Bidder_Declaration_Form_DFW1082.pdf

908 KB Posted

Attached to
RFQ-FISH-0627-02, Boat and Trailer
Solicitation number
0000040015
Issued by
California

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This is a Bidder Declaration Form (DFW 1082) issued by the State of California Department of Fish and Wildlife for Request for Quotation RFQ-FISH-0627-02 regarding the purchase of a boat and trailer to replace an existing surveyed boat deemed unsafe for operation. The form serves as a declaration mechanism for prime bidders to identify their California vendor status, current certification numbers (Minority Business, Small Business, or Disabled Veteran Business Enterprise), and to disclose any subcontractors that will be utilized for contract performance.

The form requires prime bidders to provide their California vendor name and certification status, and if subcontractors will be used, bidders must list each subcontractor's name, contact information, complete address, California certification number, specific work to be performed, and the corresponding percentage of the bid price allocated to that subcontractor. Bidders must certify under penalty of perjury that all information provided is true and correct, with authorization required by an authorized representative's signature and date. The form includes provisions for multiple subcontractors and allows for additional pages if necessary to accommodate all subcontractor disclosures.

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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 .