EXHIBIT 12.1 - DIR PUBLIC WORKS VERIFICATION FORM.pdf

This is a Public Works Contractor Registration Verification Form issued by the California Department of Industrial Relations (DIR) for use in public works contract bidding processes. The form serves as a verification document that prime bidders and proposers must complete and submit to the contract administrator along with their bid documents. The form requires contractors to list all known subcontractors and provide registration information including contractor names, license numbers, and DIR registration numbers. All prime contractors and subcontractors performing prevailing wage work are required to be registered with the DIR to bid on public works projects.

Any contractor listed on a bid document that is not registered with the DIR Contractor Registration database must register with the DIR and provide proof of payment of a $2,000 fine before bid submission. If a contractor fails to provide proof of registration, the bidder or proposer has twenty-four hours to replace the unregistered contractor with a compliant alternative. The form includes a section for contract administrator use to record the verification date and initials upon review.