Attachment_4_-_Respondents_Certification.pdf
PDF 219 KB Posted
- Solicitation number
- RFO2526-04
- Issued by
- Sacramento County, San Francisco City, California
About this file
This is a Respondent's Certification form from the California Department of Aging for RFO Number RFO-2526-04 MSSP - Organizational Change Management. The certification document serves as the official attestation that respondents submit alongside their offer packages to confirm compliance with all request for offer requirements. Respondents must complete all required sections including company information, organization type, federal and state identification numbers, applicable licenses and certifications, and authorized representative signature and date. An unsigned certification sheet will result in automatic rejection of the proposal. The form requires respondents to affirm that all statements and representations contained in their submitted documents are true and correct, and failure to do so may result in offer rejection, contract termination for cause, designation as a non-responsible offeror, or potential legal action.
The certification requires respondents to indicate whether their organization is structured as a sole proprietorship, partnership, or corporation, and to provide corresponding federal Employee Identification Numbers and California Corporation Numbers as applicable. Respondents must also disclose any relevant licenses or certifications required for the services being procured. Additionally, the form requires disclosure of any certifications held with the California Department of General Services, Office of Small Business Certification and Resources, including California Small Business certification or Disabled Veteran Business Enterprise status, with copies of such certifications required to be submitted if applicable. The instructions clarify the definitions and completion requirements for each form item to ensure accurate and complete submissions.
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California Department of Aging RFO Number: RFO-2526-04 MSSP – Organizational Change Management
ATTACHMENT 4
RESPONDENT’S CERTIFICATION
The signature affixed hereon and dated certifies compliance with all the requirements of this offer document. The signature below authorizes the verification of this certification.
By signing below, the Offeror represents and warrants that statements and representations contained in the documents and data submitted in connection with this offer are true and correct. In the event the Offeror’s submittal in connection with this offer contains false statements or misrepresentations of fact, the offer may be rejected, or any succeeding contract terminated for cause, and the Offeror deemed to be a non-responsible Offeror which may adversely affect future offers submitted by the Offeror. In addition, any misrepresentation of fact or fraud in connection with an attempt to secure a state contract could result in legal action being taken against the Offeror.
Do not return Requirements and Information or the Sample Agreement.
1. Our all-inclusive offer is submitted as detailed in Attachment 1, Response Offer Sheet
2. All required attachments are included with this certification sheet.
3. The signature affixed hereon and dated certifies compliance with all the requirements of this request. The signature below authorizes the verification of this certification. An unsigned Firm Certification Sheet will be cause for rejection.
1. Company Name 2. Telephone Number 2a. Fax Number
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. Firm’s Name (Print) 11. Title
12. Signature 13. Date
14. Are you certified with the Department of General Services, Office of Small Business Certification and Resources (OSDS) as:
a. California Small Business
Yes No
If yes, enter certification number:
a. 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 Firm Certification Sheet
Complete the numbered items on the Firm Certification Sheet by following the instructions below.
Item Numbers
Instructions
1, 2, 2a, 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.
7 Enter your federal employee tax identification number.
Enter your corporation number assigned by the California Secretary of State’s Office. This information is used to check 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, Must be completed. These items are self-explanatory.
14 Check Box #14 a. - You must be certified as a California Small Business.
File details come from the government source that posted it. Updated .