DFW_1080_Darfur.pdf

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Attached to
RFQ-LED-0627-01, Lobster Tags
Solicitation number
0000040670
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 for use in state contract bidding. The form requires bidders and proposers to certify their compliance with California Public Contract Code Section 10478 regarding business activities outside the United States. Bidders must select one of three certification options: confirming they have no international business operations in the previous three years, declaring they are a scrutinized company with written permission from the Department of General Services to bid, or certifying they have international operations but are not a scrutinized company as defined under PCC 10476. The form requires completion with the company name, Federal Employer Identification Number (FEIN), and appropriate initials or authorized signature depending on which certification option applies.

Completion and submission of this form with either the first or second paragraph initialed, or the third paragraph both initialed and certified under penalty of perjury, is mandatory for bid or proposal eligibility. State Price Schedule applications will be disqualified if this certification form is not included with the submission. The authorized signatory must execute the form in the county and state where the certification is made, ensuring legal binding of the prospective bidder or proposer to the selected certification paragraph.

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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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