Darfur_Contracting_Act_Certification_Form.pdf

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Attached to
IFB #C24-32882 Refrigeration Service & Repair (Sacramento, Yolo, West Sacramento, Santa Clara, and Sonoma Counties)
Solicitation number
C24-32882
Issued by
Yolo County, California

About this file

This document is the Darfur Contracting Act Certification Form required by the State of California for companies bidding on or submitting proposals for state contracts. The form certifies whether a company has had business activities or operations outside of the United States within the previous three years. If so, the company must either certify that it is not a "scrutinized company" under the Darfur Contracting Act, or obtain written permission from the Department of General Services to submit a bid or proposal. The form provides two options for companies to complete this certification.

The document outlines the legal requirements under California's Public Contract Code Sections 10475-10481 and the process for obtaining written permission from the Department of General Services if the company is considered a "scrutinized company." Companies without any recent business activities or operations outside the United States are not required to complete this form.

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Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.

OPTION #1 - CERTIFICATION

If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

OPTION #2 – WRITTEN PERMISSION FROM DGS

Pursuant to Public Contract Code Section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.

DEPARTMENT OF GENERAL SERVICES

PROCUREMENT DIVISION

STATE OF CALIFORNIA

DARFUR CONTRACTING ACT CERTIFICATION

DGS PD 1 (Rev. 12/19)

Date

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

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

Date

OPTION #1 - CERTIFICATION
OPTION #2 – WRITTEN PERMISSION FROM DGS
Federal ID Number:
Printed Name and Title of Person Signing:
CompanyVendor Name Printed_2:
Federal ID Number_2:
Printed Name and Title of Person Initialing:
CompanyVendor Name:
ADA Instructions:
Date of signature:
Date of signature 2:

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