Bidder_Declaration_-_DFW_1082.pdf
PDF 102 KB Posted
- Attached to
- Interpretive Panels
- Solicitation number
- 0000037849
- Issued by
- California
About this file
This is a Bidder Declaration form (DFW 1082) for a California state and local contract opportunity involving the procurement of 69 interpretive panels measuring 36 inches in height by 48 inches in width by 1/8 inch in thickness, constructed from High Pressure Laminate (HPL) material. The form requires the prime bidder to provide their California vendor name and identify any current certifications held, including Minority Business (MB), Small Business (SB), or Disabled Veteran Business Enterprise (DVBE) certifications. Bidders must declare whether subcontractors will be used for contract performance and, if so, identify the distinct elements of work the prime bidder will perform directly.
For contracts utilizing subcontractors, the form requires submission of detailed subcontractor information including company name, contact person, phone number, email address, complete business address, California certification status, description of work or goods provided, and the corresponding percentage of the bid price allocated to each subcontractor. The declaration must be signed and certified under penalty of perjury by an authorized representative, confirming the accuracy and truthfulness of all submitted information. The form accommodates up to four subcontractors with separate line items for each entity's information.
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| DFW1080ext.pdf | ||
| RFQ-SHIP_panels.docx | DOCX document |
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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 .