Bidder_Dec_DFW1082ext.pdf
PDF 980 KB Posted
- Attached to
- NR24-042 Tractor Adapters
- Solicitation number
- 0000035155
- Issued by
- Del Norte County, California
About this file
This document is a Bidder Declaration form (DFW 1082) issued by the State of California's Department of Fish and Wildlife, designed to capture key information from potential bidders on a state contract. The form requires prime bidders to provide their California vendor name, current state certifications (such as Micro Business, Small Business, or Disabled Veteran Business Enterprise), and details about subcontractors if they will be used in the contract. The form includes a section for listing subcontractors, with fields for their contact information, complete address, California certification number, specific work to be performed, and corresponding percentage of the bid price.
The form is structured to ensure transparency and compliance with state contracting requirements, featuring a certification section where the bidder affirms under penalty of perjury that the provided information is true and correct. It also includes an acknowledgment of electronic signature legality under California Civil Code §1633.5(b), allowing the bidder to electronically sign and authenticate the document. The form provides options to save, print, or clear the document, and requires the authorizer's printed name and signature along with the date of submission.
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Text version
State of California – Department of Fish and Wildlife
BIDDER DECLARATION
DFW 1082 (REV. 05/15/23)
1. Primebidder information:
a. What is your California vendor’s name?
b. Identify your current California Certification(s) number(s):
(MB/SB/DVBE): _____________ or None (If “None”, proceed to number 2)
c. Will subcontractors be used for this contract? YES NO (If yes, indicate in the space below the distinct element of work your business will perform in this contract. If no, skip to the certification at the bottom of this page.)
2. If subcontractors will be used, list all subcontractors for this contract in the table below. (Attach additional pages if necessary):
EXAMPLE
Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now John Smith Jr.
(916) 445-1234
JSmithJr@fixitnow.com
Subcontractor complete address
1234 Fix It Pl.
Sacramento, CA
95821
CA Certification Number (MB, SB, DVBE, or None)
SB # 15245
Work performed or good provided for this contract
Office repairs
Corresponding % of bid price 25%
CERTIFICATION: By signing this form (Bidder Declaration), I certify under penalty of perjury that the information provided is true and correct.
With accordance to California Civil Code §1633.5(b), I acknowledge that by providing my electronic signature for this form, I agree that my electronic signature is legal binding equivalent to a handwriting signature. I hereby confirm that my electronic signature represents my execution or authentication of this form, and my intent to be bound by it.
Authorizer’s printed name: _______________________________________ Date: ______________
Authorizer’s signature: ____________________________________________ https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fleginfo.legislature.ca.gov%2Ffaces%2Fcodes_displaySection.xhtml%3FsectionNum%3D1633.5%26lawCode%3DCIV&data=05%7C01%7CLucia.Rodriguez%40wildlife.ca.gov%7Cf7d61fe8902f4fc2ddc908db44de0a8a%7C4b633c25efbf40069f1507442ba7aa0b%7C0%7C0%7C638179492686187568%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=SgmSIctaufa78R%2BCFlJqmUDsiiE%2FYw%2FCR%2BZhi4%2BcxQ0%3D&reserved=0
| Subcontractor Name, Contact Person, Phone Number & Email |
| Fix it Now |
| MBSBDVBE: |
| Authorizers printed name: |
| Date: |
| California Vendor Name: |
| Yes: Off |
| No: Off |
| If yes,: |
| Subcontractor Name4: |
| Subcontractor Name3: |
| Subcontractor Name2: |
| Subcontractor Name1: |
| Subcontractor Address1: |
| Subcontractor Address2: |
| Subcontractor Address3: |
| Subcontractor Address4: |
| CA Cert Number1: |
| CA Cert Number2: |
| CA Cert Number3: |
| CA Cert Number4: |
| Work Performed1: |
| Work performed2: |
| Work performed3: |
| Work performed4: |
| Corresponding percent1: |
| Corresponding percent2: |
| Corresponding percent3: |
| Corresponding percent4: |
| SAVE: |
| PRINT: |
| CLEAR: |
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