Bidder Declaration Form – Fill Out and Use This PDF

Identify all current certifications issued by the State of California. If the prime bidder has no California

2. (CONTINUED) Column Labels

Subcontractor Name, Contact Person, Phone Number & Fax Number—List each element for all

certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or

subcontractors.

more of the following certifications, enter the applicable certification(s) on the line:

Subcontractor Address & Email Address—Enter the address and if available, an Email address.

•฀

Microbusiness฀(MB)

•฀

Small฀Business฀(SB)

CA Certification (MB, SB, NVSA, DVBE or None)—If the subcontractor possesses a current State of

•฀

Nonproit฀Veteran฀Service฀Agency฀(NVSA)

California certification(s), verify on this website (www.eprocure.pd.dgs.ca.gov).

•฀

Disabled฀Veteran฀Business฀Enterprise฀(DVBE)

Work performed or goods provided for this contract—Identify the distinct element of work contained

Mark either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is

in the contract to be performed or the goods to be provided by each subcontractor. Certified subcontractors

“No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract

must provide a commercially useful function for the contract. (See paragraph 1.b above for code citations

to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be

regarding the definition of commercially useful function.) If a certified subcontractor is further subcontract-

provided by subcontractors.

ing a greater portion of the work or goods provided for the resulting contract than would be expected by

Bidders certified as MB, SB, NVSA, and/or DVBE must provide a commercially useful function as defined in

normal industry practices, attach a separate sheet of paper explaining the situation.

Military and Veterans Code Section 999 for DVBEs and Government Code Section 14837(d)(4)(A) for small/

Corresponding % of bid price—Enter the corresponding percentage of the total bid price for the goods

microbusinesses.

and/or services to be provided by each subcontractor. Do not enter a dollar amount.

Bids must propose that certified bidders provide a commercially useful function for the resulting contract or

Good Standing?—Provide a response for each subcontractor listed. Enter either “Yes” or “No” to indicate

the bid will be deemed non-responsive and rejected by the State. For questions regarding the solicitation,

that the prime bidder has verified that the subcontractor(s) is in good standing for all of the following:

contact the procurement official identified in the solicitation.

฀ •฀

Possesses฀valid฀license(s)฀for฀any฀license(s)฀or฀permits฀required฀by฀the฀solicitation฀or฀by฀law

Note: A subcontractor is any person, firm, corporation, or organization contracting to perform

•฀ If฀฀a฀corporation,฀the฀company฀is฀qualiied฀to฀do฀business฀in฀California฀and฀designated฀by฀the฀State฀฀

part of the prime’s contract.

of California Secretary of State to be in good standing

•฀ Possesses฀valid฀State฀of฀California฀certiication(s)฀if฀claiming฀MB,฀SB,฀NVSA,฀and/or฀DVBE฀status

(1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or “No”. The Military and

51% Rental?—This pertains to the applicability of rental equipment. Based on the following parameters,

Veterans Code Section 999.2 (b) defines “broker” or “agent” as a certified DVBE contractor or subcon-

enter either “N/A” (not applicable),“Yes” or “No” for each subcontractor listed.

tractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or

Enter “N/A” if the:

equipment provided to an awarding department, unless one or more of the disabled veteran owners

•฀

Subcontractor฀is฀NOT฀a฀DVBE฀(regardless฀of฀whether฀or฀not฀rental฀equipment฀is฀provided฀by฀the฀฀

has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of

subcontractor) or

each piece of equipment provided under the contract.

•฀ Subcontractor฀is฀NOT฀providing฀rental฀equipment฀(regardless฀of฀whether฀or฀not฀subcontractor฀is฀a฀฀

(2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51%

DVBE)

of the equipment provided (quantity and value). If not bidding rental equipment, mark “N/A” for “not

Enter “Yes” if the subcontractor is a California certified DVBE providing rental equipment and the

applicable.”

subcontractor owns at least 51% of the rental equipment (quantity and value) it will be providing for

the contract.

2. If no subcontractors are proposed, do not complete the table. Read the certification at the bottom of the

Enter “No” if the subcontractor is a California certified DVBE providing rental equipment but the sub-

form and complete “Page ___ of ___” on the form.

contractor฀does฀NOT฀own฀at฀least฀51%฀of฀the฀rental฀equipment฀(quantity฀and฀value)฀it฀will฀be฀providing.

If subcontractors will be used, complete the table listing all subcontractors. If necessary, attach additional

pages and complete the “Page ___ of ___” accordingly.

Read the certification at the bottom of the page and complete the “Page ___ of ___” accordingly.