SUPERIOR COURT OF CALIFORNIA Solicitation#
COUNTY OF SANTA CLARA
SMALL BUSINESS DECLARATION
C
omplete this form only if Bidder will claim the small business preference associated with this solicitation. Please
review the “Small Business Declaration Instructions” before completing this form. If Bidder submits incomplete or
inaccurate information, it will not receive the small business preference.
SECTION I. COMPLETE IF THE VENDOR IS A SMALL BUSINESS
(If the Vendor is not a Small Business, skip this section.)
1. DGS Supplier ID number:
2. Small Business Certification active from to
3. Will the Vendor subcontract any portion of the contract work to subcontractors?
If yes:
a. State the percentage of the contract work the Vendor will subcontract:
b. Describe the goods and/or services to be provided by the Vendor itself in connection with the contract:
c. Explain how the Vendor is performing a “commercially useful function” for purposes of this contract.
(Please see the instructions for the definition of “commercially useful function.”)
4. Bidder must submit a copy of its Small Business certification approval letter along with this declaration.
SEC
TION II. COMPLETE IF THE VENDOR IS A NON-PROFIT VETERAN SERVICE AGENCY (NVSA)
(If Vendor is not an NVSA, skip this section.)
1. DGS Supplier ID number:
2. NVSA Certification active from to
3. Bidder must submit a copy of its NVSA certification approval letter along with this declaration.
S
ECTION III. CERTIFICATION
I, the official named below, certify under penalty of perjury that the information provided in this form is true and correct.
I am duly authorized to legally bind Bidder to this certification. This certification is made under the laws of the State
of California.
Company Name (Printed)
Tax ID Number
Address
Telephone Number
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed
Executed in the County of in the State of
GS-044 REV 10/2017
SM
ALL BUSINESS DECLARATION INSTRUCTIONS
General Instructions
In this form, (i) “DGS” refers to the Department of General Services, (ii) “Small Business” refers to an entity certified by DGS as a
small business or a microbusiness, (iii) “Bidder” refers to a person or entity that submits a response to a competitive solicitation
issued by the JBE, including both IFBs and RFPs; and (iv) “bid” refers to a response to a competitive solicitation issued by the
JBE, including both IFBs and RFPs.
If Bidder will claim the small business preference in a solicitation where a small business preference is offered, it must complete
the Small Business Declaration. If no small business preference is offered, or Bidder does not claim the small business preference,
Bidder should not complete the Small Business Declaration.
The JBE will determine whether Bidder is eligible to receive the small business preference based on information provided in the
Small Business Declaration. The JBE may, but is not obligated to, verify or seek clarification of any information set forth in the
Small Business Declaration. If Bidder submits incomplete or inaccurate information, it will not receive the small business
preference.
Instructions for Section I
(Skip this section if the Vendor is not itself a Small Business.)
1. Provide Bidder’s DGS Supplier ID number. This number is in Bidder’s DGS Supplier Profile, accessible at:
https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx
2. Provide the applicable dates. These dates are listed in Bidder’s DGS Supplier Profile, accessible at:
https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx
3. If Bidder will subcontract any portion of the contract work, answer “yes” and complete subparts A-C. If Bidder will not
subcontract any portion of the contract work, answer “no” and skip subparts A-C.
Subpart A: This percentage is equal to the amount to be paid by Bidder to all subcontractors divided by Bidder’s total bid
price, multiplied by 100. Enter a percentage; do not enter a dollar amount. For example, if the amount to be paid by
Bidder to subcontractors is $35,000 and Bidder’s total bid price is $125,000, enter “28%” (35,000 ÷ 125,000 = 0.28; 0.28
x 100 = 28).
Subpart B: Provide a detailed description of the goods and/or services the Bidder itself will provide for the contract. In
other words, provide a detailed description of the goods and/or services that will not be subcontracted. Attach additional
sheets if necessary.
Subpart C: Provide an explanation of how the Bidder’s goods and/or services constitute a “commercially useful function”
for purposes of the contract. Pursuant to Government Code section 14837, a business is deemed to perform a
“commercially useful function” if the business does all of the following: (i) is responsible for the execution of a distinct
element of the work of the contract; (ii) carries out its obligation by actually performing, managing, or supervising the work
involved; (iii) performs work that is normal for its business services and functions; (iv) is responsible, with respect to
products, inventories, materials, and supplies required for the contract, for negotiating price, determining quality and
quantity, ordering, installing, if applicable, and making payment; and (v) is not further subcontracting a portion of the work
that is greater than that expected to be subcontracted by normal industry practices. Note: a business will not be
considered to perform a “commercially useful function” if its role is limited to that of an extra participant in a transaction,
contract, or project through which funds are passed in order to obtain the appearance of Small Business participation.
Attach additional sheets if necessary.
4. Each entity certified as a Small Business by DGS will have received a Small Business certification approval letter. Bidder
must submit a copy of its Small Business certification approval letter.
Instructions for Section II
(Skip this section if the Vendor is not an NVSA.)
1. Provide Bidder’s DGS Supplier ID number. This number is in Bidder’s DGS Supplier Profile, accessible at:
https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx
2. Provide the applicable dates. These dates are listed in Bidder’s DGS Supplier Profile, accessible at:
https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx
3. Each entity certified as an NVSA by DGS will have received a certification approval letter. Bidder must submit a copy of
its certification approval letter.
Instructions for Section III
Provide Bidder’s full legal name, tax ID number, address, and telephone number in the appropriate boxes. The certification must
be signed by an authorized Bidder representative in the box labeled “By (Authorized Signature). Provide the name and title of the
authorized Bidder representative, and the date, county, and state where that person signed the certification, in the appropriate
boxes.
GS-044 REV 10/2017