DFW1082ext_(Bidder_s_Declaration).pdf

PDF 102 KB Posted

Attached to
RFQ-LRB--0625-01 (Lobster Tags)
Solicitation number
0000037407
Issued by
California

About this file

This is a Bidder Declaration form used by the State of California for state and local contract opportunities, specifically for an RFQ related to lobster trap tags needed for the 2026 lobster season. The form requires prime bidders to provide their California vendor name, current certification status (Minority Business/Small Business/Disabled Veteran Business Enterprise), and identify whether subcontractors will be used for contract performance. If subcontractors are employed, bidders must list all subcontractors with their contact information, complete addresses, California certification numbers, specific work elements or goods to be provided, and the corresponding percentage of the bid price allocated to each subcontractor. The form accommodates up to four subcontractors with space for detailed information on each.

The Bidder Declaration must be completed and signed under penalty of perjury by an authorized representative of the bidding company, certifying that all information provided is true and correct. This form serves as a mechanism for California to track minority and small business participation, verify vendor qualifications, and monitor subcontractor involvement in state and local contract awards. The form does not establish pricing terms, set-asides, or funding amounts; rather, it functions as a certification document requiring bidders to disclose their business structure and any minority or disadvantaged business certifications held by the prime bidder and associated subcontractors.

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Text version

BIDDER DECLARATION

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: ____________________________________________

(New 10/2019)

DFW 1082

CA Vendor name:
MB/SB/DVBE Certification Number:
None chek box: Off
Check box yes: Off
Check Box No: Off
Distinct element of work:
Subcontractor information 1:
Subcontractor information 2:
Subcontractor information 3:
Subcontractor information 4:
Subcontractor address 1:
Subcontractor address 2:
Subcontractor address 3:
Subcontractor address 4:
Subcontractor CA Cert number 1:
Subcontractor CA Cert number 2:
Subcontractor CA Cert number 3:
Subcontractor CA Cert number 4:
Work performed 1:
Work performed 2:
Work performed 3:
Work performed 4:
percent 1:
percent 2:
percent 3:
percent 4:
Authorizers printed name:
Date:

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