Pursuant to Public Contract Code (PCC) sections 10475-10481,
the Darfur Contracting Act’s intent is to preclude State agencies from
contracting with scrutinized companies that do business in the African nation
of
Therefore, to be eligible to contract with the California Department of Public Health, please initial one of the following three paragraphs and complete the certification below:
1. _____ We do not currently have, or we have not had within the previous
Initials three
years, business activities or other operations outside of the
OR
2. _____ We are a scrutinized company as defined in Public Contract Code
Initials section 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section 10477(b) or submit a contract/purchase order. A copy of the written permission from DGS is included with our bid, proposal or contract/purchase order.
OR
3. _____ We currently have, or we have had within the previous three years,
Initials business activities or other
operations outside of the
but we certify below that we are not a scrutinized company
as defined in Public Contract Code section 10476.
CERTIFICATION
I, the official named below,
CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this
company to the clause listed above. This certification is made under the laws of
the State of
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Company Name (Printed) |
Federal ID Number |
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By (Authorized Signature) |
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Printed Name and Title of Person Signing |
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Date Executed |
Executed in the County and State of |
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