Bidder_Declaration.pdf

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Attached to
RFQ-R5-0627-04, Catfish
Solicitation number
0000039951
Issued by
California

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This is a Bidder Declaration form (DFW 1082, Rev. 05/15/23) issued by the State of California Department of Fish and Wildlife for the RFQ-R5-0627-04 Catfish contract, which involves the procurement of live catfish to stock lakes in support of the Fishing in the City Program. The form requires prime bidders to provide their California vendor name, current California certifications (if applicable, including Minority Business, Small Business, or Disabled Veteran Business Enterprise designations), and to identify whether subcontractors will be used on the contract. If subcontractors are utilized, bidders must list all subcontractors with their complete names, contact information, addresses, California certification numbers, specific work to be performed, and the corresponding percentage of the bid price allocated to each subcontractor.

The Bidder Declaration serves as a certification mechanism requiring the authorizer to sign under penalty of perjury, confirming that all information provided is true and accurate. The form acknowledges that electronic signatures are legally binding equivalents to handwritten signatures under California Civil Code Section 1633.5(b). Bidders must complete all required fields, including the authorizer's printed name, signature, and date, before submission. The form includes space for up to four subcontractors and allows for attachment of additional pages if more subcontractors need to be listed. This declaration is a mandatory submission component for participation in the catfish procurement opportunity.

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State of California – Department of Fish and Wildlife

BIDDER DECLARATION

DFW 1082 (REV. 05/15/23)

1. Primebidder information:

a. What is your California vendor’s 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.

With accordance to California Civil Code §1633.5(b), I acknowledge that by providing my electronic signature for this form, I agree that my electronic signature is legal binding equivalent to a handwriting signature. I hereby confirm that my electronic signature represents my execution or authentication of this form, and my intent to be bound by it.

Authorizer’s printed name: _______________________________________ Date: ______________

Authorizer’s signature: ____________________________________________ https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fleginfo.legislature.ca.gov%2Ffaces%2Fcodes_displaySection.xhtml%3FsectionNum%3D1633.5%26lawCode%3DCIV&data=05%7C01%7CLucia.Rodriguez%40wildlife.ca.gov%7Cf7d61fe8902f4fc2ddc908db44de0a8a%7C4b633c25efbf40069f1507442ba7aa0b%7C0%7C0%7C638179492686187568%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=SgmSIctaufa78R%2BCFlJqmUDsiiE%2FYw%2FCR%2BZhi4%2BcxQ0%3D&reserved=0

Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now
MBSBDVBE:
Authorizers printed name:
Date:
California Vendor Name:
Yes: Off
No: Off
If yes,:
Subcontractor Name4:
Subcontractor Name3:
Subcontractor Name2:
Subcontractor Name1:
Subcontractor Address1:
Subcontractor Address2:
Subcontractor Address3:
Subcontractor Address4:
CA Cert Number1:
CA Cert Number2:
CA Cert Number3:
CA Cert Number4:
Work Performed1:
Work performed2:
Work performed3:
Work performed4:
Corresponding percent1:
Corresponding percent2:
Corresponding percent3:
Corresponding percent4:
SAVE:
PRINT:
CLEAR:

File details come from the government source that posted it. Updated .