DFW1082ext.pdf
PDF 980 KB Posted
- Attached to
- RFQ-R1-0626-02, Brush Chipper
- Solicitation number
- 0000039317
- Issued by
- California
About this file
This is a Bidder Declaration form (DFW 1082) issued by the State of California Department of Fish and Wildlife for the RFQ-R1-0626-02 Brush Chipper procurement. The form serves as a declaration document for prime bidders and subcontractors participating in this contract opportunity, which will support critical fuel reduction projects for the Department of Fish and Wildlife. The document requires bidders to provide their California vendor name, current certification status (Minority Business/Small Business/Disabled Veteran Business Enterprise), and indicate whether subcontractors will be used on the project. If subcontractors are involved, bidders must list each subcontractor's name, contact information, complete address, California certification number, the specific work or goods to be provided, and the corresponding percentage of the bid price attributed to that subcontractor.
The form requires certification under penalty of perjury that all information provided is true and accurate, with the authorizer's printed name, date, and electronic signature required at the bottom of the document. The declaration acknowledges that electronic signatures are legally binding equivalent to handwritten signatures under California Civil Code 1633.5(b). The form includes fields for up to four subcontractors and can be expanded with additional pages if needed. This document is essential for bidders to establish their eligibility, identify any minority or small business certifications, and clearly delineate subcontracting arrangements and associated work percentages for the brush chipper procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| DARFUR.pdf | ||
| std204.pdf | ||
| RFQ-R1-0626-02.pdf | ||
| 2023Mar6Form74R3__29_.pdf |
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Text version
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: |
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