Attachment_10_Darfur_Contracting_Act.pdf

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0000000010
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California

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This document is the Darfur Contracting Act Certification required for State of California contracts. The certification requires companies that have had business activities or operations outside of the United States within the previous three years to certify that they are not a scrutinized company as defined by the Act, or to provide written permission from the Department of General Services to submit a bid or proposal. Companies that have not had such international business activities do not need to complete the certification. The certification must be signed by an authorized representative of the company and submitted with the bid or proposal.

The document outlines the two options for completing the certification: 1) Certifying that the company is not a scrutinized company, or 2) Providing written permission from the Department of General Services to submit a bid as a scrutinized company. The certification requires the company's name, Federal ID number, and the signature of an authorized representative. If the company is a scrutinized company, it must include a copy of the written permission from the Department of General Services with the bid or proposal.

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REV 8/11/2010 1 of 1

DARFUR CONTRACTING ACT CERTIFICATION

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

Date Executed Executed in the County and State of

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.

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

Initials of Submitter

Printed Name and Title of Person Initialing

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