Bidder_Declaration_blank_.pdf

PDF 102 KB Posted

Attached to
RFQ-FISH-0627-01, Boat Trailer
Solicitation number
0000040471
Issued by
California

About this file

This is a Bidder Declaration form used by the California Department of Fish and Wildlife for the RFQ-FISH-0627-01 boat trailer procurement. The form requires prime bidders to provide their California vendor name, current certification status (Minority Business, Small Business, or Disabled Veteran Business Enterprise), and indicate whether subcontractors will be utilized for the contract. If subcontractors are employed, bidders must list all subcontractors with their complete contact information, business addresses, California certification numbers, the specific work or goods they will provide, and their corresponding percentage of the total bid price. The form includes space for up to four subcontractors and requires the prime bidder to clearly identify their distinct element of work when subcontractors are involved.

The form requires certification under penalty of perjury that all information provided is true and accurate, with the authorizer's printed name, signature, and date required at the bottom. This declaration serves as a compliance document ensuring that bidders meet California's contracting requirements and provide transparency regarding business structure, certifications, and subcontractor involvement in the boat trailer transportation project supporting the California Department of Fish and Wildlife Fisheries Division.

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RFQ-FISH-0627-01.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 .