DFW_1082_-_Bidder_Declaration_(09-30-2021).pdf
PDF 908 KB Posted
- Attached to
- RFQ-2024-IDR6-006, Trout Eggs
- Solicitation number
- 0000031332
- Issued by
- California
About this file
The given document is a Bidder Declaration form (DFW 1082) from the California Department of Fish and Wildlife. It requests information from prime bidders regarding the use of subcontractors, their California certifications (MB/SB/DVBE), and the specific elements of work they will perform on the contract. The related state and local contract opportunity is for the supply of domestic triploid rainbow trout eggs to stock the Fillmore Hatchery during the late fall and winter trout planting season.
The form requires bidders to provide their California vendor name, indicate if subcontractors will be used, and list any subcontractors along with their contact information, certification status, and the work they will perform and the corresponding percentage of the bid price. The certification at the bottom of the form states that the information provided is true and correct under penalty of perjury.
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Other files
| File | Type | Posted |
|---|---|---|
| DFW_1080_-_Darfur_Contracting_Certification_Form_(02-14-19).pdf | ||
| RFQ-2024-IDR6-006_FIL_Trout_Eggs.docx | DOCX document | |
| DGS_PD_843_-_DVBE_Declarations.pdf | ||
| STD_204_-_Payee_Data_Record.pdf |
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Text version
State of California – Department of Fish and Wildlife
BIDDER DECLARATION
DFW 1082 (REV. 09/30/21)
1. Prime bidder information:
a. What is your California vendor name?
b. Identify your current California Certification(s) number(s):
(MB/SB/DVBE):_____________ or None (If “None”, proceed to number 2)
c. Will subcontractors be used for this contract? YES NO (If yes, indicate in the space below the distinct element of work your business will perform in this contract. If no, skip to the certification at the bottom of this page.)
2. If subcontractors will be used, list all subcontractors for this contract in the table below. (Attach additional pages if necessary):
EXAMPLE
Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now John Smith Jr.
(916) 445-1234
JSmithJr@fixitnow.com
Subcontractor complete address
1234 Fix It Pl.
Sacramento, CA
95821
CA Certification Number (MB, SB, DVBE, or None)
SB # 15245
Work performed or good provided for this contract
Office repairs
Corresponding % of bid price 25%
CERTIFICATION: By signing this form (Bidder Declaration), I certify under penalty of perjury that the information provided is true and correct.
Authorizers printed name: _______________________________________ Date: _______________
Authorizers signature: ____________________________________________
| Subcontractor Name, Contact Person, Phone Number & Email |
| Fix it Now |
| Authorizers Printed Name: |
| Date: |
| SAVE: |
| PRINT: |
| CLEAR: |
| What is your California vendor name: |
| MB SB DVBE: |
| None: Off |
| Will subcontractors be used for this contract Yes: Off |
| Will subcontractors be used for this contract No: Off |
| If yes indicate in the space below the distinct element of work your business will perform in this contract If no skip to the certification at the bottom of this page: |
| Subcontractor Name Contact Person Phone Number and Email: |
| 0: |
| Subcontractor Name Contact Person Phone Number and Email 1: |
| Subcontractor Name Contact Person Phone Number and Email 2: |
| Subcontractor Name, Contact Person, Phone Number and Email: |
| 3: |
| Subcontractor complete address: |
| 0: |
| 1: |
| 2: |
| 3: |
| CA Certification Number MB SB DVBE or None 0: |
| CA Certification Number MB SB DVBE or None 1: |
| CA Certification Number (MB, SB, DVBE, or None) 2: |
| CA Certification Number MB SB DVBE or None 3: |
| Work performed or good provided for this contract 0: |
| Work performed or good provided for this contract: |
| 1: |
| Work performed or good provided for this contract 2: |
| Work performed or good provided for this contract 3: |
| Corresponding percentage of bid price 0: |
| Corresponding percentage of bid price 2: |
| Corresponding percentage of bid price 1: |
| Corresponding percentage of bid price 3: |
File details come from the government source that posted it. Updated .