DFW1080ext_(1).pdf

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Interpretive Panels
Solicitation number
0000037973
Issued by
California

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This is a Darfur Contracting Act Certification form (DFW 1080, Revised 05/15/23) issued by the State of California Department of Fish and Wildlife for use in connection with a state and local contract opportunity for interpretive panels consisting of 36" (h) x 48" (w) x 1/8" (thick) High Pressure Laminate (HPL) panels. The form requires bidders and proposers to certify their eligibility under California Public Contract Code sections 10476 through 10478 by disclosing whether they have conducted business activities or operations outside the United States within the previous three years. Bidders must complete one of three certification options: confirming no international business activities, providing written permission from the Department of General Services as a scrutinized company, or certifying they are not a scrutinized company despite having international operations. The form requires submission of the company name, Federal Employer Identification Number (FEIN), and appropriate signatures or initials with dates.

Completion and inclusion of the DFW 1080 form with either paragraph 1 or 2 initialed, or paragraph 3 both initialed and certified, is mandatory for all State Price Schedule (SPS) applications to avoid disqualification. For paragraph 3 certifications, an authorized company official must provide a signature under penalty of perjury, acknowledging that electronic signatures are legally binding under California law. The form includes fields for the executing official's printed name and title, the county and state where execution occurred, and the execution date.

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State of California - Department of Fish and Wildlife

DARFUR CONTRACTING ACT CERTIFICATION

DFW 1080 (REV. 05/15/23)

Pursuant to California Code, Public Contract Code (PCC) – PCC § 10478, if a bidder or proposer currently or within the previous three years has had business activities or other operations outside of the United States, it must certify that it is not a “scrutinized” company as defined in PCC § 10476.

Therefore, to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number (FEIN) and complete only one of the following three paragraphs (via initials for paragraph 1 or paragraph 2, or via initials and certification for paragraph 3)

Company/Vendor Name (Printed) FEIN

Printed Name and Title of Person Initialing (option 1 or 2) Date

1. ________ Initials

2. ________ Initials

3. ________ Initials

We do not currently have, or we have not had within the previous three years, business activities or other operations outside of the United States.

OR

We are a scrutinized company as defined in PCC § 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to PCC § 10477(B). A copy of the written permission from DGS is included with our bid or proposal.

OR

We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company as defined in PCC § 10476.

CERTIFICATION For Number 3

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective proposer/bidder to the clause listed above in paragraph 3. This certification is made under the laws of the State of California.

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.

By (Authorized Signature)

Printed Name and Title of Person Signing

Executed in the County and State of Date Executed

NOTE: State Price Schedule (SPS) Applications will be disqualified unless your application includes this form with either paragraph 1 or paragraph 2 initialed or paragraph 3 initialed and certified.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10478.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

http://www.dgs.ca.gov/dgs/Home.aspx https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10477.

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC&sectionNum=10476.

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

OR
OR
CompanyVendor Name Printed:
FEIN:
Printed Name and Title of Person Initialing option 1 or 2:
Date:
Initials:
Initials_2:
Initials_3:
Printed Name and Title of Person Signing:
Executed in the County and State of:
Date Executed:
SAVE:
PRINT:
CLEAR:

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