in the space below the distinct element of work your business will perform in this contract. If no, skip to the certification at the bottom of this page.)

2. If subcontractors will be used, list all subcontractors for this contract in the table below. (Attach additional pages if necessary):

EXAMPLE

Subcontractor Name, Contact Person, Phone Number & Email

Fix it Now John Smith Jr.

(916) 445-1234

JSmithJr@fixitnow.com

Subcontractor complete address

1234 Fix It Pl.

Sacramento, CA

95821

CA Certification Number (MB, SB, DVBE, or None)

SB # 15245

Work performed or good provided for this contract

Office repairs

Corresponding % of bid price 25%

CERTIFICATION: By signing this form (Bidder Declaration), I certify under penalty of perjury that the information provided is true and correct.

Authorizers printed name: _______________________________________ Date: _______________

Authorizers signature: ____________________________________________

Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now
Authorizers Printed Name:
Date:
SAVE:
PRINT:
CLEAR:
What is your California vendor name:
MB SB DVBE:
None: Off
Will subcontractors be used for this contract Yes: Off
Will subcontractors be used for this contract No: Off
If yes indicate in the space below the distinct element of work your business will perform in this contract If no skip to the certification at the bottom of this page:
Subcontractor Name Contact Person Phone Number and Email:
0:
Subcontractor Name Contact Person Phone Number and Email 1:
Subcontractor Name Contact Person Phone Number and Email 2:
Subcontractor Name, Contact Person, Phone Number and Email:
3:
Subcontractor complete address:
0:
1:
2:
3:
CA Certification Number MB SB DVBE or None 0:
CA Certification Number MB SB DVBE or None 1:
CA Certification Number (MB, SB, DVBE, or None) 2:
CA Certification Number MB SB DVBE or None 3:
Work performed or good provided for this contract 0:
Work performed or good provided for this contract:
1:
Work performed or good provided for this contract 2:
Work performed or good provided for this contract 3:
Corresponding percentage of bid price 0:
Corresponding percentage of bid price 2:
Corresponding percentage of bid price 1:
Corresponding percentage of bid price 3:

File details come from the government source that posted it. Updated .