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STATE OF CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS

ADDITIONAL BID INFORMATION

CalVet: February 2021 - 1 - Project Number: CA19-0119

Bidders are advised to read the Instructions to Bidders, Document 00 21 00 of the Project Manual.

YOUR CALIFORNIA STATE CONTRACTOR’S LICENSE HAS NOT BEEN VERIFIED BY THE DEPARTMENT OF VETERANS AFFAIRS. YOUR BID IS SUBJECT TO REJECTION AT THE TIME OF BID OPENING IF:

1. Your license does not meet the requirements as set forth in the project manual.

2. Your license is suspended.

3. Your license is expired.

4. Your license has been cancelled.

5. Your company or any listed subcontractor is not currently registered with the Department of Industrial

Relations (DIR).

6. Your company did not attend a mandatory pre-bid inspection meeting, if required.

BIDDING INSTRUCTIONS

REGISTER WITH THE DIR

1. ALL Contractors and subcontractors for public works projects must register with DIR. Check out http://www.dir.ca.gov/Public-Works/PublicWorks.html for complete information and the online registration site.

2. Beginning March 1, 2015, any contractor is not qualified to bid, be listed in a bid or engage in the performance of any contract for public work if they are not registered. Refer to Instructions to Bidders (00 21 00), Article 2 for more information.

PROPOSAL FORM REQUIREMENTS

1. Submit bids on the enclosed Bid Form.

2. Present bids under sealed cover, clearly identifying the project.

3. The Bid Form is not transferable.

ELECTRONIC SUBMISSSION

1. Electronic submission will be excepted, digital signature with time and date required.

2. E-mail digital copies of all required documents on Bid Form.

3. All documents must be e-mailed to: LeJuan.Bean@calvet.ca.gov

BIDDER’S NAME

1. Submit the Bid Form under the same name as licensed.

BIDDER’S SECURITY

1. Bid Security is not required for bids under ten thousand dollars ($10,000).

2. Bid Security shall be a minimum of ten percent (10%) of the bid.

3. Bid Security may be bidder’s bond, cashier’s check, certified check or cash. Personal checks will not be accepted.

4. Bid Security shall be made payable to: California Department of Veterans Affairs.

5. When a Bidder’s Bond is used, it is required to be on the CalVet Bid Bond form attached to the Bid Form.

Attached the power of attorney for the attorney-in-fact and the signature must be notarized. Contact this office if another copy of the form is needed.

SIGNATURE

1. The Bidder, or Bidder’s authorized representative, is required to sign the bid.

2. Include the address of the Bidder or the authorized representative.

3. If the Bidder is a corporation, affix the corporate seal.

4. Sign the Bidder’s Bond.

5. Include applicable documentation; see Instructions to Bidders (00 21 00), Article 9.2.

http://www.dir.ca.gov/Public-Works/PublicWorks.html mailto:LeJuan.Bean@calvet.ca.gov

CalVet: February 2021 - 2 - Project Number: CA19-0119

ADDENDUM

1. Refer to the Instructions to Bidders for addendum information. Acknowledge the addendum on the appropriate page of the Bid Form.

WITHDRAWAL OF BID

1. A written notice to withdraw a bid is required prior to the bid opening. A notice not bearing an original signature will not be accepted.

IRREGULATIES

1. The Bid may be rejected if the Bid Form is altered. Alterations are, but not limited to:

a. Additions or erasures not requested or required.

b. An incomplete bid.

c. A conditioned bid.

d. Irregularities of any kind.

e. Use of the term “N/A”.

2. If the bid amount or other items including the subcontractors list are changed after being inserted on the Bid

Form, initial or sign the change.

3. Avoid the acronym “N/A” or the term ‘not applicable’ when filling out the Bid Form.

PAYEE DATA RECORD

Bidders are requested to complete and return the State’s Payee Data Record form, Std. 204, included with the Bid Forms. The Payee Data Record form is required in lieu of IRS W-9 when doing business with the State of California, and will be used by the State to prepare tax information returns as stated on the form.

Failures to submit the completed form with the Bid will not be cause for rejection of a bid, but will be required prior to Award of Contract if not on file.

AWARDS

The award of an Agreement, if it is to be awarded, shall be made to the lowest responsible Bidder whose Bid complies with all requirements prescribed herein. In the event Bidder submits more than one (1) bid under this bid process, CalVet shall select the lowest bid and reject all other bids from this Bidder.

Whenever an Agreement is awarded under a procedure which provides for competitive bidding, but the Agreement is not to be awarded to the low bidder, the low bidder shall be notified by electronic mail, facsimile transmission, overnight courier, or personal delivery five (5) working days prior to the award of the Agreement.

Notice of the Intent to Award shall be posted in a public place in the office of the awarding agency at least five

(5) working days prior to awarding the Agreement, if requested in writing by any bidder who submitted a bid.

Upon receipt of a tentative award, the apparent winning Bidder must return all required documents to the contract analyst within thirty (30) days of receipt. Failure to do so will result in the disqualification of the bidder’s submission. A tentative award will then be issued to the next lowest responsive responsible bidder.

STATE OF CALIFORNIA – DEPARTMENT OF FINANCE

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

Section 1 – Payee Information NAME (This is required. Do not leave this line blank. Must match the payee’s federal tax return)

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above)

MAILING ADDRESS (number, street, apt. or suite no.) (See instructions on Page 2)

CITY, STATE, ZIP CODE E-MAIL ADDRESS

Section 2 – Entity Type Check one (1) box only that matches the entity type of the Payee listed in Section 1 above. (See instructions on page 2)

CORPORATION (see instructions on page 2)☐ SOLE PROPRIETOR / INDIVIDUAL ☐ MEDICAL (e.g., dentistry, chiropractic, etc.)☐ SINGLE MEMBER LLC Disregarded Entity owned by an individual

☐ PARTNERSHIP

☐ ESTATE OR TRUST

☐ LEGAL (e.g., attorney services)

☐ EXEMPT (e.g., nonprofit)

☐ ALL OTHERS

Section 3 – Tax Identification Number

Enter your Tax Identification Number (TIN) in the appropriate box. The TIN must match the name given in Section 1 of this form. Do not provide more than one (1) TIN.

The TIN is a 9-digit number. Note: Payment will not be processed without a TIN.

For Individuals, enter SSN.

If you are a Resident Alien, and you do not have and are not eligible to get an SSN, enter your ITIN.

Grantor Trusts (such as a Revocable Living Trust while the grantors are alive) may not have a separate FEIN. Those trusts must enter the individual grantor’s SSN.

For Sole Proprietor or Single Member LLC (disregarded entity), in which the sole member is an individual, enter SSN (ITIN if applicable) or FEIN (FTB prefers SSN).

For Single Member LLC (disregarded entity), in which the sole member is a business entity, enter the owner entity’s FEIN. Do not use the disregarded entity’s FEIN.

For all other entities including LLC that is taxed as a corporation or partnership, estates/trusts (with FEINs), enter the entity’s FEIN.

Social Security Number (SSN) or Individual Tax Identification Number (ITIN)

OR

Federal Employer Identification Number

(FEIN)

Section 4 – Payee Residency Status (See instructions)

☐ CALIFORNIA RESIDENT – Qualified to do business in California or maintains a permanent place of business in California.

☐ CALIFORNIA NONRESIDENT – Payments to nonresidents for services may be subject to state income tax withholding.

☐No services performed in California ☐Copy of Franchise Tax Board waiver of state withholding is attached.

Section 5 – Certification I hereby certify under penalty of perjury that the information provided on this document is true and correct.

Should my residency status change, I will promptly notify the state agency below.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE E-MAIL ADDRESS

SIGNATURE DATE TELEPHONE (include area code)

Section 6 – Paying State Agency Please return completed form to:

STATE AGENCY/DEPARTMENT OFFICE UNIT/SECTION

MAILING ADDRESS FAX TELEPHONE (include area code)

CITY STATE ZIP CODE E-MAIL ADDRESS

STATE OF CALIFORNIA – DEPARTMENT OF FINANCE

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6.

Prompt return of this fully completed form will prevent delays when processing payments.

Information provided in this form will be used by California state agencies/departments to prepare Information Returns (Form1099).

NOTE: Completion of this form is optional for Government entities, i.e. federal, state, local, and special districts.

A completed Payee Data Record, STD 204 form, is required for all payees (non-governmental entities or individuals) entering into a transaction that may lead to a payment from the state. Each state agency requires a completed, signed, and dated STD 204 on file; therefore, it is possible for you to receive this form from multiple state agencies with which you do business.

Payees who do not wish to complete the STD 204 may elect not to do business with the state. If the payee does not complete the STD 204 and the required payee data is not otherwise provided, payment may be reduced for federal and state backup withholding. Amounts reported on Information Returns (Form 1099) are in accordance with the Internal Revenue Code (IRC) and the California Revenue and Taxation Code (R&TC).

Section 1 – Payee Information Name – Enter the name that appears on the payee's federal tax return. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

• Sole Proprietor/Individual/Revocable Trusts – enter the name shown on your federal tax return.

• Single Member Limited Liability Companies (LLCs) that is disregarded as an entity separate from its owner for federal tax purposes - enter the name of the individual or business entity that is tax liable for the business in section 1. Enter the DBA, LLC name, trade, or fictitious name under Business Name.

• Note: for the State of California tax purposes, a Single Member LLC is not disregarded from its owner, even if they may be disregarded at the Federal level.

• Partnerships, Estates/Trusts, or Corporations – enter the entity name as shown on the entity’s federal tax return. The name provided in Section 1 must match to the TIN provided in section 3. Enter any DBA, trade, or fictitious business names under Business Name.

Business Name – Enter the business name, DBA name, trade or fictitious name, or disregarded LLC name.

Mailing Address – The mailing address is the address where the payee will receive information returns. Use form STD 205, Payee Data Record Supplement to provide a remittance address if different from the mailing address for information returns, or make subsequent changes to the remittance address.

Section 2 – Entity Type If the Payee in Section 1 is a(n)… THEN Select the Box for… Individual ● Sole Proprietorship ● Grantor (Revocable Living) Trust disregarded for federal tax purposes Sole Proprietor/Individual Limited Liability Company (LLC) owned by an individual and is disregarded for federal tax purposes Single Member LLC-owned by an individual Partnerships ● Limited Liability Partnerships (LLP) ● and, LLC treated as a Partnership Partnerships Estate ● Trust (other than disregarded Grantor Trust) Estate or Trust Corporation that is medical in nature (e.g., medical and healthcare services, physician care, nursery care, dentistry, etc. ● LLC that is to be taxed like a Corporation and is medical in nature

Corporation-Medical

Corporation that is legal in nature (e.g., services of attorneys, arbitrators, notary publics involving legal or law related matters, etc.) ● LLC that is to be taxed like a Corporation and is legal in nature

Corporation-Legal

Corporation that qualifies for an Exempt status, including 501(c) 3 and domestic non-profit corporations. Corporation-Exempt Corporation that does not meet the qualifications of any of the other corporation types listed above ● LLC that is to be taxed as a Corporation and does not meet any of the other corporation types listed above

Corporation-All Other

Section 3 – Tax Identification Number The State of California requires that all parties entering into business transactions that may lead to payment(s) from the state provide their Taxpayer Identification Number (TIN). The TIN is required by R&TC sections 18646 and 18661 to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

Section 4 – Payee Residency Status Are you a California resident or nonresident?

• A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary of State to do business in

California.

• A partnership is considered a resident partnership if it has a permanent place of business in California.

• An estate is a resident if the decedent was a California resident at time of death.

• A trust is a resident if at least one trustee is a California resident.

o For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:

Withholding Services and Compliance Section: 1-888-792-4900 E-mail address: wscs.gen@ftb.ca.gov For hearing impaired with TDD, call: 1-800-822-6268 Website: www.ftb.ca.gov

Section 5 – Certification Provide the name, title, email address, signature, and telephone number of individual completing this form and date completed. In the event that a SSN or ITIN is provided, the individual identified as the tax liable party must certify the form. Note: the signee may differ from the tax liable party in this situation if the signee can provide a power of attorney documented for the individual.

Section 6 – Paying State Agency This section must be completed by the state agency/department requesting the STD 204.

Privacy Statement Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it. It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and state law imposes noncompliance penalties of up to $20,000. You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

All questions should be referred to the requesting state agency listed on the bottom front of this form.

www.ftb.ca.gov mailto:wscs.gen@ftb.ca.gov

CITY STATE ZIP CODE:

EMAIL ADDRESS:

NAME OF AUTHORIZED PAYEE REPRESENTATIVE:

TITLE:

EMAIL ADDRESS_2:

DATE:

TELEPHONE include area code:

STATE AGENCYDEPARTMENT OFFICE:

UNITSECTION:

MAILING ADDRESS:

FAX:

TELEPHONE include area code_2:

CITY:

STATE:

ZIP CODE:

EMAIL ADDRESS_3:

MAILING ADDRESS (number, street, apt:

or suite no:

) (See instructions on Page 2):

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above):

NAME (This is required:

Do not leave this line blank:

Must match the payee’s federal tax return):

Social Security Number (SSN) or:

Federal Employer Identification Number (FEIN):

sole: Off single: Off partnership: Off estate: Off corpMedical: Off corpLegal: Off corpExempt: Off corpOthers: Off calRes: Off calNonRes: Off calNonResNo: Off calNonResCopy: Off

ResetForm:

PrintForm:

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

(This form is optional. Form is used to provide remittance address information if different than the mailing address on the STD 204 – Payee Data Record.

Use this form to provide additional remittance addresses and additional Authorized Representatives of the Payee not identified on the STD 204.)

STD 205 (New 03/2021)

Payee Information (must match the STD 204) NAME (Required. Do not leave blank.)

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above)

TAX ID NUMBER (Required) SSN, ITIN, or FEIN that matches Tax ID number provided on STD 204

Additional Remittance Address Information

• Use the fields below to provide remittance addresses for payee if different from the mailing address on the STD 204.

• The addresses provided below are for remittance purposes only. 1099 information returns will be sent to the mailing address specified on the STD 204.

REMITTANCE ADDRESS (number, street, apt or suite no.)

CITY STATE ZIP CODE

REMITTANCE ADDRESS

Additional Contact Information Use the fields below to provide additional Authorized Representatives for the Payee if applicable.

CONTACT NAME

TELEPHONE (Include area code) EMAIL

TELEPHONE EMAIL

TELEPHONE EMAIL

Certification I hereby certify under penalty of perjury that the information provided on this supplemental document is true and correct.

By signing this document, I authorize the State of California to remit payment to the addresses specified on this supplemental form (STD 205) and certify that all persons identified on this form are authorized representatives of this payee. Payments remitted to any of the listed addresses may be reported on 1099 information returns to the tax liable entity identified on the accompanying Payee Data Record - STD 204.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE

(Print or Type name)

TITLE E-MAIL ADDRESS

SIGNATURE

X___________________________________________

DATE TELEPHONE (Include area code)

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

(This form is optional. Form is used to provide remittance address information if different than the mailing address on the STD 204 – Payee Data Record.

Use this form to provide additional remittance addresses and additional Authorized Representatives of the Payee not identified on the STD 204.)

STD 205 (New 03/2021)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record Supplement, STD 205. Sign, date, and return to the state agency/department with a completed STD 204. Prompt return of the fully completed forms will prevent delays when processing payments.

Purpose – Completion of this form (STD 205) is optional. Payees may use this form to provide remittance addresses or contact information in addition to the 1099 information return mailing address provided on the STD 204. This form shall only be used in conjunction with the STD 204, and will not be accepted without a STD 204.

Please note: The State of California Government will issue 1099 information returns to the mailing address provided on the most recently dated form STD 204 validated by the Payee. Addresses provided on this form (STD 205) will be used for remittance purposes only. If the payee would like to update the address for receiving 1099 information returns, please complete the STD 204.

Payee Information: The Payee’s Tax ID number (TIN) and Name (including any Business, DBA, or Disregarded LLC names) are required. This information is subject to TIN matching via the IRS database for validation. Payee Information provided in this section must clearly match the STD 204. Any discrepancies may result in delays of payment, up to and including denial of the request.

Name – Enter the name of the Payee. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

Business Name – Enter the business name, DBA name, trade or fictitious name, or disregarded LLC name.

Tax ID Number-The State of California requires that all parties entering into business transactions that may lead to payment(s) from the state provide their Taxpayer Identification Number (TIN). The TIN is required by R&TC sections 18646 and 18661 to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

Additional Remittance Address Information - Enter the Payee’s additional remittance address(s) that are not listed on STD 204. Up to five (5) addresses may be provided on this form. The Payee may provide additional remittance addresses on a second STD 205 form if needed.

Additional Contact Information - Enter the Payee’s additional or updated contact information. Up to three contacts may be identified on this form. Payee may provide additional contacts on a second STD 205 if needed.

PRIVACY STATEMENT

Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.

It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and state law imposes noncompliance penalties of up to $20,000.

You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

All questions should be referred to the requesting state agency listed on the bottom front of the STD 204 form.

CITY_2:

STATE_2:

ZIP CODE_2:

CITY_3:

STATE_3:

ZIP CODE_3:

CITY_4:

STATE_4:

ZIP CODE_4:

CITY_5:

STATE_5:

ZIP CODE_5:

EMAIL:

EMAIL_2:

EMAIL_3:

TITLE:

EMAIL ADDRESS:

DATE:

remAddress1:

CITY1:

STATE1:

ZIPCODE1:

nameReq1:

nameDiffAbove1:

taxIDNumber:

remAddress2:

remAddress3:

remAddress4:

remAddress5:

TELEPHONE_1:

TELEPHONE_2:

TELEPHONE_3:

contactName1:

contactName2:

contactName3:

certTelephone:

certName:

PrintForm:

ResetForm:

STATE OF CALIFORNIA – DEPARTMENT OF GENERAL SERVICES PROCUREMENT DIVISION

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS

DGS PD 843 (Rev. 9/2019) Formerly STD. 843 Instructions: The disabled veteran (DV) owner(s) and DV manager(s) of the Disabled Veteran Business Enterprise (DVBE) must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, services or equipment [Military and Veterans Code Section 999.2]. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. All signatures are made under penalty of perjury.

SECTION 1

Name of certified DVBE: DVBE Ref. Number:

Description (materials/supplies/services/equipment proposed):

Solicitation/Contract Number: SCPRS Ref. Number:__________________________

(FOR STATE USE ONLY)

SECTION 2

APPLIES TO ALL DVBEs. Check only one box in Section 2 and provide original signatures.

I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code Section 999.2 (b), of materials, supplies, services or equipment listed above. Also, complete Section 3 below if renting equipment.

Pursuant to Military and Veterans Code Section 999.2 (f), I (we) declare that the DVBE is a broker or agent for the principal(s) listed below or on an attached sheet(s). (Pursuant to Military and Veterans Code 999.2 (e), State funds expended for equipment rented from equipment brokers pursuant to contracts awarded under this section shall not be credited toward the 3-percent DVBE participation goal.)

All DV owners and managers of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):

(Printed Name of DV Owner/Manager) (Signature of DV Owner/ Manager) (Date Signed)

(Printed Name of DV Owner/Manager) (Signature of DV Owner/Manager) (Date Signed)

Firm/Principal for whom the DVBE is acting as a broker or age nt:

(If more than one firm, list on extra sheets.) (Print or Type Name)

Firm/Principal Phone: Address:

SECTION 3

APPLIES TO ALL DVBEs THAT RENT EQUIPMENT AND DECLARE THE DVBE IS NOT A BROKER.

Pursuant to Military and Veterans Code Section 999.2 (c), (d) and (g), I am (we are) the DV(s) with at least 51% ownership of the DVBE, or a DV manager(s) of the DVBE. The DVBE maintains certification requirements in accordance with Military and Veterans Code Section 999 et. seq.

The undersigned owner(s) own(s) at least 51% of the quantity and value of each piece of equipment that will be rented for use in the contract identified above. I (we), the DV owners of the equipment, have submitted to the administering agency my (our) personal federal tax return(s) at time of certification and annually thereafter as defined in Military and Veterans Code 999.2, subsections (c) and (g). Failure by the disabled veteran equipment owner(s) to submit their personal federal tax return(s) to the administering agency as defined in Military and Veterans Code 999.2, subsections

(c) and (g), will result in the DVBE being deemed an equipment broker.

Disabled Veteran Owner(s) of the DVBE (attach additional pages with signature blocks for each person to sign):

(Printed Name) (Signature) (Date Signed)

(Address of Owner) (Telephone) (Tax Identification Number of Owner)

Disabled Veteran Manager(s) of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):

(Printed Name of DV Manager) (Signature of DV Manager) (Date Signed)

Page of

Line

DVBErefno:

description:

SCno:

DVBEname:

Principal:

DVBEowner2:

PrincipalAddress:

OwnBusiness: Off

OwnEquipment: Off

DVBEowner1:

DVBEowner2date:

DVBEowner1date:

DVBEmgr:

DVBEmanagerDate:

DVBEowner3:

PrincipalPhone:

PageNo:

TotalPages:

YNagent: Off

PrintButton:

ClearButton:

SCPRS Reference Number:

DVBEowner3Address:

DVBEowner3Phone:

DVBEowner3TaxID:

DVBEowner3Date:

State of California Department of Veterans Affairs

COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM

CV 012 (REV. 08/2016) Page 1 of 2

Solicitation Number:

Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.

1. CONTRACTOR NAME (Completing Form) "DOING BUSINESS AS" (DBA) NAME: OSDS REF # (Currently certified firms only): Expiration Date:

2. COMMERCIALLY USEFUL FUNCTIONS (CUF)

All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).

Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:

Mark all that apply: DVBE Small Business Micro Business

1 If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work? Yes No

2 If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved? Yes No

3 If awarded a contract, will you perform work that is normal for your business, service and functions? Yes No

4 If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices? Yes No

5 If awarded a contract, will your business role be 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 SB and/or DVBE participation? Yes No

A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.

3. WRITTEN STATEMENT

Provide a written statement below detailing the role, services and goods your company will provide to meet the commercially useful function requirement. At the State's option prior to award, you may be required to submit additional clarifying information

State of California Department of Veterans Affairs

CV 012 (REV. 08/2016) Page 2 of 2

AUTHORIZING SIGNATURE (REQUIRED)

The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

AUTHORIZED REPRESENTATIVE SIGNATURE: TITLE:

PRINTED NAME: DATE:

State of California Department of Veterans Affairs

CV 012 (REV. 08/2016) Page 1 of 2

Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.

1. CONTRACTOR NAME (Completing Form)

2. COMMERCIALLY USEFUL FUNCTIONS (CUF)

All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).

Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:

Mark all that apply:

If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work?

If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved?

If awarded a contract, will you perform work that is normal for your business, service and functions?

If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices?

If awarded a contract, will your business role be 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 SB and/or DVBE participation?

A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.

3. WRITTEN STATEMENT

State of California Department of Veterans Affairs

COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM

CV 012 (REV. 08/2016) Page 2 of 2

AUTHORIZING SIGNATURE (REQUIRED)

The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

9.0.0.2.20101008.1.734229

SolicitationNumber:

DoingBusinessAs:

OSDSRefNumber:

ExpirationDate:

Yes:

No:

ProvideAWrittenStatement:

AuthorizedRepresentative:

Title:

PrintedName:

Date:

DEPARTMENT OF GENERAL SERVICES

OFFICE OF PROJECT MANAGEMENT BRANCH STATE OF CALIFORNIA

SMALL BUSINESS PREFERENCE AND CERTIFICATION REQUEST

(For Construction Contractors Only)

STD. 811 (REV. 10/2019)

READ BEFORE SIGNING

(THIS REQUEST MUST REMAIN WITH THE BID PACKAGE)

1. PENALTY ASSESSMENT

A business will be assessed a penalty and be ineligible to transact any business with the Department for furnishing incorrect information. (Title 2 of the California Code of Regulations)

2. PUBLIC WORKS AGREEMENTS EXCEEDING $100,000 AND REQUIRING TYPE "A" OR "B" CONTRACTORS

LICENSE.

On public works agreements where the lowest responsible bid exceeds $100,000, and the work to be performed requires a type "A" or "B" contractor's license and two or more subcontractors will be used, preferences shall only be granted to those small business bidders who certify, under penalty of perjury, that at least fifty percent (50%) of subcontractors utilized on the job are certified small businesses. In meeting the 50% requirement, bidders may use certified small business and/or small businesses that have applied for certification no later than 5:00 P.M. on the bid opening date and are subsequently granted certification. The 50% small business subcontractor utilization level shall be maintained through the term of the contract.

3. JOINT BIDDERS/COMBINATION BIDDERS

Bidders bidding jointly or as a combination of several business organizations are especially cautioned that such bidders must be jointly licensed and approved in the form and style in which the bid is executed.

4. NAME STYLE

The Small Business Preference and Certification Request must be signed in the same name style in which the bidder is licensed by the Contractors' State License Board.

BIDDER'S(S') LEGAL NAME STYLE FEDERAL EMPLOYER IDENTIFICATION NUMBER

OSDC CERTIFICATION NUMBER

CERTIFICATION

5. The undersigned hereby requests preference as a "SMALL BUSINESS" and further certifies under perjury, that the firm still meets the requirements of Section 1896(L) Title 2 of the California Code of Regulations. A completed form STD.812 meeting all applicable requirements must be on file in the Office of Small Business and DVBE Certification (OSDC) by 5:00 p.m. of the bid opening date. The form STD. 812 may be obtained from the OSDS Office at 707 Third Street, First Floor, Room 1-400, West Sacramento, CA 95605 or can be downloaded at . www.pd.dgs.ca.gov/smbus/paperapp.htm

BIDDER'S SIGNATURE DATE SIGNED

6. BIDDERS RECEIVING BOND ASSISTANCE

In the event the bidder has received assistance in obtaining bonding for this project, he/she shall set forth the name and nature of the firm providing such assistance. Should the firm be listed as a subcontractor, bidder shall set forth the percentage of the contract to be performed by the subcontractor.

NAME OF FIRM PROVIDING BONDING ASSISTANCE

NATURE OF FIRM PROVIDING BONDING ASSISTANCE

SUBCONTRACTOR ASSISTANCE

YES - Percentage NO www.pd.dgs.ca.gov/smbus/paperapp.htm

Accessibility Report

Filename:

std 811 Remediated.pdf

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[Enter personal and organization information through the Preferences > Identity dialog.]

Summary

The checker found no problems in this document.

Needs manual check: 0

Passed manually: 5

Failed manually: 0

Skipped: 0

Passed: 27

Failed: 0

Detailed Report

Document

Rule Name Status Description

Accessibility permission flag Passed Accessibility permission flag must be set

Image-only PDF Passed Document is not image-only PDF

Tagged PDF Passed Document is tagged PDF

Logical Reading Order Passed manually Document structure provides a logical reading order

Primary language Passed Text language is specified

Title Passed Document title is showing in title bar

Bookmarks Passed Bookmarks are present in large documents

Color contrast Passed manually Document has appropriate color contrast

Page Content

Rule Name Status Description

Tagged content Passed All page content is tagged

Tagged annotations Passed All annotations are tagged

Tab order Passed Tab order is consistent with structure order

Character encoding Passed Reliable character encoding is provided

Tagged multimedia Passed All multimedia objects are tagged

Screen flicker Passed manually Page will not cause screen flicker

Scripts Passed manually No inaccessible scripts

Timed responses Passed manually Page does not require timed responses

Navigation links Passed Navigation links are not repetitive

Forms

Rule Name Status Description

Tagged form fields Passed All form fields are tagged

Field descriptions Passed All form fields have description

Alternate Text

Rule Name Status Description

Figures alternate text Passed Figures require alternate text

Nested alternate text Passed Alternate text that will never be read

Associated with content Passed Alternate text must be associated with some content

Hides annotation Passed Alternate text should not hide annotation

Other elements alternate text Passed Other elements that require alternate text

Tables

Rule Name Status Description

Rows Passed TR must be a child of Table, THead, TBody, or TFoot

TH and TD Passed TH and TD must be children of TR

Headers Passed Tables should have headers

Regularity Passed Tables must contain the same number of columns in each row and rows in each column

Summary Passed Tables must have a summary

Lists

Rule Name Status Description

List items Passed LI must be a child of L

Lbl and LBody Passed Lbl and LBody must be children of LI

Headings

Rule Name Status Description

Appropriate nesting Passed Appropriate nesting

Back to Top bidder'sname:

fein:

OSBCRNO:

1:

date signed:

bonding firm name:

bonding firm nature:

sub's asst: Off subcontractor asst?: Off percent:

Print:

Clear Form:

Solicitation Number:_________________

STANDARD FORM OF GUARANTEE

STATE OF CALIFORNIA

CMU 100

GUARANTEE

1.1 The Contractor unconditionally guarantees the work will be completed in accordance with the requirements of the Contract Documents, and will remain free of defects in workmanship and materials for a period of one year from the date of Acceptance of the Work, per agreement Number ______________, unless a longer guarantee period is specifically called for in the Contract Documents. The Contractor shall repair or replace any and all work, together with any adjacent work that may have been damaged or displaced, which was not in accordance with the requirements of the Contract Documents, or that may be defective in its workmanship or material within the guarantee period specified in the Contract Documents, without any expense whatsoever to the State; ordinary wear and tear and abuse excepted.

1.2 The Contractor further agrees, within 14 days after being notified in writing by the State, of any work not in accordance with the requirements of the Contract Documents or any defects in the Work, that the Contractor shall commence and execute, with due diligence, all work necessary to fulfill the terms of the guarantee. If the State finds that the Contractor fails to perform any of the work under the guarantee, the State will proceed to have the work completed at the Contractor's expense and the Contractor will pay costs of the work upon demand. The State will be entitled to all costs, including reasonable attorney's fees necessarily incurred upon the Contractor's refusal to pay the above costs.

1.3 Notwithstanding the foregoing Subparagraph, in the event of an emergency constituting an immediate hazard to health or safety of State employees, property, or licensees, the State may undertake, at the Contractor's expense and without prior notice, all work necessary to correct such hazardous condition(s) when it is caused by work of the Contractor not being in accordance with the requirements of the Contract Documents.

Print Name of Firm as shown on Contract

State Contract Number

Contractor’s Signature and Title

Print Contractor’s Name and Title

Date

Solicitation Number:

Print Name of Firm as shown on Contract:

State Contract Number:

Print Contractors Name and Title:

Date:

Soliciation Number:

NONDISCRIMINATION COMPLIANCE STATEMENT

STD. 19 (Rev. 10/2019)

COMPANY NAME

The company named above (herinafter referred to as "prospective contractor") hereby certifies, unless specifically exempted, compliance with Government Code Section 12990 (a-f) and California Code of

Regulations, Title 2, Division 4, Chapter 5 in matters relating to reporting requirements and the development, implementation and maintenance of a Nondiscrimination Program. Prospective contractor agrees not to unlawfully discriminate, harass or allow harassment against any employee or applicant for employment because of sex, race, color, ancestry, religious creed, national origin, physical disability

(including HIV and AIDS), medical condition (cancer), age (over 40), marital status, denial of family care leave and denial of pregnancy disability leave.

I, the official named below, hereby swear that I am duly authorized to legally bind the prospective contractor to the above described certification. I am fully aware that this certification, executed on the date and in the county below, is made under penalty of perjury under the laws of the State of California.

OFFICIAL'S NAME

DATE EXECUTED EXECUTED IN THE COUNTY OF

PROSPECTIVE CONTRACTOR'S SIGNATURE

PROSPECTIVE CONTRACTOR'S TITLE

PROSPECTIVE CONTRACTOR'S LEGAL BUSINESS NAME

Filename:

std019 remediated.pdf

Report created by:

Organization:

Needs manual check: 0

Passed manually: 2

Failed manually: 0

Skipped: 1

Passed: 29

Failed: 0

Document

Rule Name Status Description

Accessibility permission flag Passed Accessibility permission flag must be set

Image-only PDF Passed Document is not image-only PDF

Tagged PDF Passed Document is tagged PDF

Logical Reading Order Passed manually Document structure provides a logical reading order

Primary language Passed Text language is specified

Title Passed Document title is showing in title bar

Bookmarks Passed Bookmarks are present in large documents

Color contrast Passed manually Document has appropriate color contrast

Page Content

Rule Name Status Description

Tagged content Passed All page content is tagged

Tagged annotations Passed All annotations are tagged

Tab order Passed Tab order is consistent with structure order

Character encoding Passed Reliable character encoding is provided

Tagged multimedia Passed All multimedia objects are tagged

Screen flicker Passed Page will not cause screen flicker

Scripts Passed No inaccessible scripts

Timed responses Passed Page does not require timed responses

Navigation links Passed Navigation links are not repetitive

Forms

Rule Name Status Description

Tagged form fields Passed All form fields are tagged

Field descriptions Passed All form fields have description

Alternate Text

Rule Name Status Description

Figures alternate text Passed Figures require alternate text

Nested alternate text Passed Alternate text that will never be read

Associated with content Passed Alternate text must be associated with some content

Hides annotation Passed Alternate text should not hide annotation

Other elements alternate text Passed Other elements that require alternate text

Tables

Rule Name Status Description

Rows Passed TR must be a child of Table, THead, TBody, or TFoot

TH and TD Passed TH and TD must be children of TR

Headers Passed Tables should have headers

Regularity Passed Tables must contain the same number of columns in each row and rows in each column

Summary Skipped Tables must have a summary

Lists

Rule Name Status Description

List items Passed LI must be a child of L

Lbl and LBody Passed Lbl and LBody must be children of LI

Headings

Rule Name Status Description

Appropriate nesting Passed Appropriate nesting name1:

offname:

date1:

co1:

titl1:

busname:

Clear:

Print:

DRUG-FREE WORKPLACE CERTIFICATION

STD. 21 (Rev. 10/2019)

I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or grant recipient to the certification described below. I am fully aware that this certification, executed on the date below, is made under penalty of perjury under the laws of the State of California.

CONTRACTOR/BIDDER FIRM NAME FEDERAL ID NUMBER

BY(Authorized Signature)

DATE EXECUTED

PRINTED NAME AND TITLE OF PERSON SIGNING TELEPHONE NUMBER (Include Area Code)

TITLE

CONTRACTOR/BIDDER FIRM'S MAILING ADDRESS

The contractor or grant recipient named above hereby certifies compliance with Government Code Section 8355 in matters relating to providing a drug-free workplace. The above named contractor or grant recipient will:

1. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations, as required by Government Code Section 8355(a).

2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to inform employees about all of the following:

(a) The dangers of drug abuse in the workplace,

(b) The person's or organization's policy of maintaining a drug-free workplace,

(c) Any available counseling, rehabilitation and employee assistance programs, and

(d) Penalties that may be imposed upon employees for drug abuse violations.

3. Provide as required by Government Code Section 8355(c), that every employee who works on the proposed contract or grant:

(a) Will receive a copy of the company's drug-free workplace policy statement, and

(b) Will agree to abide by the terms of the company's statement as a condition of employment on the contract or grant.

4. At the election of the contractor or grantee, from and after the "Date Executed" and until

(DATE)

(NOT TO EXCEED 36 MONTHS), the state will regard this certificate as valid for all contracts or grants entered into between the contractor or grantee and this state agency without requiring the contractor or grantee to provide a new and individual certificate for each contract or grant. If the contractor or grantee elects to fill in the blank date, then the terms and conditions of this certificate shall have the same force, meaning, effect and enforceability as if a certificate were separately, specifically, and individually provided for each contract or grant between the contractor or grantee and this state agency.

Filename:

std021 remediated.pdf

Report created by:

Organization:

Needs manual check: 0

Passed manually: 2

Failed manually: 0

Skipped: 1

Passed: 29

Failed: 0

Document

Rule Name Status Description

Accessibility permission flag Passed Accessibility permission flag must be set

Image-only PDF Passed Document is not image-only PDF

Tagged PDF Passed Document is tagged PDF

Logical Reading Order Passed manually Document structure provides a logical reading order

Primary language Passed Text language is specified

Title Passed Document title is showing in title bar

Bookmarks Passed Bookmarks are present in large documents

Color contrast Passed manually Document has appropriate color contrast

Page Content

Rule Name Status Description

Tagged content Passed All page content is tagged

Tagged annotations Passed All annotations are tagged

Tab order Passed Tab order is consistent with structure order

Character encoding Passed Reliable character encoding is provided

Tagged multimedia Passed All multimedia objects are tagged

Screen flicker Passed Page will not cause screen flicker

Scripts Passed No inaccessible scripts

Timed responses Passed Page does not require timed responses

Navigation links Passed Navigation links are not repetitive

Forms

Rule Name Status Description

Tagged form fields Passed All form fields are tagged

Field descriptions Passed All form fields have description

Alternate Text

Rule Name Status Description

Figures alternate text Passed Figures require alternate text

Nested alternate text Passed Alternate text that will never be read

Associated with content Passed Alternate text must be associated with some content

Hides annotation Passed Alternate text should not hide annotation

Other elements alternate text Passed Other elements that require alternate text

Tables

Rule Name Status Description

Rows Passed TR must be a child of Table, THead, TBody, or TFoot

TH and TD Passed TH and TD must be children of TR

Headers Passed Tables should have headers

Regularity Passed Tables must contain the same number of columns in each row and rows in each column

Summary Skipped Tables must have a summary

Lists

Rule Name Status Description

List items Passed LI must be a child of L

Lbl and LBody Passed Lbl and LBody must be children of LI

Headings

Rule Name Status Description

Appropriate nesting Passed Appropriate nesting ctrct1:

fedid1:

date1:

name1:

ph1:

ph2:

title1:

address1:

date2:

Print:

Clear:

State of California Solicitation Number:

Department of Veterans Affairs

CERTIFICATES OF INSURANCE

DATE (MM/DD/YY) / /

PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS

NO RIGHT UPON THE CERTIFICATE HOLDER. THIS COVERAGE DOES NOT AMEND,

EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW.

COMPANIES AFFORDING COVERAGE

COMPANY

A

INSURED COMPANY

B

COMPANY

C

COMPANY

D

COVERAGES

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDIDTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH

POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

TYPE OF INSURANCE POLlCY NUMBER

POLICY

EFFECTIVE

DATE

(MM/DD/YY)

POLICY

EXPIRATION

DATE

(MM/DD/YY)

LIMITS

GENERAL LIABILITY GENERAL AGGREGATE $

COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $

CLAIMS

MADE

OCCUR PERSONAL & ADV INJURY $

OWNER AND CONTRACTOR’S PROT EACH OCCURRENCE $

FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT $

ANY AUTO

ALL OWNED AUTOS BODILY INJURY (Per person) $

SCHEDULED AUTOS

HIRED AUTOS BODILY INJURY (Per accident) $

NON-OWNED AUTOS

PROPERTY DAMAGE $

GARAGE LIABILITY

AUTO ONLY - EA ACCIDENT $

ANY AUTO OTHER THAN AUTO ONLY:

EACH ACCIDENT $

AGGREGATE $

EXCESS LIABILITY

EACH OCCURRENCE $

UMBRELLA FORM AGGREGATE $

OTHER THAN UMBRELLA FORM $

WORKERS COMPENSATION AND

EMPLOYERS’ LIABILITY

STATUTORY LIMITS

THE PROPRIETOR/ EACH ACCIDENT $

PARTNERS/ EXECUTIVE

OFFICERS ARE:

INCL DISEASE - POLICY LIMIT $

EXCL DISEASE - EACH EMPLOYEE $

OTHER

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

The State of California, its officers, agents, employees and servants are hereby named as additional insured but only with respect to work performed for the State of California.

CERTIFICATE HOLDER

ATTENTION:

BID NO.

STATE OF CALIFORNIA

P.O. Box 4038…