Bidder_Declaration_Form_DFW1082.pdf
PDF 908 KB Posted
- Attached to
- RFQ-LED-0625-08, UTV Trailer
- Solicitation number
- 0000035403
- Issued by
- California
About this file
The document is a Bidder Declaration form (DFW 1082) issued by the State of California's Department of Fish and Wildlife, designed to capture critical information about prime bidders and potential subcontractors for a state contract opportunity. The form requires bidders to provide their California vendor name, current state certifications (Minority-Owned Business/Small Business/Disabled Veteran Business Enterprise), and details about any subcontractors who will be involved in the contract, including their contact information, complete address, certification status, specific work to be performed, and corresponding percentage of the bid price.
The form includes an example entry demonstrating how subcontractor information should be completed, with a sample subcontractor "Fix it Now" listed as performing office repairs representing 25% of the bid price. The document requires the authorizing individual to certify under penalty of perjury that all provided information is true and correct, and provides spaces for the authorizer's printed name, signature, and date. The form appears to be part of California's efforts to track and potentially prioritize diverse business participation in state contract opportunities, with specific fields for identifying different business certification types.
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Other files
| File | Type | Posted |
|---|---|---|
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| DARFUR_DFW1080ext.pdf | ||
| Payee_Data_Form_std204.pdf | ||
| 05_RFQ_RFQ-LED-0625-08,_UTV_Trailer.docx | DOCX document |
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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: 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 .