DFW1082ext_Bidder_Dec.pdf

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

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This is a Bidder Declaration form (DFW 1082) issued by the State of California Department of Fish and Wildlife for the contract opportunity NR25-078 Custom Nets. The form serves as a certification document requiring prime bidders to declare their California vendor information, current state certifications (Minority Business, Small Business, or Disabled Veteran Business Enterprise), and details regarding any subcontractors that will be used to perform work on the contract. Bidders must identify the specific elements of work their business will perform and list all subcontractors with their contact information, complete addresses, certification numbers, work descriptions, and corresponding percentages of the bid price.

The declaration requires bidders to certify under penalty of perjury that all information provided is true and correct, with electronic signatures carrying the same legal binding authority as handwritten signatures in accordance with California Civil Code 1633.5(b). The form includes designated spaces for up to four subcontractors and requires the authorizer's printed name, signature, and date of execution. This document is a mandatory component of the bidding process and must be completed and submitted by all prospective contractors responding to the custom fishing nets procurement.

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State of California – Department of Fish and Wildlife

BIDDER DECLARATION

DFW 1082 (REV. 05/15/23)

1. Primebidder information:

a. What is your California vendor’s 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.

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.

Authorizer’s printed name: _______________________________________ Date: ______________

Authorizer’s signature: ____________________________________________ 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

Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now
MBSBDVBE:
Authorizers printed name:
Date:
California Vendor Name:
Yes: Off
No: Off
If yes,:
Subcontractor Name4:
Subcontractor Name3:
Subcontractor Name2:
Subcontractor Name1:
Subcontractor Address1:
Subcontractor Address2:
Subcontractor Address3:
Subcontractor Address4:
CA Cert Number1:
CA Cert Number2:
CA Cert Number3:
CA Cert Number4:
Work Performed1:
Work performed2:
Work performed3:
Work performed4:
Corresponding percent1:
Corresponding percent2:
Corresponding percent3:
Corresponding percent4:
SAVE:
PRINT:
CLEAR:

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