_DFW_1080__Darfur.pdf
PDF 957 KB Posted
- Attached to
- 2026-IDR6-004, Live Catfish
- Solicitation number
- 0000040891
- Issued by
- Riverside County, California
About this file
This is a Darfur Contracting Act Certification form (DFW 1080) issued by the State of California Department of Fish and Wildlife in connection with a state and local contract opportunity for live catfish needed for Fishing in the City events in Riverside and San Bernardino Counties. The form is a mandatory compliance document required under California Public Contract Code Section 10478 for all bidders and proposers with business activities or operations outside the United States within the previous three years. Bidders must certify their status by selecting one of three options: confirming no international business activities, disclosing scrutinized company status with written Department of General Services approval, or certifying compliance with non-scrutinized company requirements. The form requires completion with the company name, Federal Employer Identification Number (FEIN), authorized representative initials or signature, and execution date before submission with the bid or proposal.
Bidders must complete this certification form as a prerequisite for bid submission, with the form explicitly noting that State Price Schedule Applications will be disqualified if this document is not included with either paragraph one or two initialed, or paragraph three initialed and certified. The certification under paragraph three requires an authorized representative to attest under penalty of perjury that the prospective bidder is legally bound by the stated compliance representation. Electronic signatures are accepted and deemed legally binding equivalent to handwritten signatures under California Civil Code Section 1633.5(b). Failure to properly complete and submit this form with the bid submission will result in automatic disqualification from the procurement process.
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Text version
State of California - Department of Fish and Wildlife
DARFUR CONTRACTING ACT CERTIFICATION
DFW 1080 (REV. 05/15/23)
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 Number 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.
With accordance to California Civil Code §1633.5(b), I acknowledge that by providing my electronic signature for this form, I agree that my electronic signature is legal binding equivalent to a handwriting signature. I hereby confirm that my electronic signature represents my execution or authentication of this form, and my intent to be bound by it.
By (Authorized Signature)
Printed Name and Title of Person Signing
Executed in the County and State of Date Executed
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.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10478.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10476.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10476.
http://www.dgs.ca.gov/dgs/Home.aspx https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10477.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10476.
https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fleginfo.legislature.ca.gov%2Ffaces%2Fcodes_displaySection.xhtml%3FsectionNum%3D1633.5%26lawCode%3DCIV&data=05%7C01%7CLucia.Rodriguez%40wildlife.ca.gov%7Cf7d61fe8902f4fc2ddc908db44de0a8a%7C4b633c25efbf40069f1507442ba7aa0b%7C0%7C0%7C638179492686187568%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=SgmSIctaufa78R%2BCFlJqmUDsiiE%2FYw%2FCR%2BZhi4%2BcxQ0%3D&reserved=0
| 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: |
| Executed in the County and State of: |
| Date Executed: |
| SAVE: |
| PRINT: |
| CLEAR: |
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