DFW_1082_Bidder_Declaration_Oct2019_.pdf
PDF 102 KB Posted
- Attached to
- NCR-HQ-RFQ-24-F0072A: medical wire dry swabs
- Solicitation number
- 0000033507
- Issued by
- Sacramento County, California
About this file
This document is a Bidder Declaration form for a California state and/or local government contract opportunity. It requires the prime bidder to provide information about their California vendor name, current California Certification(s) number(s), and whether subcontractors will be used for the contract. If subcontractors are to be used, the form requires the bidder to list the subcontractor names, contact information, certification numbers, work to be performed, and corresponding percentage of the bid price. The form must be signed by the authorizing party certifying the information provided is true and correct.
The document does not provide any additional details about the specific contract opportunity, such as the products or services requested, project overview, quantities, response dates, award dates, contract term, or renewal options. Likewise, it does not include information about pricing terms, set asides, incumbents, funding requirements and sources, or other salient details.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| NCR-HQ-RFQ-24-F0072A.pdf | ||
| Darfur_Certification_Form.doc.pdf | ||
| Postconsumer_Content_CalRecycle74.pdf | ||
| Payee_Data_std204.pdf | ||
| sellerspermit-EXAMPLE.pdf | ||
| GenAI.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
BIDDER DECLARATION
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: ____________________________________________
(New 10/2019)
DFW 1082
| CA Vendor name: |
| MB/SB/DVBE Certification Number: |
| None chek box: Off |
| Check box yes: Off |
| Check Box No: Off |
| Distinct element of work: |
| Subcontractor information 1: |
| Subcontractor information 2: |
| Subcontractor information 3: |
| Subcontractor information 4: |
| Subcontractor address 1: |
| Subcontractor address 2: |
| Subcontractor address 3: |
| Subcontractor address 4: |
| Subcontractor CA Cert number 1: |
| Subcontractor CA Cert number 2: |
| Subcontractor CA Cert number 3: |
| Subcontractor CA Cert number 4: |
| Work performed 1: |
| Work performed 2: |
| Work performed 3: |
| Work performed 4: |
| percent 1: |
| percent 2: |
| percent 3: |
| percent 4: |
| Authorizers printed name: |
| Date: |
File details come from the government source that posted it. Updated .