DFW1082ext.pdf
PDF 956 KB Posted
- Solicitation number
- 0000035390
- Issued by
- Los Angeles County, California
About this file
This document is a Bidder Declaration form issued by the State of California's Department of Fish and Wildlife (DFW), specifically form DFW 1082 (Revised 05/15/23). The form is designed to collect information from potential bidders regarding their business certifications, subcontractor details, and electronic signature acknowledgment. The form requires bidders to provide their California vendor name, current state certifications (Micro Business/Small Business/Disabled Veteran Business Enterprise), and comprehensive information about any subcontractors who will be involved in the contract, including their contact details, address, certification status, specific work to be performed, and corresponding percentage of the bid price.
The form includes a certification section where the bidder must affirm under penalty of perjury that the provided information is accurate. Additionally, the document incorporates an electronic signature provision under California Civil Code §1633.5(b), which allows the electronic signature to be legally binding and equivalent to a handwritten signature. The form provides fields for the authorizer's printed name and signature, along with a date, to complete the declaration process. The document also features interactive buttons for saving, printing, and clearing the form, indicating it is a digital-friendly template for contract bidding.
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| DFW1080ext.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: |
File details come from the government source that posted it. Updated .