DFW_1080_Darfur.pdf

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RFQ-R5-0627-01, Live Catfish
Solicitation number
0000039791
Issued by
California

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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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