DARFUR_DFW1080ext.pdf
PDF 875 KB Posted
- Attached to
- RFQ-BMB-0625-01, Window Film
- Solicitation number
- 0000034810
- Issued by
- Sacramento County, San Francisco City, California
About this file
This document is a Darfur Contracting Act Certification form from the State of California's Department of Fish and Wildlife (DFW), specifically form DFW 1080 dated 02/14/19. The form is a mandatory certification required for bidders or proposers who have had business activities outside the United States within the previous three years, ensuring compliance with California Public Contract Code (PCC) § 10478. The form requires companies to certify whether they are a "scrutinized" company as defined in PCC § 10476, with three potential attestation options: (1) no business activities outside the US in the past three years, (2) a scrutinized company with written DGS permission, or (3) having international business activities but certifying they are not a scrutinized company.
The certification is a legal requirement for State Price Schedule (SPS) Applications, with applications being disqualified if the form is not properly completed. Companies must provide their company/vendor name, Federal ID Number (FEIN), and an authorized signature certifying their status under penalty of perjury. The form is designed to prevent businesses that potentially support prohibited activities from participating in California state contracts, specifically targeting companies with connections to regions of concern such as Darfur. Failure to complete the form correctly or provide the necessary documentation will result in automatic disqualification from the bidding or proposal process.
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Other files
| File | Type | Posted |
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| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| Payee_Data_Form_std204.pdf | ||
| Bidder_Declaration_Form_DFW1082.pdf | ||
| 04_RFQ-BMB-0625-01,_Window_Film.docx | DOCX document |
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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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