Darfur_Certification_DFW1080ext_[Fillable].pdf
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- Solicitation number
- 0000033212
- Issued by
- Alameda County, Cedar Ridge CDP, California
About this file
This document is a Darfur Contracting Act Certification form required by the California Department of Fish and Wildlife for state and local contract opportunities. The form certifies that the bidder/proposer either does not have, nor has had within the previous three years, any business activities or operations outside of the United States, or that the bidder/proposer is not a "scrutinized" company as defined in the California Public Contract Code. Bidders/proposers must complete one of the three paragraphs on the form, either initialing paragraphs 1 or 2, or initialing and certifying paragraph 3. This certification must be included with the bid or proposal submission, and failure to do so will result in disqualification of the State Price Schedule (SPS) application.
The document does not provide any additional details about the specific state or local contract opportunity, such as the products or services requested, project overviews, response dates, award information, or contract term. It solely focuses on the certification requirements related to business activities and operations outside of the United States.
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Text version
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
1. _______ Initials
2. ________ Initials
3.
Initials
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.
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
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.
| 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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