DARFUR_DFW1080ext.pdf
PDF 875 KB Posted
- Attached to
- RFQ-R1-0626-01, UTV
- Solicitation number
- 0000039283
- Issued by
- Lassen County, California
About this file
This is a Darfur Contracting Act Certification form (DFW 1080) issued by the State of California Department of Fish and Wildlife. The form is required pursuant to California Public Contract Code sections 10476-10478 and must be completed by all bidders and proposers to establish eligibility for contract submission. Bidders are required to certify their international business activities status by selecting one of three options: confirmation that they have no business operations outside the United States within the previous three years, acknowledgment of scrutinized company status with written Department of General Services approval, or certification that despite international business activities they are not a scrutinized company. The form requires completion with the company name, Federal Employer Identification Number (FEIN), authorized signature, printed name and title, date, and county and state of execution.
State Price Schedule (SPS) applications will be automatically disqualified if the certification form is not included with either paragraph one or two initialed, or paragraph three both initialed and certified. The form provides fillable fields for all required information and includes save, print, and clear functions for digital completion. Submission of this certification is mandatory for all prospective bidders and proposers seeking to participate in California state contracting opportunities through the Department of Fish and Wildlife.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Payee_Data_Form_std204.pdf | ||
| 06_RFQ-R1-0626-01_UTV.docx | DOCX document | |
| Bidder_Declaration_Form_DFW1082.pdf | ||
| PostConsumer-Content_Certification_Form__CIWMB074.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .