DFW1080ext.pdf

957 KB Posted

Attached to
NR25-078 Custom Nets
Solicitation number
0000037268
Issued by
California

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DFW 1080 Darfur Contracting Act Certification Form Summary

This is a Darfur Contracting Act Certification form issued by the State of California Department of Fish and Wildlife. The form is required for all bidders and proposers seeking to submit bids or proposals for state contracts. Bidders must certify their business operations status regarding international activities in accordance with California Public Contract Code sections 10476, 10477, and 10478. The form requires completion of one of three certification options: confirmation that the company has no business activities outside the United States in the previous three years; evidence of written permission from the Department of General Services if the company is a scrutinized entity; or certification under penalty of perjury that despite having international operations, the company does not meet the definition of a scrutinized company under state law.

All applicants must submit this completed form with their bid or proposal, with either paragraph one or two initialed or paragraph three both initialed and certified by an authorized representative. Electronic signatures are accepted and carry the same legal weight as handwritten signatures under California Civil Code 1633.5(b). Failure to include this form with appropriate authorization will result in disqualification from state price schedule applications. The form requires the company name, Federal Employer Identification Number (FEIN), printed name and title of the authorizing individual, date of execution, county and state where executed, and an authorized signature for certification purposes.

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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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