_DFW_1082__Bidder_Declaration.pdf

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Attached to
RFQ-2026-IDR6-002
Solicitation number
0000040132
Issued by
Imperial County, California

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This is a Bidder Declaration form (DFW 1082, Revised 05/15/23) issued by the State of California Department of Fish and Wildlife for contract opportunity RFQ-2026-IDR6-002, which involves procurement of seed for farming operations to provide nesting cover and forage for various species on Wildlife Areas. The form requires prime bidders to provide their California vendor name, current state certification numbers (if applicable, including Minority Business, Small Business, or Disabled Veteran Business Enterprise designations), and confirmation of whether subcontractors will be utilized on the contract. If subcontractors are employed, bidders must identify all subcontractors and specify the distinct elements of work the prime contractor will perform.

The form requires complete disclosure of all subcontractors in a tabular format, including subcontractor names, contact persons, phone numbers, email addresses, complete addresses, applicable California certification numbers, description of work performed or goods provided, and the corresponding percentage of the bid price allocated to each subcontractor. The bidder must certify under penalty of perjury that all information provided is true and correct and acknowledge that their electronic signature is legally binding equivalent to a handwritten signature in accordance with California Civil Code 1633.5(b). The form requires the authorizer's printed name, date, and electronic signature.

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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 .