DFW1082_-_Bidder_Declaration_093021.pdf

PDF 908 KB Posted

Attached to
WLB-LAB250041 / Custom SNP Assays
Solicitation number
0000037303
Issued by
California

About this file

This is a Bidder Declaration form (DFW 1082, revised September 30, 2021) required by the State of California Department of Fish and Wildlife for contract opportunity WLB-LAB250041 regarding custom SNP assays for genetic identification of Roosevelt, Rocky Mountain, and Tule elk subspecies and hybridization detection. The form serves as a certification document in which prime bidders must provide their California vendor name, current California certification number if applicable (Minority Business, Small Business, or Disadvantaged Veteran Business Enterprise), and indicate whether subcontractors will be used on the contract. If subcontractors are utilized, bidders must list all subcontractors with their complete contact information, addresses, certification status, specific work elements or goods provided, and corresponding percentage of the bid price allocated to each subcontractor.

The declaration requires bidders to certify under penalty of perjury that all information provided is accurate and complete. The form includes fields for the authorizing representative's printed name, signature, and date of certification. Bidders responding to this contract opportunity must complete this form as part of their bid submission, with provisions for additional pages if multiple subcontractors are involved in contract performance.

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Text version

State of California – Department of Fish and Wildlife

BIDDER DECLARATION

DFW 1082 (REV. 09/30/21)

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: ____________________________________________

Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now
Authorizers Printed Name:
Date:
SAVE:
PRINT:
CLEAR:
What is your California vendor name:
MB SB DVBE:
None: Off
Will subcontractors be used for this contract Yes: Off
Will subcontractors be used for this contract No: Off
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:
Subcontractor Name Contact Person Phone Number and Email:
0:
Subcontractor Name Contact Person Phone Number and Email 1:
Subcontractor Name Contact Person Phone Number and Email 2:
Subcontractor Name, Contact Person, Phone Number and Email:
3:
Subcontractor complete address:
0:
1:
2:
3:
CA Certification Number MB SB DVBE or None 0:
CA Certification Number MB SB DVBE or None 1:
CA Certification Number (MB, SB, DVBE, or None) 2:
CA Certification Number MB SB DVBE or None 3:
Work performed or good provided for this contract 0:
Work performed or good provided for this contract:
1:
Work performed or good provided for this contract 2:
Work performed or good provided for this contract 3:
Corresponding percentage of bid price 0:
Corresponding percentage of bid price 2:
Corresponding percentage of bid price 1:
Corresponding percentage of bid price 3:

File details come from the government source that posted it. Updated .