17-Generative_AIDisclosure_Form__DPR-97B_.pdf
PDF 748 KB Posted
- Attached to
- S25650009
- Solicitation number
- 0000039040
- Issued by
- Shasta County, Shasta CDP, Shasta Lake City, Mount Shasta City, California
About this file
This is an Artificial Intelligence (AI) Disclosure Form issued by the California Department of Parks and Recreation (DPR) for use in state and local contract solicitations. The form is designed to identify and track the use of artificial intelligence technology, particularly generative AI, in products and services being procured by DPR. Bidders are required to complete Section I with their contact information and a detailed description of services, then proceed to Section II if they intend to use or offer any AI technology. If AI is being utilized, bidders must disclose the type of AI (traditional or generative), whether it is required for the product, the specific model and version, the applicable license tier, and the delivery method (IaaS, PaaS, SaaS, or on-premises deployment). The form includes space for alternative contact information if questions regarding AI implementation arise, and requires bidder certification through signature in Section III.
The disclosure form serves as a risk assessment and compliance tool for DPR procurement efforts involving AI technology. If generative AI is identified in a bid response, DPR staff must complete the SIMM 5305-F GenAI Intelligence Risk Assessment and submit it to the Information Security and Privacy Office (ISPO) with copies to the Project Management Office (PMO) and DPR IT Procurement for approval by the California Department of Technology (CDT). The form applies to the Boat Boarding Float Replacement project at McArthur-Burney Falls Memorial State Park (Solicitation Number S25650009) and establishes a standardized process for evaluating potential risks associated with generative AI purchases before procurement efforts proceed. No pricing information, set-asides, or contract term details are specified in the disclosure form itself.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
State of California – Natural Resources Agency
DEPARTMENT OF PARKS AND RECREATION
ARTIFICIAL INTELLIGENCE (AI) DISCLOSURE FORM
Instructions for this form are on Page 3.
I. BIDDER CONTACT INFORMATION
BUSINESS NAME SOLICITATION NUMBER
REPRESENTATIVE NAME BUSINESS TELEPHONE NUMBER
BUSINESS ADDRESS CITY STATE ZIP CODE
Description of Services:
Describe in detail the services being provided. Include names of products and large language model.
II. DISCLOSURE
Will you and/or your subcontractor(s) be using or offering AI technology, model, service, or system (collectively, “product”) for this product in question?
No. (Skip to Section IIII) Yes. (Answer 1-5 below)
1. What type of AI is included?
Traditional AI Generative AI
2. Is the AI required for this product?
No Yes Other:
DPR 97B (Rev. 6/2025)(Word to PDF 6/18/2025)(Page 1 of 3)
ARTIFICIAL INTELLIGENCE (AI) DISCLOSURE FORM (Continued)
3. What is the model and version of this product?
4. What is the license tier of the AI product, if applicable (free, enterprise, platinum, etc.)?
5. How is the AI solution delivered: IaaS, PaaS, SaaS, or will it be deployed on-premises? (Indicate if this is a thin client, thick client, web extension, plugin, etc.)
Provide the best contact for information related to questions related to the AI included in the product (if different than the representative listed in Section I.)
NAME E-MAIL PHONE NUMBER
III. SIGNATURE
By signing this document, I have identified and reported any AI use in the performance of this product in question.
Signature Date
DPR 97B (Rev. 6/2025)(Page 2 of 3)
ARTIFICIAL INTELLIGENCE (AI) DISCLOSURE FORM (Instructions)
Instructions:
The Department of Parks and Recreation (DPR) is required to track and complete risk assessments for any Generative Artificial Intelligence (GenAI) purchases. This document is intended to help DPR identify GenAI and assess the risk related to any GenAI purchases.
Section I:
Bidders shall fill in their contact information.
The DPR staff shall fill out the Description of Services in detail and/or reference the applicable Statement of Work or attachment(s). Include the services to be provided related to AI and include the names of products and large language model. It is important to include as much detail as possible related to any AI aspect of the potential purchase.
Section II:
Bidders shall disclose any aspect of AI related to the purchase.
If “no” is selected, no further information is required in this section.
If “yes” is selected, the Bidder shall fill out answers to questions 1-5. Bidders should provide as much detail as possible related to the AI technology, model, service or system as it relates to what the DPR is soliciting for.
If GenAI is selected and the DPR staff intends to pursue the product, the DPR staff must complete the SIMM 5305-F GenAI Intelligence Risk Assessment, Data Classification section and the Risk Assessment Questionnaire questions a-j; and submit it to ISPO@parks.ca.gov with a cc: to both PMO@parks.ca.gov and DPR-IT.Procurement@parks.ca.gov. Contact ISPO@parks.ca.gov for assistance with completing this assessment.
Upon review, ISPO will contact the DPR staff for more information, if needed, prior to submitting the finalized document to the California Department of Technology.
Procurement efforts will be placed on temporary hold pending CDT approval.
Definitions:
IaaS – Infrastructure as a Service is a cloud computing model that provides on-demand access to virtualized computing resources like servers, storage, and networking.
PaaS – Platform as a Service is a cloud computing model that provides a complete platform for developing, running, and managing applications.
SaaS – Software as a Service a cloud-based software delivery model where users access and use applications over the internet via a subscription rather than purchasing and installing software locally.
Section III:
Bidder signatures are required to certify all provided information on this document is true and accurate to the best of their knowledge.
DPR 97B (Rev. 6/2025)(Page 3 of 3) https://cdt.ca.gov/wp-content/uploads/2025/01/SIMM-5305-F-GenAI-Risk-Assessment-2025_0131-final.pdf mailto:ISPO@parks.ca.gov mailto:ISPO@parks.ca.gov mailto:PMO@parks.ca.gov mailto:DPR-IT.Procurement@parks.ca.gov
| ARTIFICIAL INTELLIGENCE (AI) DISCLOSURE FORM |
| I. |
| II. |
| Describe in detail the services being provided. Include names of products and large language model. |
| 4. |
| SIGNATURE |
| III. |
| Name and description of productservice: |
| BUSINESS NAME: |
| BUSINESS ADDRESS: |
| STATE: |
| ZIP CODE: |
| CITY: |
| Solicitation Number: |
| AI being offered: Off |
| 1: |
| What type AI: Off |
| 2: |
| Is the AI required for this product?: Off |
| Other: |
| 3: |
| Model: |
| 4: |
| license tier: |
| 5: |
| delivery: |
| Date2: |
| REPRESENTATIVE NAME: |
| BUSINESS TELEPHONE NUMBER: |
| ContactPhone: |
| Contact Name: |
| Contact Email: |
File details come from the government source that posted it. Updated .