attachment_3,_proposer_certification_sheet.docx
DOCX document 27 KB Posted
- Attached to
- RFP 25-3021 - Alternative Methodology
- Solicitation number
- 0000037189
- Issued by
- California
About this file
This is a Proposal/Proposer Certification Sheet issued by the California Department of Social Services for RFP 25-3021. The document serves as a mandatory certification form that must be completed, signed, and submitted with all required attachments as a sealed package in accordance with RFP instructions. Proposers are required to acknowledge compliance with Disabled Veteran Business Enterprise (DVBE) participation requirements and demonstrate that they have met applicable participation goals. The certification sheet requests standard company information including name, contact details, address, organization type (sole proprietorship, partnership, or corporation), federal employee identification number, California corporation number, and any applicable licenses or certifications required for the services being procured.
The form requires certification and signature from an authorized representative of the proposing organization, with submission of the unsigned certification sheet potentially resulting in proposal rejection. Additionally, proposers must indicate whether they are certified with the California Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as either a California Small Business or Disabled Veteran Business Enterprise, and must submit copies of any active certifications. If certifications are pending, proposers are instructed to provide the date the application was submitted to OSDS. The document includes completion instructions for each numbered item to ensure proposers understand the requirements for accurate submission.
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PROPOSAL/PROPOSER CERTIFICATION
This Proposal/Proposer Certification Sheet must be signed and returned along with all the "required attachments" as an entire package with original signatures. The proposal must be transmitted in a sealed envelope in accordance with RFP instructions.
A. Place all required attachments behind this certification sheet.
B. I have read and understand the DVBE Participation requirements and have included documentation demonstrating that I have met the participation goals.
C. The signature affixed hereon and dated certifies compliance with all the requirements of this proposal document. The signature below authorizes the verification of this certification.
An Unsigned Proposal/Proposer Certification Sheet May Be Cause for Rejection
| 1. Company Name |
| 2. Telephone Number |
| 2a. Fax Number |
| ( ) |
| ( ) |
2b. Email Address
3. Address
Indicate your organization type:
| 4. |_| Sole Proprietorship |
| 5. |_| Partnership |
| 6. |_| Corporation |
Indicate the applicable employee and/or corporation number:
| 7. Federal Employee ID No. (FEIN) |
| 8. California Corporation No. |
9. Indicate applicable license and/or certification information:
| 10. Bidder’s Name (Print) |
| 11. Title |
| 12. Signature |
| 13. Date |
14. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as:
a. California Small Business Yes |_| No |_| If yes, enter certification number:
b. Disabled Veteran Business Enterprise Yes |_| No |_| If yes, enter your service code below:
NOTE: A copy of your Certification is required to be included if either of the above items is checked “Yes.”
| Date application was submitted to OSDS, if an application is pending: |
Completion Instructions for Proposal/Proposer Certification Sheet
Complete the numbered items on the Proposal/Proposer Certification Sheet by following the instructions below.
Item Numbers
Instructions
1, 2, 2a, 2b, 3
Must be completed. These items are self-explanatory.
Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business.
Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit.
Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.
Enter your federal employee tax identification number
Enter your corporation number assigned by the California Secretary of State’s Office. This information is used for checking if a corporation is in good standing and qualified to conduct business in California.
Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required for the type of services being procured.
10, 11, 12, 13
Must be completed. These items are self-explanatory.
If certified as a California Small Business, place a check in the "Yes" box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the "Yes" box and enter your service code on the line. If you are not certified to one or both, place a check in the "No" box. If your certification is pending, enter the date your application was submitted to OSDS.
| IFB 13-40 | ATTACHMENT 2 |
| California Department of Social Services | Page 1 of 2 |
| RFP 25-3021 | Attachment 3 |
| California Department of Social Services | Page 1 of 2 |
File details come from the government source that posted it. Updated .