Attachment4-ProposerCertification.docx
DOCX document 102 KB Posted
- Attached to
- RFP-2526-01 Aging Resource Directory
- Solicitation number
- RFP2526-01
- Issued by
- California
About this file
This document is a Proposer's Certification form for the California Department of Aging (CDA) Request for Proposal (RFP) Number RFP-2526-01 for an Aging Resource Directory. The certification form requires potential bidders to provide comprehensive details about their organization, including business type (sole proprietorship, partnership, or corporation), federal tax identification number, and any relevant state certifications. The document emphasizes the importance of accurate representations, warning that false statements or misrepresentations could result in proposal rejection, contract termination, or potential legal action.
The certification form includes options for small business and disabled veteran business enterprise (DVBE) certification, with instructions to include a copy of certification if applicable. Proposers must complete all required sections, including company name, contact information, organizational type, and licensing details. The form serves as a legal declaration of compliance with solicitation requirements and authorizes the verification of the provided information. Key requirements include submitting a comprehensive proposal, including all required attachments, and ensuring the certification sheet is signed, as an unsigned sheet will result in automatic proposal rejection.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum1-RFP-2526-01-AgingResourceDirectory-Correction.pdf | ||
| Attachment1-ProposalSubmissionChecklist.docx | DOCX document | |
| Attachment12-InsuranceCertification.docx | DOCX document | |
| Attachment5-MinimumQualifications.docx | DOCX document | |
| Attachment13-FinancialSolvencyCertification.docx | DOCX document | |
| Attachment6-References.docx | DOCX document | |
| Attachment7-ContractorRateSheet-Word.docx | DOCX document | |
| Attachment14-ContractorCertificationClauses.docx | DOCX document | |
| Attachment15-TACPA.pdf | ||
| Attachment7-ProposersRateSheet-Excel.xlsx | XLSX spreadsheet | |
| Attachment8-CivilRightCertification.docx | DOCX document | |
| RFP-2526-01-AgingResourceDirectory.pdf | ||
| Attachment10-DVBECert.pdf | ||
| Attachment11-PayeeData.pdf | ||
| Attachment9-BidderDeclaration.pdf |
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Text version
California Department of Aging RFP Number: RFP-2526-01 Aging Resource Directory
ATTACHMENT 4
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 to check 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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