DFW_1080_Darfur.pdf

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Attached to
RFQ-LRB--0625-01 (Lobster Tags)
Solicitation number
0000037407
Issued by
California

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This is a Darfur Contracting Act Certification form (DFW 1080) issued by the State of California Department of Fish and Wildlife, pursuant to California Public Contract Code Section 10478. The form applies to the RFQ-LRB-0625-01 contract opportunity for lobster trap tags needed for the 2026 lobster season in California. Bidders and proposers must complete this certification form to establish eligibility to submit bids or proposals. The form requires companies to disclose whether they have conducted business activities or operations outside the United States within the previous three years and to certify their status as non-scrutinized companies under PCC Section 10476.

Bidders must select one of three options: certify that they have no international business activities, certify that they are a scrutinized company with written DGS approval to bid, or certify that despite international business activities they are not a scrutinized company as defined by state law. Paragraph 3 certification requires an authorized official to sign under penalty of perjury and specify the county and state where the certification is executed. State Price Schedule applications will be disqualified unless the form is properly completed with either Paragraph 1 or 2 initialed or Paragraph 3 both initialed and certified. The form includes fields for company name, Federal Employer Identification Number (FEIN), authorized representative information, and execution details.

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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

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.

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.

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

1. ________

Initials

2. ________ Initials

3. ________ Initials https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10478.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

http://www.dgs.ca.gov/dgs/Home.aspx https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10477.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

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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