DFW_1082_Bidder_Declaration.pdf

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Attached to
RFQ-SED-2425-01, conex boxes
Solicitation number
0000033371
Issued by
Orange County, California

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This document is a Bidder Declaration form from the California Department of Fish and Wildlife. It requires prime bidders to provide information about any subcontractors they plan to use for the contract, including the subcontractor's name, contact information, certification status, work to be performed, and corresponding percentage of the bid price. The form must be completed and submitted by the bidder. It does not provide details about the specific contract opportunity, such as the products or services being procured, project overview, response dates, or contract term.

The form focuses on collecting information about the use of subcontractors, their certification status, and the work they will perform. Bidders must indicate whether they will use subcontractors and, if so, provide the required details about each one. Bidders who do not plan to use subcontractors can skip that section and proceed directly to the certification at the bottom of the form.

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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 .