Attachment_8_-_Small_Business_Declaration.docx
DOCX document 24 KB Posted
- Attached to
- RFP 23-21 On-site Scanning and Imaging Services
- Solicitation number
- 0000031328
- Issued by
- California
About this file
This document is the Small Business Declaration for RFP 23-21 On-site Scanning and Imaging Services, a contract opportunity issued by the California Department of General Services (DGS). The RFP solicits bids for on-site scanning and imaging services. Bidders claiming the small business preference must complete this form, which requires providing the Bidder's DGS Supplier ID, small business certification dates, subcontracting details, and an explanation of how the Bidder will perform a "commercially useful function" for the contract. Bidders must submit a copy of their small business certification approval letter from DGS along with the completed form.
The small business preference is only available if the Bidder is a certified small business or non-profit veteran service agency (NVSA). Bidders must indicate if they will subcontract any portion of the work and provide details on the services they will perform directly. To qualify for the preference, the Bidder must demonstrate it is responsible for executing a distinct element of the work, carrying out its obligations by performing or managing the work, and is not merely a pass-through for funds. Failure to provide complete and accurate information will result in the Bidder not receiving the small business preference.
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RFP 23-21 On-site Scanning and Imaging ServicesATTACHMENT 8
SMALL BUSINESS DECLARATION
Complete this form only if the Bidder will claim the small business preference associated with this solicitation. Please review the “Small Business Declaration Instructions” before completing this form. If the Bidder submits incomplete or inaccurate information, it will not receive the small business preference.
SECTION I. COMPLETE IF THE BIDDER IS A SMALL BUSINESS
If the Bidder is not a Small Business, skip this section.
1. DGS Supplier ID number: _______________
2. Small Business Certification active from ___________ to ___________ *Note status must be active as of the date the bid closes.
3. Will the Bidder subcontract any portion of the contract work to subcontractors? _____
If yes:
A. State the percentage of the contract work the Bidder will subcontract: _____
B. Describe the goods and/or services to be provided by the Bidder itself in connection with the contract: ________________________________________________________________________
| C. Explain how the Bidder is performing a “commercially useful function” for purposes of this contract. (Please see the instructions for the definition of “commercially useful function.”) |
| ________________________________________________________________________ |
4. The Bidder must submit a copy of its Small Business certification approval letter along with this declaration.
SECTION II. COMPLETE IF THE BIDDER IS A NON-PROFIT VETERAN SERVICE AGENCY (NVSA)
If Bidder is not an NVSA, skip this section.
1. DGS Supplier ID number: _______________
2. NVSA Certification active from ___________ to ___________
3. The Bidder must submit a copy of its NVSA certification approval letter along with this declaration.
SECTION III. CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that the information provided in this form is true and correct and that I am duly authorized to legally bind the Bidder to this certification. This certification is made under the laws of the State of California.
| Legal Name of Company (Printed): |
| Federal ID Number: |
| Address: |
| Phone Number: |
| Signature: |
| Date Executed: |
Printed Name and Title of Person Signing:
| Executed in the County of: |
| In the State of: |
SMALL BUSINESS DECLARATION INSTRUCTIONS
General Instructions
In this form, (i) “DGS” refers to the Department of General Services, and (ii) “Small Business” refers to an entity certified by DGS as a small business or a microbusiness.
If the Bidder will claim the small business preference in a solicitation where a small business preference is offered, it must complete the Small Business Declaration. If no small business preference is offered, or the Bidder does not claim the small business preference, the Bidder should not complete the Small Business Declaration.
The Court will determine whether the Bidder is eligible to receive the small business preference based on information provided in the Small Business Declaration. The Court may, but is not obligated to, verify or seek clarification of any information set forth in the Small Business Declaration. If the Bidder submits incomplete or inaccurate information, it will not receive the small business preference.
Instructions for Section I (skip this section if the Bidder is not itself a Small Business)
| 1. | Provide the Bidder’s DGS Supplier ID number. This number is in the Bidder’s DGS Supplier Profile, accessible at http://www.dgs.ca.gov/pd/Programs/OSDS.aspx. |
| 2. | Provide the applicable dates. These dates are listed in the Bidder’s DGS Supplier Profile, accessible at http://www.dgs.ca.gov/pd/Programs/OSDS.aspx. |
| 3. | If the Bidder will subcontract any portion of the contract work, answer “yes” and complete subparts A-C. If the Bidder will not subcontract any portion of the contract work, answer “no” and skip subparts A-C. |
| Subpart A: This percentage is equal to the amount to be paid by the Bidder to all subcontractors divided by the Bidder’s total proposal price, multiplied by 100. Enter a percentage; do not enter a dollar amount. For example, if the amount to be paid by the Bidder to subcontractors is $35,000 and the Bidder’s total proposal price is $125,000, enter “28%” (35000 ÷ 125000 = 0.28; 0.28 x 100 = 28). | |
| Subpart B: Provide a detailed description of the goods and/or services the Bidder itself will provide for the contract. In other words, provide a detailed description of the goods and/or services that will not be subcontracted. Attach additional sheets if necessary. | |
| Subpart C: Provide an explanation of how the Bidder’s goods and/or services constitute a “commercially useful function” for purposes of the contract. Pursuant to Government Code section 14837, a business is deemed to perform a “commercially useful function” if the business does all of the following: (i) is responsible for the execution of a distinct element of the work of the contract; (ii) carries out its obligation by actually performing, managing, or supervising the work involved; (iii) performs work that is normal for its business services and functions; (iv) is responsible, with respect to products, inventories, materials, and supplies required for the contract, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment; and (v) is not further subcontracting a portion of the work that is greater than that expected to be subcontracted by normal industry practices. Note: a business will not be considered to perform a “commercially useful function” if its role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of Small Business participation. Attach additional sheets if necessary. | |
| 4. | Each entity certified as a Small Business by DGS will have received a Small Business certification approval letter from DGS. The Bidder must submit a copy of its Small Business certification approval letter. |
Instructions for Section II (skip this section if the Bidder is not an NVSA)
| 1. | Provide the Bidder’s DGS Supplier ID number. This number is in the Bidder’s DGS Supplier Profile, accessible at http://www.dgs.ca.gov/pd/Programs/OSDS.aspx. |
| 2. | Provide the applicable dates. These dates are listed in the Bidder’s DGS Supplier Profile, accessible at http://www.dgs.ca.gov/pd/Programs/OSDS.aspx. |
| 3. | Each entity certified as an NVSA by DGS will have received a certification approval letter. The Bidder must submit a copy of its certification approval letter. |
Instructions for Section III
Provide the Bidder’s full legal name, tax ID number, address, and telephone number in the appropriate boxes. The certification must be signed by an authorized Bidder representative in the box labeled “By (Authorized Signature).” Provide the name and title of the authorized Bidder representative, and the date, county, and state where that person signed the certification, in the appropriate boxes.
Rev. 2020-07 Page 3 of 3
File details come from the government source that posted it. Updated .