Bidder_Declaration_Form_DFW1082.pdf
PDF 908 KB Posted
- Attached to
- RFQ-LED-0626-01, Cargo Trailers
- Solicitation number
- 0000037060
- Issued by
- Shasta County, San Bernardino City, California
About this file
This is a Bidder Declaration form (DFW 1082) issued by the State of California Department of Fish and Wildlife for state and local contract bidding purposes. The form requires bidders to provide their California vendor name and current certification status, including Minority Business (MB), Small Business (SB), and Disabled Veteran Business Enterprise (DVBE) certifications, if applicable. Bidders must disclose whether subcontractors will be used on the contract and, if so, must provide complete information for all subcontractors, including contact details, addresses, certification numbers, specific work elements to be performed, and the corresponding percentage of the bid price allocated to each subcontractor.
The form includes a certification statement in which the bidder declares under penalty of perjury that all information provided is true and correct. The bidder's authorized representative must sign and date the form before submission. The form provides a sample table demonstrating how subcontractor information should be formatted, with space for multiple subcontractors and allowance for additional pages if needed. This declaration ensures transparency regarding business participation and compliance with California's small business and veteran business certification programs.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Payee_Data_Form_std204.pdf | ||
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| 03_RFQ-LED-0626-01_Cargo_Trailers.docx | DOCX document | |
| DARFUR_DFW1080ext.pdf |
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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 .