Bidder_Declaration_DFW1082_[Fillable].pdf
PDF 966 KB Posted
- Solicitation number
- 0000033621
- Issued by
- Marin County, California
About this file
This is a Bidder Declaration form (DFW 1082) from the California Department of Fish and Wildlife that requires prime bidders to provide information about their business and any subcontractors they plan to use for contract work. The form requires disclosure of the bidder's California vendor name, certification numbers (MB/SB/DVBE), and whether subcontractors will be utilized.
The form includes a detailed table for listing all subcontractors, requiring information such as subcontractor name, contact person, phone number, email, complete address, California certification number, work to be performed, and corresponding percentage of bid price. An example is provided showing "Fix it Now" as a sample subcontractor performing office repairs at 25% of the bid price. The form must be signed under penalty of perjury by an authorized representative certifying the information provided is true and correct.
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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 .