About this file

The document is a Darfur Contracting Act Certification form issued by the California Department of General Services (DGS) Procurement Division. The form is designed for companies bidding on state contracts that have had business activities outside the United States within the previous three years. Companies must certify they are either not a "scrutinized company" under Public Contract Code Sections 10475-10481 or, if they are a scrutinized company, they must have obtained written permission from the Department of General Services to submit a proposal.

The form provides two options for compliance: Option #1 requires companies to certify under penalty of perjury that they are not a scrutinized company, while Option #2 allows scrutinized companies to submit a bid if they have received written permission from DGS on a case-by-case basis. The certification is specifically aimed at ensuring that companies bidding on California state contracts do not have business operations that conflict with the state's contracting restrictions, particularly those related to regions like Darfur. Companies must provide their company name, Federal ID Number, and an authorized signature to complete the certification process.

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IFB_STD204.pdf PDF

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Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.

OPTION #1 - CERTIFICATION

If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

OPTION #2 – WRITTEN PERMISSION FROM DGS

Pursuant to Public Contract Code Section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.

DEPARTMENT OF GENERAL SERVICES

PROCUREMENT DIVISION

STATE OF CALIFORNIA

DARFUR CONTRACTING ACT CERTIFICATION

DGS PD 1 (Rev. 12/19)

Date

We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477(b). A copy of the written permission from DGS is included with our bid or proposal.

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

Date

OPTION #1 - CERTIFICATION
OPTION #2 – WRITTEN PERMISSION FROM DGS
Federal ID Number:
Printed Name and Title of Person Signing:
CompanyVendor Name Printed_2:
Federal ID Number_2:
Printed Name and Title of Person Initialing:
CompanyVendor Name:
ADA Instructions:
Date of signature:
Date of signature 2:

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