Darfur_Contracting_Act.pdf

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Attached to
25RS0008 - Off-Site Dental Services
Solicitation number
0000036586
Issued by
Plumas County, Shasta County, Siskiyou County, Tehama County, Trinity County, Plumas Eureka CDP, San Bernardino City, Shasta CDP, Shasta Lake City, Mount Shasta City, Rancho Tehama Reserve CDP, Tehama City, Trinity Center CDP, Trinity Village CDP, Plumas Lake CDP, California

About this file

This document is a Darfur Contracting Act Certification form issued by the California Department of General Services' Procurement Division. The form applies to companies that have conducted business activities outside the United States within the previous three years and are seeking to bid on or submit a proposal for a State of California contract. The document provides two certification options: Option #1 allows companies to certify they are not a "scrutinized company" under penalty of perjury, while Option #2 is for scrutinized companies that have obtained written permission from the Department of General Services to submit a bid or proposal.

The certification requirements stem from Public Contract Code Sections 10475-10481, which mandate that companies with international business activities must either affirm they are not a scrutinized company or demonstrate they have received explicit permission to bid. Companies that have not conducted business outside the United States in the past three years are exempt from completing the form. The document provides space for companies to enter their vendor name, Federal ID Number, authorized signature, and other pertinent information to comply with the state's contracting regulations.

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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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