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DARFUR CONTRACTING ACT CERTIFICATION <br />Public Contract Code, Sections 10475 -10481 applies to any company that currently or within <br />the previous three years has had business activities or other operations outside of the United <br />States. For such a company to bid on or submit a proposal for a State of California contract, the <br />company must certify that it is either a) not a scrutinized company; or b) a scrutinized company <br />that has been granted permission by the Department of General Services to submit a proposal. <br />If your company has not, within the previous three years, had any business activities or <br />other operations outside of the United States, you do not need to complete this form. <br />OPTION #1 - CERTIFICATION <br />If your company, within the previous three years, has had business activities or other operations <br />outside of the United States, in order to be eligible to submit a bid or proposal, please insert <br />your company name and Federal ID Number and completethe certification below. <br />I, the official named below, CERTIFY UNDER PEWTY OF PERJURY that a) the prospective <br />proposer /bidder named below is not a scrutinii d company per Public Contract Code 10476; <br />and b) I am duly authorized to legally bind tie prospective proposer /bidder named below. This <br />certification is made under the laws of tb State of California. <br />Ii Federal ID Number <br />OPTION #2 —WRITTEN PERMISSION FROM DGS <br />Pursuant to Public Contract Code, Section 10477(b), the Director of the Department of General <br />Services may permit a scrutinized company, on a case -by -case basis, to bid on or submit a <br />proposal for a contract with a state agency for goods or services, if it is in the best interests of <br />the state. If you are a scrutinized company that has obtained written permission from the DGS <br />to submit a bid or proposal, complete the information below. <br />We are a scrutinized company as defined in Public Contract Code, Section 10476, but we have <br />received written permission from the Department of General Services to submit a bid or <br />proposal pursuant to Public Contract Code, Section 10477(b). A copy of the written permission <br />from DGS is Included with our bid or proposal. <br />I Company/Vendor Name (Printed) Federal ID Number <br />Initials of Submitter <br />I� <br />Printed Name and Title of Person Initialing <br />FDO19 (Rev. 7/28/10) <br />25C -17 <br />