Bidder_Declaration_DFW1082_[Fillable].pdf
PDF 966 KB Posted
- Solicitation number
- 0000032292
- Issued by
- Alameda County, California
About this file
This document is a Bidder Declaration form from the California Department of Fish and Wildlife. It requires bidders to provide information about their California vendor name, certification status, and whether they will be using subcontractors for the contract. If using subcontractors, the form requires details on the subcontractor's name, contact information, certification status, work to be performed, and percentage of the bid price. The contract opportunity referenced is for the procurement of live Channel Catfish for the Region 3 Fishing In The City Program.
The form indicates that the contract will be awarded to a certified Micro Business (MB), Small Business (SB), or Disabled Veteran Business Enterprise (DVBE) contractor. If the prime contractor is not certified, they must disclose their use of certified subcontractors and the percentage of work to be performed by each. The successful bidder will need to complete and submit this form as part of their bid response.
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Text version
State of California – Department of Fish and Wildlife
BIDDER DECLARATION
DFW 1082 (REV. 09/30/21)
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: ____________________________________________
| Subcontractor Name, Contact Person, Phone Number & Email |
| Fix it Now |
| Authorizers Printed Name: |
| Date: |
| SAVE: |
| PRINT: |
| CLEAR: |
| What is your California vendor name: |
| MB SB DVBE: |
| None: Off |
| Will subcontractors be used for this contract Yes: Off |
| Will subcontractors be used for this contract No: 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: |
| Subcontractor Name Contact Person Phone Number and Email: |
| 0: |
| Subcontractor Name Contact Person Phone Number and Email 1: |
| Subcontractor Name Contact Person Phone Number and Email 2: |
| Subcontractor Name, Contact Person, Phone Number and Email: |
| 3: |
| Subcontractor complete address: |
| 0: |
| 1: |
| 2: |
| 3: |
| CA Certification Number MB SB DVBE or None 0: |
| CA Certification Number MB SB DVBE or None 1: |
| CA Certification Number (MB, SB, DVBE, or None) 2: |
| CA Certification Number MB SB DVBE or None 3: |
| Work performed or good provided for this contract 0: |
| Work performed or good provided for this contract: |
| 1: |
| Work performed or good provided for this contract 2: |
| Work performed or good provided for this contract 3: |
| Corresponding percentage of bid price 0: |
| Corresponding percentage of bid price 2: |
| Corresponding percentage of bid price 1: |
| Corresponding percentage of bid price 3: |
File details come from the government source that posted it. Updated .