(DFW_1082)_Bidder_Declaration.pdf
PDF 980 KB Posted
- Attached to
- 2025-IDR6-007, John Deere End-Wheel Grain Drill
- Solicitation number
- 0000037814
- Issued by
- San Bernardino County, California
About this file
This Bidder Declaration form (DFW 1082) is submitted to the State of California Department of Fish and Wildlife for the procurement of an End-Wheel Grain Drill (Contract 2025-IDR6-007) to be used for planting upland game crops. The form requires prime bidders to provide their California vendor name, current certification numbers if applicable (Minority Business, Small Business, or Disabled Veteran Business Enterprise), and to declare whether subcontractors will be used for the contract. If subcontractors are utilized, bidders must list all subcontractors with complete contact information, addresses, California certification numbers, specific work to be performed, and the corresponding percentage of the bid price allocated to each subcontractor.
The declaration serves as a certification mechanism whereby the authorizer confirms under penalty of perjury that all information provided is true and correct, with the electronic signature carrying the same legal binding effect as a handwritten signature pursuant to California Civil Code 1633.5(b). Bidders without any applicable certifications may proceed directly to the certification section. The form allows for listing up to four subcontractors with detailed information for each, including work descriptions and budget allocations, with additional pages available if more subcontractors are involved in the project.
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Text version
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 .