Bidder_Declaration(blank).pdf
PDF 102 KB Posted
- Attached to
- RFQ-R4-626-03, Trailer
- Solicitation number
- 0000038435
- Issued by
- San Luis Obispo County, California
About this file
This is a Bidder Declaration form for the State of California, Department of Fish and Wildlife, related to Request for Quotation RFQ-R4-626-03 for a trailer procurement. The document serves as the official declaration form that bidders must complete and submit with their proposals. The form requires prime bidders to provide their California vendor name and identify any current minority-owned business (MB), small business (SB), or disabled veteran business enterprise (DVBE) certifications. Bidders must also declare whether subcontractors will be utilized for contract performance and, if so, provide detailed information about each subcontractor's name, contact information, address, certification status, scope of work, and percentage of bid price. The form includes certification language requiring the authorizer to sign under penalty of perjury, confirming the accuracy and truthfulness of all submitted information.
The declaration form does not contain pricing information, set-asides, incumbent contractor data, or funding details. Instead, it functions as a compliance and transparency document designed to ensure that all bidders accurately disclose their business status, subcontracting plans, and any minority or small business certifications relevant to the California contracting process. The form was last updated in October 2019 and is designated as DFW 1082 in the state's documentation system.
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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 .