Attachment4-ProposerCertification.docx
DOCX document 23 KB Posted
- Solicitation number
- RFP2425-03
- Issued by
- Sacramento County, San Francisco City, California
About this file
This is a Proposer Certification attachment document from the California Department of Aging (CDA) for RFP Number RFP-2324-06 regarding HICAP Modernization. The document serves as a formal certification form that proposers must complete to verify compliance with all proposal requirements and certify the truthfulness of their submitted information.
The document requires companies to provide essential business information including company name, contact details, organization type (sole proprietorship, partnership, or corporation), Federal Employee ID Number (FEIN), California Corporation Number, and applicable licenses or certifications. It specifically asks whether the firm is certified as a California Small Business or Disabled Veteran Business Enterprise through the Department of General Services, Office of Small Business Certification and Resources (OSDS), requiring certification documentation if applicable. The document includes detailed instructions for completing each section of the certification form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment7-ProposersRateSheet-Word.docx | DOCX document | |
| Attachment10-DVBECert.pdf | ||
| Attachment1-ProposalSubmissionChecklist.docx | DOCX document | |
| RFP-2425-03-T3-Addendum1.pdf | ||
| Attachment8-CivilRightsCert.docx | DOCX document | |
| Attachment16-CA_DVBE_ProgramRequirements.pdf | ||
| Attachment11-PayeeData.pdf | ||
| RFP-2425-03-CA_Title3-B-LegalSvcsPN.pdf | ||
| Attachment15-Tacpa.pdf | ||
| Attachment5-MinimumQualifications.docx | DOCX document | |
| Attachment17-GenAI-STD1000.pdf | ||
| Attachment9-ProposerDeclaration.pdf | ||
| Attachment12-InsuranceCert.docx | DOCX document | |
| Attachment7-ProposersRateSheet-Excel.xlsx | XLSX spreadsheet | |
| Attachment13-FinancialSolvencyCert.docx | DOCX document | |
| Attachment6-References.docx | DOCX document | |
| Attachment14-CCC-417.docx | DOCX document |
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Text version
California Department of Aging RFP Number: RFP-2324-06 HICAP Modernization
ATTACHMENT 2
Proposer’s Certification 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.
By signing below, the Proposer represents and warrants that statements and representations contained in the documents and data submitted in connection with this proposal are true and correct. In the event the Proposer’s submittal in connection with this proposal contains false statements or misrepresentations of fact, the proposal may be rejected, or any succeeding contract terminated for cause, and the Proposer deemed to be a non-responsible Proposer which may adversely affect future proposals submitted by the Proposer. 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 Proposer.
Do not return Requirements and Information or the Sample Agreement.
1. Our all-inclusive proposal is submitted as detailed in Attachment 1, Response Proposal 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 solicitation. 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. |
| 4 |
| 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. |
| 5 |
| 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. |
| 6 |
| 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. |
| 8 |
| 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. |
| 9 |
| 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. |
| 14 |
| Check Box #14 a. - You must be certified as a California Small Business. |
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