DARFUR__blank_.pdf

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RFQ-R6-0627-02 - Goose Neck Trailer
Solicitation number
0000040125
Issued by
California

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This is a Darfur Contracting Act Certification form issued by the State of California Department of Fish and Wildlife (DFW) in connection with RFQ-R6-0627-02 for a Goose Neck Trailer. The certification form is required under California Public Contract Code Section 10478 and must be completed by all bidders and proposers prior to submission. Bidders are required to certify their company's foreign business activities status by selecting one of three options: confirming no business operations outside the United States in the previous three years, declaring scrutinized company status with written DGS permission to bid, or certifying non-scrutinized status despite having had international operations. The form requires completion of company name, Federal ID Number (FEIN), authorized personnel signatures, and execution date and location. State Price Schedule (SPS) Applications will be disqualified if this certification form is not properly completed with one of the three paragraphs initialed or, in the case of paragraph 3, both initialed and formally certified under penalty of perjury.

The Goose Neck Trailer will be procured for use by California Department of Fish and Wildlife employees to transport state equipment to various wildlife area locations throughout the state. This certification requirement applies to all eligible bidders and is a mandatory compliance document for bid submission. No pricing information, contract term, or specific procurement timeline details are contained within this certification form, as it serves solely as a regulatory compliance document establishing bidder eligibility based on foreign business activity status under California law.

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State of California - Department of Fish and Wildlife

DARFUR CONTRACTING ACT CERTIFICATION

DFW 1080 (NEW 02/14/19)

Pursuant to California Code, Public Contract Code (PCC) – PCC § 10478, if a bidder or proposer currently or within the previous three years has had business activities or other operations outside of the United States, it must certify that it is not a “scrutinized” company as defined in PCC § 10476.

Therefore, to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number (FEIN) and complete only one of the following three paragraphs (via initials for paragraph 1 or paragraph 2, or via initials and certification for paragraph 3)

Company/Vendor Name (Printed) FEIN

Printed Name and Title of Person Initialing (option 1 or 2) Date

We do not currently have, or we have not had within the previous three years, business activities or other operations outside of the United States.

OR

We are a scrutinized company as defined in PCC § 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to PCC § 10477(B). A copy of the written permission from DGS is included with our bid or proposal.

OR

We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company as defined in PCC § 10476.

NOTE: State Price Schedule (SPS) Applications will be disqualified unless your application includes this form with either paragraph 1 or paragraph 2 initialed or paragraph 3 initialed and certified.

CERTIFICATION For 3 I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective proposer/bidder to the clause listed above in paragraph 3. This certification is made under the laws of the State of California.

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

1. ________

Initials

2. ________ Initials

3. ________ Initials https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10478.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

http://www.dgs.ca.gov/dgs/Home.aspx https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10477.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

OR
OR
CompanyVendor Name Printed:
FEIN:
Printed Name and Title of Person Initialing option 1 or 2:
Date:
Initials:
Initials_2:
Initials_3:
Printed Name and Title of Person Signing:
Date Executed:
Executed in the County and State of:
SAVE:
PRINT:
CLEAR:

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