DFW_1080_Darfur.pdf

854 KB Posted

Attached to
PE-R6-0627-01, Skid Steer
Solicitation number
0000040248
Issued by
Sacramento County, California

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This is a Darfur Contracting Act Certification form issued by the State of California Department of Fish and Wildlife for use in bidding on state contracts. The form implements Public Contract Code Section 10478 requirements and applies to any bidder or proposer with business activities or operations outside the United States within the previous three years. Bidders must certify their compliance status by selecting one of three options: confirming no international business activities, disclosing scrutinized company status with written DGS permission, or certifying non-scrutinized status despite international operations. The form requires completion with the company name, Federal ID Number (FEIN), authorized signatures, and dates of execution. The related contract opportunity PE-R6-0627-01 involves the California Department of Fish and Wildlife's procurement of a new skid steer for vegetation management and infrastructure repair on Department-managed lands.

All bidders submitting proposals, including State Price Schedule (SPS) applications, must include this completed certification form as a mandatory requirement for bid eligibility. The form provides space for the initialing or signing of the appropriate certification paragraph and requires identification of the county and state where the certification is executed. Failure to include the properly completed form will result in automatic disqualification of applications. No pricing terms, set-asides, funding sources, or contract duration information is specified within this certification document.

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PE-R6-0627-01_Skid_Steer_Invitation_for_Bid.docx DOCX document
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DFW1082ext__Bidder_s_Declaration_.pdf PDF

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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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