DARFUR_DFW1080ext.pdf
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- Attached to
- RFQ-LED-0625-08, UTV Trailer
- Solicitation number
- 0000035403
- Issued by
- California
About this file
This document is a Darfur Contracting Act Certification form issued by the California Department of Fish and Wildlife (DFW), which is a mandatory compliance document for state contract bidders or proposers. The form requires businesses to certify their status regarding international business activities, specifically focusing on companies with operations outside the United States within the previous three years. Bidders must choose and complete one of three paragraphs: affirming no international business activities, confirming written permission from the Department of General Services (DGS) despite being a "scrutinized" company, or certifying they are not a "scrutinized" company as defined in Public Contract Code (PCC) § 10476.
The certification is critical for State Price Schedule (SPS) Applications, as applications will be disqualified without this completed form. The document mandates that companies either initial paragraphs 1 or 2, or initial and fully certify paragraph 3, including an authorized signature certifying compliance under penalty of perjury. The form requires companies to provide their name, Federal ID Number (FEIN), and details of the authorized representative, with a clear warning that incomplete submissions will result in automatic disqualification from the bidding or proposal process.
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Other files
| File | Type | Posted |
|---|---|---|
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| Payee_Data_Form_std204.pdf | ||
| 05_RFQ_RFQ-LED-0625-08,_UTV_Trailer.docx | DOCX document | |
| Bidder_Declaration_Form_DFW1082.pdf |
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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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