Attachment4-ProposerCertification.docx
DOCX document 23 KB Posted
- Attached to
- SB1249 Consulting
- Solicitation number
- RFP252604
- Issued by
- California
About this file
This is a Proposer's Certification form for the California Department of Aging's RFP Number RFP-2324-06 for HICAP Modernization. The certification document serves as a binding attestation that all statements and representations contained in a proposer's submission are true and accurate. Proposers must complete all required fields including company name, contact information, business structure designation (sole proprietorship, partnership, or corporation), federal employee identification number, California corporation number, and any applicable licenses or certifications. A duly authorized representative must sign and date the certification; unsigned submissions will result in automatic rejection. The form also requires disclosure of certifications with the California Department of General Services, Office of Small Business Certification and Resources, including California Small Business status and Disabled Veteran Business Enterprise status, with copies of relevant certifications required if applicable.
The certification document emphasizes that false statements or misrepresentations of fact may result in proposal rejection, contract termination for cause, designation as a non-responsible proposer, and potential adverse effects on future proposals submitted by the organization. Additionally, misrepresentation or fraud in connection with securing a state contract may result in legal action against the proposer. The document specifies that proposers must submit all required attachments alongside the certification sheet and must not return the Requirements and Information or Sample Agreement documents with their submission. This form is a critical component of the overall proposal package and establishes the legal accountability of the submitting organization for all representations made throughout the solicitation process.
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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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