Bidder_Declaration(blank).pdf
PDF 102 KB Posted
- Attached to
- RFQ-LRB-0624-02, Lobster Tags
- Solicitation number
- 0000030615
- Issued by
- Santa Cruz County, California
About this file
This document is a Bidder Declaration form for a state and local contract opportunity issued by the California Department of Fish and Wildlife. The contract is for the supply of lobster trap tags to be used by lobster operator permit holders in California. The contract will be for the Santa Cruz County jurisdiction. The form requires bidders to provide information about their California certification status, whether subcontractors will be used, and details about any subcontractors. Bidders must certify the accuracy of the information provided. The contract opportunity does not provide details on quantities, response due dates, award dates, or contract term.
The pricing terms, set asides, funding sources, and other salient information are not included in this Bidder Declaration form. The form is focused on collecting bidder information and certifications related to the use of subcontractors.
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Other files
| File | Type | Posted |
|---|---|---|
| RFQ-LRB-0624-02.pdf | ||
| Payee_Data_Record_STD_204(blank).pdf | ||
| DARFUR_(blank).pdf | ||
| Postconsumer-Content_Certification(blank).pdf |
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Text version
BIDDER DECLARATION
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: ____________________________________________
(New 10/2019)
DFW 1082
| CA Vendor name: |
| MB/SB/DVBE Certification Number: |
| None chek box: Off |
| Check box yes: Off |
| Check Box No: Off |
| Distinct element of work: |
| Subcontractor information 1: |
| Subcontractor information 2: |
| Subcontractor information 3: |
| Subcontractor information 4: |
| Subcontractor address 1: |
| Subcontractor address 2: |
| Subcontractor address 3: |
| Subcontractor address 4: |
| Subcontractor CA Cert number 1: |
| Subcontractor CA Cert number 2: |
| Subcontractor CA Cert number 3: |
| Subcontractor CA Cert number 4: |
| Work performed 1: |
| Work performed 2: |
| Work performed 3: |
| Work performed 4: |
| percent 1: |
| percent 2: |
| percent 3: |
| percent 4: |
| Authorizers printed name: |
| Date: |
File details come from the government source that posted it. Updated .