Bidder_Declaration_Form_DFW1082.pdf

PDF 908 KB Posted

Attached to
RFQ-R1-0626-01, UTV
Solicitation number
0000039283
Issued by
Lassen County, California

About this file

This is a Bidder Declaration Form (DFW 1082) issued by the State of California Department of Fish and Wildlife. The form serves as a certification document for prime bidders and subcontractors participating in state contract opportunities. The form requires bidders to provide their California vendor name, identify any current California certifications (Minority Business, Small Business, or Disadvantaged Veteran Business Enterprise), and declare whether subcontractors will be used on the contract. If subcontractors are utilized, bidders must list each subcontractor's name, contact information, complete address, California certification status, description of work or goods provided, and the corresponding percentage of the bid price allocated to that subcontractor.

The declaration must be signed under penalty of perjury by an authorized representative of the bidding organization, certifying that all information provided is true and correct. The form allows for multiple subcontractors to be listed, with provisions for additional pages if necessary. This document is a standard procurement requirement for California Department of Fish and Wildlife contracts and does not independently establish pricing, set-asides, or funding terms, but rather serves as a verification tool to confirm bidder qualifications, certifications, and subcontractor information as part of the overall bid submission package.

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06_RFQ-R1-0626-01_UTV.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 .