DVBE DECLARATION SECTION 1. MUST BE COMPLETED BY ALL DVBEs Disabled Veteran Business Enterprise (DVBE) name: ________________ DGS Supplier ID number: _______________ SECTION 2. MUST BE COMPLETED BY ALL DVBEs Check only one box in Section 2 and provide original signatures of all disabled veteran (DV) owners and managers of the DVBE. I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code (MVC) section 999.2(b), of the goods and/or services provided by the DVBE in connection with the solicitation identified above. Pursuant to MVC 999.2(f), I (we) declare that the DVBE is a broker or agent for the following principal. (attach additional sheets if more than one principal) Principal Name: _________________________ Principal Phone: ________________ Principal Address: _______________________________________________________ Disabled veteran owners and managers of the DVBE: (attach additional sheets if necessary) Printed Name of DV owner/manager Date signed Signature of DV owner/manager Printed Name of DV Date signed Signature of DV owner/manager Printed Name of DV owner/manager Date signed Signature of DV owner/manager SECTION 3. MUST BE COMPLETED BY DVBEs THAT PROVIDE RENTAL EQUIPMENT AND ARE NOT BROKERS/AGENTS Skip this section if (i) the DVBE is not providing rental equipment or (ii) the DVBE indicated in Section 2 that it is a broker or agent.
DVBE DECLARATION SECTION 1. MUST BE COMPLETED BY ALL DVBEs Disabled Veteran Business Enterprise (DVBE) name: ________________ DGS Supplier ID number: _______________ SECTION 2. MUST BE COMPLETED BY ALL DVBEs Check only one box in Section 2 and provide original signatures of all disabled veteran (DV) owners and managers of the DVBE. I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code (MVC) section 999.2(b), of the goods and/or services provided by the DVBE in connection with the solicitation identified above. Pursuant to MVC 999.2(f), I (we) declare that the DVBE is a broker or agent for the following principal. (attach additional sheets if more than one principal) Principal Name: _________________________ Principal Phone: ________________ Principal Address: _______________________________________________________ Disabled veteran owners and managers of the DVBE: (attach additional sheets if necessary) Printed Name of DV owner/manager Date signed Signature of DV owner/manager Printed Name of DV Date signed Signature of DV owner/manager Printed Name of DV owner/manager Date signed Signature of DV owner/manager SECTION 3. MUST BE COMPLETED BY DVBEs THAT PROVIDE RENTAL EQUIPMENT AND ARE NOT BROKERS/AGENTS Skip this section if (i) the DVBE is not providing rental equipment or (ii) the DVBE indicated in Section 2 that it is a broker or agent.
DVBE_Declaration_with_instructions.docx