DFW1080ext.pdf
PDF 957 KB Posted
- Attached to
- Interpretive Panels
- Solicitation number
- 0000037849
- Issued by
- California
About this file
This is a Darfur Contracting Act Certification form (DFW 1080) issued by the State of California Department of Fish and Wildlife that establishes eligibility requirements for bidders and proposers on state contracts. The form requires all bidders with business activities or operations outside the United States within the previous three years to certify their status regarding "scrutinized companies" as defined under California Public Contract Code Section 10476. Bidders must complete one of three certification options: confirm they have no international business activities, provide written permission from the Department of General Services if they are a scrutinized company, or certify under penalty of perjury that despite having international operations they do not qualify as a scrutinized company. The related contract opportunity involves the procurement of 69 interpretive panels measuring 36 inches in height by 48 inches in width by 1/8 inch in thickness, constructed of High Pressure Laminate (HPL) material.
Applications for State Price Schedule positions will be disqualified if this certification form is not completed with either paragraph 1 or 2 initialed, or paragraph 3 both initialed and certified by an authorized representative. The form requires the company name, Federal Employer Identification Number (FEIN), and appropriate signatures or initials with dates. Electronic signatures are accepted and considered legally binding equivalent to handwritten signatures under California Civil Code 1633.5(b). This certification is mandatory for all bidders regardless of their international business status and serves as a prerequisite for bid submission eligibility on California Department of Fish and Wildlife contracts.
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| File | Type | Posted |
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| STD_204_-_Payee_Data_Record.pdf | ||
| Bidder_Declaration_-_DFW_1082.pdf | ||
| PostConsumerForm.pdf | ||
| RFQ-SHIP_panels.docx | DOCX document |
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Text version
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§ionNum=10478.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10476.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10476.
http://www.dgs.ca.gov/dgs/Home.aspx https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=10477.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PCC§ionNum=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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