Bidder_Declaration.pdf

908 KB Posted

Attached to
NCR-HQ-RFQ-25-E0023 Interpretive Panels
Solicitation number
0000037948
Issued by
California

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This is a Bidder Declaration form issued by the State of California Department of Fish and Wildlife (DFW 1082, Rev. 09/30/21) for the NCR-HQ-RFQ-25-E0023 Interpretive Panels contract opportunity. The form requires prime bidders to provide their California vendor name and identify any current California certifications, including Minority Business (MB), Small Business (SB), or Disadvantaged Veteran Business Enterprise (DVBE) designations. Bidders must declare whether subcontractors will be used on the contract and, if so, provide a distinct description of the work the prime business will perform.

The form includes a structured table for documenting all subcontractors involved in the contract, requiring the subcontractor name, contact person, phone number, email address, complete address, California certification number or designation, work performed or goods provided, and the corresponding percentage of the bid price for each subcontractor. An example is provided showing Fix it Now as a subcontractor performing office repairs for 25 percent of the bid price with SB certification number 15245. The form concludes with a certification section in which the authorizer must sign under penalty of perjury affirming that all information provided is true and correct.

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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: Off
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 .