Bidder_Declaration_Form_DFW1082.pdf
PDF 908 KB Posted
- Attached to
- RFQ-LRB-0625-02, Lobster Tags
- Solicitation number
- 0000035079
- Issued by
- Yolo County, California
About this file
The document is a Bidder Declaration Form (DFW 1082, Revised 09/30/21) issued by the State of California's Department of Fish and Wildlife. The form is designed to capture essential information about prime bidders and potential subcontractors for a state contract, requiring bidders to disclose their California vendor name, current certification status (Minority Business/Small Business/Disabled Veteran Business Enterprise), and details about any subcontractors who will participate in the contract.
The form provides a structured template for bidders to list subcontractor details, including company name, contact information, complete address, California certification number, specific work to be performed, and the corresponding percentage of the bid price. The document requires the authorizing representative to certify under penalty of perjury that all provided information is true and correct, with space for a printed name, signature, and date. While the specific contract details are not included in this form, it serves as a critical compliance document for vendors seeking to bid on California Department of Fish and Wildlife contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| DARFUR_DFW1080ext.pdf | ||
| 06_RFQ-LRB-0625-02_REVISED.docx | DOCX document | |
| Payee_Data_Form_std204.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 .