Specifications

STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
OBS 1500 (06/11)
DARFUR CONTRACTING ACT
Bid Number: 6000001312
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.
Select only one of the following options:
OPTION #1 – NO ACTIVITIES OUTSIDE THE US
If your company has not, within the previous three years, had any business activities or other operations outside
of the United States, print your company name, date and signature below:
Company/Vendor Name (Printed)
Date
By (Authorized Signature)
OPTION #2 - 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
Date Executed
Executed in the County and State Of:
OPTION #3 – 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.
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
Bid 6000001312
State of California
11/14/2013 2:35 PM
p. 133