Specifications

Bidder Acknowledgement/Certification (OBS 300) Bid No. 6000001312
California Department of Corrections and Rehabilitation (CDCR)
Page 1 of 1
The bidder hereby agrees to provide all labor, materials, supplies, licenses, permits, equipment and transportation necessary
to perform all services required for the foregoing titled work in accordance with the Scope of Work, all Terms and Conditions,
Disabled Veteran Business Enterprise (DVBE) requirements, if applicable, and such addenda thereto as may be issued before
the public bid opening date, at the rates set forth by the bidder in Exhibit B-1, Rate Sheet. Exhibit B-1 Rate Sheet must be
submitted with this Bidder Acknowledgement/Certification form.
Exhibit B-1 Rate Sheet shall remain in force for the stated term of this Agreement and shall include every item of expense,
direct and indirect, including any taxes incidental to the specified rates.
By virtue of submitting this bid, the undersigned is accepting the terms and conditions expressed in this IFB. Any and all
services performed outside the scope of this Agreement shall be at the sole risk and expense of the bidder.
COMPANY NAME:
STREET ADDRESS:
P.O. BOX:
CITY, STATE AND ZIP CODE:
CITY, STATE AND ZIP CODE:
TELEPHONE NUMBER: FAX NUMBER:
( )
( )
FEDERAL ID or SOCIAL SECURITY NUMBER:
E-MAIL ADDRESS:
TAX STATUS
[ ] Individual/Sole Proprietor [ ] Estate or Trust [ ] Partnership
[ ] Corporation (State in which incorporated _______) [ ] Other: ______________________
By signing this document, I CERTIFY UNDER PENALTY OF PERJURY, that I am duly authorized to legally bind the
prospective proposer/bidder to the requirements of this bid document. This certification is made under the laws of the State of
California.
PRINT NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE OF AUTHORIZED REPRESENTATIVE:
DATE:
Bidding Preferences Claimed (Check only the preferences claimed)
Preferences:
Certification Number/Expiration Date

DGS certified Small Business

DGS certified Micro Business

Non-Small Business Subcontractor Preference (committing use of 25% or more of DGS certified
Small/Micro Business Subcontractors) include the OBS 555

DGS certified Disabled Veteran Business Enterprise

DVBE Incentive requested by bidder (include the completed OBS 554 with bid)

NVSA preference request
Check all that bidder is applying for:

TACPA

LAMBRA

EZA Attach all applicable forms
Bidder Providing Facility(ies) If the bidder is supplying the facility(ies) for services, please specify the complete
address(es) of the facility(ies) where services will be provided (use additional sheets if necessary). The bidder hereby
authorizes the State to insert the bidder’s facility(ies) listed below into the Exhibit A Scope of Work.
Street Address, City, State, Zip Code
Street Address, City, State, Zip Code
Bid 6000001312
State of California
11/14/2013 2:35 PM
p. 19