Commercially_Useful_Function_(CUF)_Certification_Form.pdf

184 KB Posted

Attached to
25CRY016 - Temporary Relief Cook Staffing Services
Solicitation number
0000036336
Issued by
Alameda County, Contra Costa County, Marin County, Mendocino County, Napa County, San Francisco County, Solano County, Sonoma County, Yolo County, Alameda City, Contra Costa Centre CDP, Marina Del Rey CDP, San Marino City, Lucas Valley-Marinwood CDP, Marin City CDP, Mendocino CDP, Marina City, Napa City, San Francisco City, South San Francisco City, Sonoma City, Sonoma State University CDP, Yolo CDP, California

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Written by GovTribe AI ·

This document is a Commercially Useful Function (CUF) Certification Form issued by the State of California Department of Veterans Affairs for solicitation number 25CRY016. The form is designed for certified Small Businesses (SB), Micro Businesses (MB), and Disabled Veteran Business Enterprises (DVBE) who will perform work in a state contract. It requires businesses to demonstrate they will play a substantive role in contract execution by answering five key questions about their proposed involvement, including whether they will be responsible for a distinct element of work, actually perform or manage the work, do work normal to their business functions, and avoid excessive subcontracting.

The form serves as a compliance mechanism to ensure small and veteran-owned businesses are genuinely participating in state contracts, not merely serving as pass-through entities. A "No" response to questions 1-3 or a "Yes" to question 4 may result in the quote being deemed non-responsive and disqualified. The form requires an authorized representative to certify under penalty of perjury that all provided information is truthful and accurate, with space for the business to provide a written statement detailing their specific role, services, and goods they will provide to meet the commercially useful function requirement.

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State of California Department of Veterans Affairs

COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM

CV 012 (REV. 08/2023) Page 1 of 2

Solicitation Number:

Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.

1. CONTRACTOR NAME (Completing Form) "DOING BUSINESS AS" (DBA) NAME: OSDS REF # (Currently certified firms only): Expiration Date:

2. COMMERCIALLY USEFUL FUNCTIONS (CUF)

All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).

Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:

Mark all that apply: DVBE Small Business Micro Business

1 If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work? Yes No

2 If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved? Yes No

3 If awarded a contract, will you perform work that is normal for your business, service and functions? Yes No

4 If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices? Yes No

5 If awarded a contract, will your business role be limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation? Yes No

A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.

3. WRITTEN STATEMENT

Provide a written statement below detailing the role, services and goods your company will provide to meet the commercially useful function requirement. At the State's option prior to award, you may be required to submit additional clarifying information

State of California Department of Veterans Affairs

CV 012 (REV. 08/2023) Page 2 of 2

AUTHORIZING SIGNATURE (REQUIRED)

The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

AUTHORIZED REPRESENTATIVE SIGNATURE: TITLE:

PRINTED NAME: DATE:

State of California Department of Veterans Affairs

CV 012 (REV. 08/2023) Page 1 of 2 Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.

1. CONTRACTOR NAME (Completing Form)

2. COMMERCIALLY USEFUL FUNCTIONS (CUF)

All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).

Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:

Mark all that apply:

If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work?

If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved?

If awarded a contract, will you perform work that is normal for your business, service and functions?

If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices?

If awarded a contract, will your business role be limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation?

A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.

3. WRITTEN STATEMENT

State of California Department of Veterans Affairs

COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM

CV 012 (REV. 08/2023) Page 2 of 2

AUTHORIZING SIGNATURE (REQUIRED)

The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

9.0.0.2.20101008.1.734229

SolicitationNumber: 25CRY016
DoingBusinessAs:
OSDSRefNumber:
ExpirationDate:
:
Yes:
No:
ProvideAWrittenStatement:
AuthorizedRepresentative:
Title:
PrintedName:
Date:

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