DFW1082ext.pdf

PDF 102 KB Posted

Attached to
RFQ-WLB-25-L-0018
Solicitation number
0000037815
Issued by
California

About this file

This is a Bidder Declaration form (DFW 1082) used by the State of California for contract bidding purposes related to RFQ-WLB-25-L-0018, which requests canvas photo prints for conference rooms. The form requires prime bidders to provide their California vendor name, current state certifications (Minority Business/Small Business/Disabled Veteran Business Enterprise), and indicate whether subcontractors will be utilized for the contract. If subcontractors are employed, bidders must list all subcontractors with their contact information, complete addresses, California certification numbers, specific work elements or goods provided, and the corresponding percentage of the bid price allocated to each subcontractor. The form accommodates up to four subcontractors with designated fields for each entry.

The declaration requires bidders to certify under penalty of perjury that all provided information is true and correct, with signature and date fields for the authorized representative. The form does not address specific pricing terms, set-asides, or other financial requirements; rather, it serves as a standardized certification document to establish bidder eligibility and subcontractor participation for the canvas photo prints procurement. The form was last revised in October 2019 and represents California's requirement for transparency regarding business certifications and subcontracting arrangements in state and local contracting opportunities.

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Other files

File Type Posted
std204.pdf PDF
CalRecycle_74_(Revised_01-23)_.pdf PDF
Sellers-Permit_Example.png PNG image
DFW1080ext.pdf PDF
WLB-25-L-0018_Canvas_Prints.docx DOCX document

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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 .