DARFUR_DFW1080ext.pdf
PDF 875 KB Posted
- Attached to
- RFQ-LED-0627-01, Forklift
- Solicitation number
- 0000040241
- Issued by
- California
About this file
This is a DARFUR Contracting Act Certification form (DFW 1080) issued by the California Department of Fish and Wildlife for use in state contracting. The form applies to bidders and proposers for the RFQ-LED-0627-01 forklift procurement for a California law enforcement warehouse facility in Southern California, with quotes due September 16, 2026. The procurement is seeking a forklift and accessories to support equipment movement and delivery handling across multiple enforcement districts and programs at the new facility, with operation restricted to certified staff.
The certification form requires eligible bidders to declare their international business activities status under California Public Contract Code sections 10476-10478. Bidders must select one of three compliance options: certify they have no business operations outside the United States in the previous three years; declare scrutinized company status with written Department of General Services permission; or certify current or recent international business activities while confirming they are not a scrutinized company as defined by statute. Bidders selecting the third option must provide a sworn certification under penalty of perjury. Completion and inclusion of this form with the bid or proposal—with either paragraph one or two initialed or paragraph three initialed and certified—is mandatory for eligibility, with specific notation that State Price Schedule applications will be disqualified without this certification.
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Other files
| File | Type | Posted |
|---|---|---|
| Payee_Data_Form_std204.pdf | ||
| 06_RFQ-LED-0627-01__Forklift.docx | DOCX document | |
| PostConsumer-Content_Certification_Form__CIWMB074.pdf | ||
| 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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