Form DGS PD804 "Nonprofit Recognition Application (For Prompt Payment Benefits)" - California

What Is Form DGS PD804?

This is a legal form that was released by the California Department of General Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DGS PD804 by clicking the link below or browse more documents and templates provided by the California Department of General Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form DGS PD804 "Nonprofit Recognition Application (For Prompt Payment Benefits)" - California

738 times
Rate (4.7 / 5) 52 votes
State of California
For State Use Only
NONPROFIT RECOGNITION APPLICATION
(for Prompt Payment Benefits)
Reviewed by
DGS PD 804 (Rev. 10/2019)
Return completed application and required
documentation to:
Approval Date
Small Business and DVBE
Certification 707 Third St., 1st
OSDS Supplier
Floor, Room 400 MS 210
Number
West Sacramento, CA 95605 (916) 375-4940
Date Stamp
(Receptionist)
NP-
PROGRAM DESCRIPTION AND SUBMISSION REQUIREMENTS
Non-profit organizations are eligible to participate in the Prompt Payment Program as set forth
in California Government Code, Title1, 927 et seq. The Prompt Payment Act encourages
expeditious invoice payment to recognized non-profit organizations. Although nonprofit
organizations are not eligible for small business and/or disabled veteran business enterprise
certification, the Office of Small Business and DVBE Certification recognizes non-profit
organizations for Prompt Payment Program eligibility. Once recognized, your organization will
receive a recognition letter.
1. FEDERAL EMPLOYER ID. #(FEIN)
2. BUSINESS TELEPHONE NUMBER
3. LEGAL BUSINESS NAME
4. BUSINESS FAX NUMBER
5. MAILING ADDRESSS (Number, Street, City, State
6. E-MAIL ADDRESS
and Zip +4code, P.O. Box OK)
7. PHYSICAL ADDRESS OF YOUR PRINCIPAL
8. HOMEPAGE
OFFICE
9. CONTACT PERSON NAME 10. CONTACT
11. CONTACT PERSON PHONE
PERSON TITLE
NUMBER
12. BUSINESS
13. TAX YEAR
14. SEC OF STATE
15. STATE BUSINESS
START DATE
BEGINNING MONTH
CORP NUMBER
INCORPORATED IN
State of California
For State Use Only
NONPROFIT RECOGNITION APPLICATION
(for Prompt Payment Benefits)
Reviewed by
DGS PD 804 (Rev. 10/2019)
Return completed application and required
documentation to:
Approval Date
Small Business and DVBE
Certification 707 Third St., 1st
OSDS Supplier
Floor, Room 400 MS 210
Number
West Sacramento, CA 95605 (916) 375-4940
Date Stamp
(Receptionist)
NP-
PROGRAM DESCRIPTION AND SUBMISSION REQUIREMENTS
Non-profit organizations are eligible to participate in the Prompt Payment Program as set forth
in California Government Code, Title1, 927 et seq. The Prompt Payment Act encourages
expeditious invoice payment to recognized non-profit organizations. Although nonprofit
organizations are not eligible for small business and/or disabled veteran business enterprise
certification, the Office of Small Business and DVBE Certification recognizes non-profit
organizations for Prompt Payment Program eligibility. Once recognized, your organization will
receive a recognition letter.
1. FEDERAL EMPLOYER ID. #(FEIN)
2. BUSINESS TELEPHONE NUMBER
3. LEGAL BUSINESS NAME
4. BUSINESS FAX NUMBER
5. MAILING ADDRESSS (Number, Street, City, State
6. E-MAIL ADDRESS
and Zip +4code, P.O. Box OK)
7. PHYSICAL ADDRESS OF YOUR PRINCIPAL
8. HOMEPAGE
OFFICE
9. CONTACT PERSON NAME 10. CONTACT
11. CONTACT PERSON PHONE
PERSON TITLE
NUMBER
12. BUSINESS
13. TAX YEAR
14. SEC OF STATE
15. STATE BUSINESS
START DATE
BEGINNING MONTH
CORP NUMBER
INCORPORATED IN
16. Original Signature of Nonprofit Representative
Any person willfully providing false information is subject to serious penalties. The signatory of
this document must be the applicant firm’s owner and/or officer and certify that he/she has read
and understands the foregoing statement and that all information provided herein is accurate
and truthful. I declare under the penalty of perjury under the laws of the State of California that
the foregoing is true and correct.
SIGNATURE
TITLE
PRINTED NAME
DATE SIGNED
For recognition as a Nonprofit Organization, submit the following:
A completed “Nonprofit Recognition Application”
The entire signed Form 990 “Return of Organization Exempt from Income Tax” for the most
recently completed tax year.
If the nonprofit organization was established less than one year ago and has not yet filed Form 990
submit:
A completed “Nonprofit Recognition Application”
The nonprofit’s Articles of Incorporation as filed with the California Secretary of State’s Office.
Pursuant to the Federal Privacy Act (P.L. 93-579) of 1974 and the Information Practices Act
(IPA) of 1977 (Civil code Sections 1798, et. Seq.), notice is hereby given for the request of
personal information by this Application. The requested personal information is Mandatory. The
principal purpose of the mandatory information is to determine eligibility for recognition as a
Nonprofit Organization. The failure to provide all or any part of the requested information may
delay processing of this Application. No disclosure of personal information will be made unless
permissible under Article 6, Section 1798.24 of the IPA of 1977.
Each individual has the right upon request and proper identification, to inspect all personal
information in any record maintained on the individual by an identifying particular. Direct any
inquiries on information maintenance to the appropriate IPA Officer in the Department of
General Services.
Page of 2