(DFW_1082)_Bidder_Declaration.pdf

980 KB Posted

Attached to
RFQ-2025-IDR6-003, Seeds
Solicitation number
0000036492
Issued by
California

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This document is a Bidder Declaration form issued by the State of California's Department of Fish and Wildlife (DFW), specifically form DFW 1082 (Revised 05/15/23). The form is designed to collect critical information from potential bidders regarding their vendor status, California certifications, and subcontractor details for a state contract. The form requires prime bidders to disclose their California vendor name, current certification numbers (such as Minority Business/Small Business/Disabled Veteran Business Enterprise), and whether subcontractors will be utilized in the contract.

The declaration includes a comprehensive table for listing subcontractor information, which captures details like subcontractor name, contact information, complete address, California certification number, specific work to be performed, and the corresponding percentage of the bid price. The form also includes a certification section where the authorizer acknowledges the truthfulness of the provided information under penalty of perjury and agrees to the legal binding nature of an electronic signature in accordance with California Civil Code §1633.5(b). Bidders must complete all relevant sections, provide accurate information about their business and potential subcontractors, and sign the document to be considered for the contract opportunity.

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State of California – Department of Fish and Wildlife

BIDDER DECLARATION

DFW 1082 (REV. 05/15/23)

1. Primebidder information:

a. What is your California vendor’s 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.

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.

Authorizer’s printed name: _______________________________________ Date: ______________

Authorizer’s signature: ____________________________________________ 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

Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now
MBSBDVBE:
Authorizers printed name:
Date:
California Vendor Name:
Yes: Off
No: Off
If yes,:
Subcontractor Name4:
Subcontractor Name3:
Subcontractor Name2:
Subcontractor Name1:
Subcontractor Address1:
Subcontractor Address2:
Subcontractor Address3:
Subcontractor Address4:
CA Cert Number1:
CA Cert Number2:
CA Cert Number3:
CA Cert Number4:
Work Performed1:
Work performed2:
Work performed3:
Work performed4:
Corresponding percent1:
Corresponding percent2:
Corresponding percent3:
Corresponding percent4:
SAVE:
PRINT:
CLEAR:

File details come from the government source that posted it. Updated .