Bidder_Declaration(blank).pdf
PDF 102 KB Posted
- Attached to
- RFQ-LED-0625-10
- Solicitation number
- 0000035400
- Issued by
- California
About this file
The Bidder Declaration form is a California Department of Fish and Wildlife (DFW) document (form DFW 1082, dated 10/2019) designed to collect information from potential contractors bidding on a state contract. The form requires prime bidders to provide details about their California vendor name, current California certifications (Minority-Owned Business/Small Business/Disabled Veteran Business Enterprise), and subcontractor information if applicable.
The document provides a structured template for bidders to disclose subcontractor details, including the subcontractor's name, contact information, complete address, California certification number, specific work to be performed, and corresponding percentage of the bid price. The form concludes with a certification section where the authorized representative must sign, affirming under penalty of perjury that all provided information is true and correct. This declaration helps ensure transparency, accountability, and compliance with state contracting requirements, particularly regarding minority and small business participation.
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| File | Type | Posted |
|---|---|---|
| Postconsumer-Content_Certification(blank).pdf | ||
| RFQ-LED-0625-10.pdf | ||
| DARFUR_(blank).pdf | ||
| Payee_Data_Record_STD_204(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 .