Bidder_Declaration_blank_.pdf

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Attached to
RFQ-R6-0627-02 - Goose Neck Trailer
Solicitation number
0000040125
Issued by
California

About this file

This is a Bidder Declaration form used by the California Department of Fish and Wildlife for state procurement purposes. The form serves as the primary documentation vehicle for prime bidders and subcontractors to disclose their involvement in the contract opportunity RFQ-R6-0627-02 for a Goose Neck Trailer, which will be utilized by department employees to transport state equipment to various wildlife area locations. The declaration requires bidders to provide their California vendor name, current certification status (Minority Business, Small Business, or Disadvantaged Veteran Business Enterprise), and confirmation of whether subcontractors will be used on the project. If subcontractors are employed, bidders must identify all subcontractors and specify the distinct element of work the prime bidder will perform.

The form includes detailed requirements for subcontractor disclosure, with space for up to four subcontractors including their contact information, complete addresses, California certification numbers, scope of work to be performed, and corresponding percentage of bid price. The bidder declaration must be certified under penalty of perjury by an authorized representative with printed name, signature, and date. This standardized form, designated as DFW 1082 and effective October 2019, ensures compliance with California's small business and disadvantaged veteran business enterprise participation goals while providing transparency regarding prime bidder and subcontractor roles and qualifications for the equipment procurement.

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RFQ-R6-0627-02.pdf PDF
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Text version

BIDDER DECLARATION

1. Prime bidder information:

a. What is your California vendor 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.

Authorizers printed name: _______________________________________ Date: _______________

Authorizers signature: ____________________________________________

(New 10/2019)

DFW 1082

CA Vendor name:
MB/SB/DVBE Certification Number:
None chek box: Off
Check box yes: Off
Check Box No: Off
Distinct element of work:
Subcontractor information 1:
Subcontractor information 2:
Subcontractor information 3:
Subcontractor information 4:
Subcontractor address 1:
Subcontractor address 2:
Subcontractor address 3:
Subcontractor address 4:
Subcontractor CA Cert number 1:
Subcontractor CA Cert number 2:
Subcontractor CA Cert number 3:
Subcontractor CA Cert number 4:
Work performed 1:
Work performed 2:
Work performed 3:
Work performed 4:
percent 1:
percent 2:
percent 3:
percent 4:
Authorizers printed name:
Date:

File details come from the government source that posted it. Updated .