Bidder_Declaration_Form_(2).pdf

State of C alifornia—

O epartm eni of G eneral Services, Procurem ent D ivision

G

SPD-O

S-1 d5 (REV 08!09) S olicitation N

1.

Prim e bidder inform ation (R eview attached B idder D eclaration Instructions prior to com pletion of this form a.

Identify current C alifornia certifications) (M

B, SB, N

VSA, Q

VBE):

or N one ~

(If "N one; go to Item

#2) b.

W ill subcontractors be used for this contract? Yes Q

N o Q

{If yes, indicate the distinct elem ent of w ork your firm w ill perform in this contract e.g., list the proposed products produced by your firm , state if your firm ow ns the transportation vehicles that w ill deliver the products to the State, identify w hich solicited services your firm w ill perform etc.). Use additional sheets,as necessary.

c.

If you are a C alifornia certified DVBE:

(1) Are you a broker or agent? Yes ~

N o a

(2) If the contract includes equipm ent rental, does our co any o n at least 51 % of the equipm ent provided in this contract (quantity and value}? Yes ~

N o ~

N /A

2.

If no subcontractors w ill be used, skip to certification below . O therw ise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name,Contact Person, Phone Number &Fax Number

Subcontractor Address &Email Address to tertifitation (MB,SB, NVSA, DUBE or None)

Work performed or gaotls provided for this contract

Corresponding of bid price Good

Standing?

51%

Rental?

0%

0%0%

CERTIFICATIO

PI: By signing the bid response, I certify under penalty of perjury that the inform ation provided is true and correct.

P a g e of c ~'