DARFUR_DFW1080ext.pdf
PDF 875 KB Posted
- Attached to
- RFQ-LED-0626-01, Cargo Trailers
- Solicitation number
- 0000037060
- Issued by
- Shasta County, San Bernardino City, California
About this file
This is a Darfur Contracting Act Certification form from the State of California Department of Fish and Wildlife (DFW 1080, revised February 14, 2019). The form is required for all bidders and proposers submitting bids or proposals to state contracts.
The form requires bidders to certify their compliance with California Public Contract Code Section 10478, which mandates disclosure of business activities or operations conducted outside the United States within the previous three years. Bidders must complete one of three certification options: (1) attest that they have no business activities or operations outside the United States; (2) declare that they are a scrutinized company but have received written permission from the Department of General Services to submit a bid or proposal; or (3) certify that despite having international business activities, they are not a scrutinized company as defined in PCC Section 10476. Option 3 requires an authorized signature and certification under penalty of perjury. The form mandates that bidders provide their company name and Federal Employer Identification Number (FEIN). All State Price Schedule applications must include this completed certification form with either paragraph 1 or paragraph 2 initialed, or paragraph 3 both initialed and certified, or the application will be disqualified.
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Other files
| File | Type | Posted |
|---|---|---|
| Payee_Data_Form_std204.pdf | ||
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| 03_RFQ-LED-0626-01_Cargo_Trailers.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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