2015-01911_IFB_EXHIBITS_FINAL_031516.docx

IFB ATTACHMENTS AND EXHIBITS DOCUMENT

State of California IFB 2015-01911 California Governor’s Offices of Emergency Services

ATTACHMENT 1 – TEMPLATE FOR QUESTION SUBMITTAL

Bidders are requested to use this form when submitting questions to the Procurement Official listed in Section 1.6. Instructions are as follows:

Name of Bidder – Provide the name of the Bidding firm Contact Person – Provide the name of the person to contact if the State needs clarification about the question.

Contact Email and Phone # – Provide the email and phone number (including area code) for the listed contact person.

Q # – Sequentially number each question, always starting at one (1) for each submission.

Document(s) – Identify the document(s) the question pertains to, such as, Exhibit XX.

Section # – Identify the section number(s) that the question pertains to.

Question – Write the question in this column.

Expand or reduce the number of rows to accommodate the number of questions of each submission.

Table1 Question Submittal Form IFB Bidder Question Form

Name of Bidder:

Contact Person:

Contact Email and Phone Number:

PAGE INTENTIONALLY LEFT BLANK

ATTACHMENT 2 – TEMPLATE FOR REQUEST FOR CHANGES SUBMITTAL

Bidders are requested to use this form when submitting request for changes to the Procurement Official listed in Section 1.6. Instructions are as follows:

Name of Bidder – Provide the name of the Bidding firm Contact Person – Provide the name of the person to contact if the State needs clarification about the request for change.

Contact Email and Phone # – Provide the email and phone number (including area code) for the listed contact person.

Ch # – Sequentially number each change, always starting at one (1) for each submission.

Document(s) – Identify the document(s) the request pertains to, such as, IFB Section 6, Business; Functional and Technical Requirements.

Section # – Identify the section number(s) that the change pertains to.

Proposed Change – Write the requested change in this column. The Bidder shall apply tracked changes to ensure the change is evident.

Expand or reduce the number of rows to accommodate the number of questions of each submission.

Table2 Bidder Request for Change Form IFB Bidder Request for Change Form

Name of Bidder:

Contact Person:

Contact Email and Phone Number:

ATTACHMENT 3 – BID SUBMISSION CHECKLIST

Has your firm submitted the following pre-bid information?

Does your Final Bid follow the format specified in IFB Section 8?

Is your Final Bid provided in the following order, as identified in IFB Section 8?

Volume 1 – Response to Administrative, Business, Functional and Technical Requirements

|_| Exhibit 10: Iran Contracting Act of 2010

|_| Exhibit 13: DVBE Declarations

Preference/Incentive Exhibits (required only as indicated) |_| Exhibit 14: STD 830, TACPA Preference Request (required if claiming TACPA preference)

Volume 2 – STD 213, Standard Agreement with Statement of Work attached |_| Exhibit 15: STD 213, Standard Agreement with Statement of Work, ATTACHED (4 originally signed copies)

|_| Exhibit A: Statement of Work

Volume 3 – Cost Information – Exhibit B-1

The State makes no warranty that the checklist is a full and comprehensive listing of every requirement specified in the solicitation. Checking off the items on the checklist does not establish your firm’s intent nor does it constitute responsiveness to the requirements. The checklist is only a tool to assist participating Bidders in compiling the Final Bid response. Bidders are encouraged to carefully read the entire solicitation. The need to verify all documentation and responses prior to the submission of Final Bids cannot be over emphasized.

ATTACHMENT 4 – PROCEDURES FOR CONDUCTING PROTESTS UNDER THE ALTERNATIVE PROTEST PROCESS California Code of Regulations, Title 1, Division 2.

Chapter 5. Procedures for Conducting Protests under the Alternative Protest Process Article 1. General Provisions §1400. Purpose; Scope of Chapter.

Protests under the Alternative Protest Pilot Project (AB 1159, Chapter 762 of 1997 Statutes, Public Contract Code Division 2, Part 2, Chapter 3.6 (sections 12125-12130)) shall be resolved by arbitration as defined and established by this chapter.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New chapter 5 (articles 1-3), article 1 (sections 1400-1404) and section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1402. Definitions.

(1) It is wholly without merit.

(2) It is insufficient on its face.

(3) The Protestant has not submitted a rational argument based upon the evidence or law which supports the protest.

(4) The protest is based on grounds other than those specified in section 1410.

Authority cited: Section 12126, Public Contract Code. Reference: Section 11702, Government Code; and Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1404. Notice of Intent to Award Contract.

The Contracting Department shall post a Notice of Intent to Award Contract in a public place specified in the Solicitation, send rejection facsimiles to rejected Bidders, and send Notice of Intent to Award Contract facsimiles to any Bidder who made a written request for notice and provided a facsimile number. The Contracting Department shall indicate that the Solicitation File is available for inspection. The Contracting Department has the discretion to award a contract immediately, upon approval by the Director of the Department of General Services and, if the Solicitation was for a Major Information Technology Acquisition, the Director of the Department of Information Technology.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

Article 2. Protest Procedure §1406. Notice of Intent to Protest; Service List.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New article 2 (sections 1406-1418) and section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1408. Filing a Protest.

(1) Verify that the pages sent were all received by the Coordinator; and

(2) Remit the required deposit and filing fee to Coordinator by any reasonable means. If sending via carrier, the postmark date or equivalent shall be used to determine timeliness.

(c) Each Protestant not certified as a Small Business shall make a deposit of the estimated arbitration costs, by check or money order made payable to the Office of Administrative Hearings, as determined by the Estimated Contract Value.

(1) For contracts up to $100,000.00, the deposit shall be $1500.00.

(2) For contracts of $100,000.00 up to $250,000.00, the deposit shall be $3,000.00.

(3) For contracts of $250,000.00 up to $500,000.00, the deposit shall be $5,000.00.

(4) For contracts of $500,000.00 and above, the deposit shall be $7,000.00.

(5) Failure to remit a timely required deposit waives the right of protest.

(6) Any refund to Protestant(s) shall be made per section 1436.

(d) Each Protestant certified as a Small Business shall submit a copy of the Small Business Certification in lieu of the deposit specified in subsection (c). If Protestant is a Small Business and the protest is denied by the arbitrator, the Contracting Department shall collect the costs of the arbitration from Protestant. If Protestant does not remit the costs due, the Contracting Department may offset any unpaid arbitration costs from other contracts with Protestant and/or may declare Protestant to be a non-responsible Bidder on subsequent solicitations.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1410. Grounds for Protest.

(a) The Public Contract Code, at section 12126(d) provides: Authority to protest under this chapter shall be limited to participating Bidders.

(1) Grounds for Major Information Technology Acquisition protests shall be limited to violations of the Solicitation procedures and that the Protestant should have been selected.

(2) Any other acquisition protest filed pursuant to this chapter shall be based on the ground that the bid or proposal should have been selected in accordance with selection criteria in the Solicitation document.

(b) The burden of proof for protests filed under this chapter is preponderance of the evidence, and Protestant(s) must bear this burden.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1412. Detailed Written Statement of Protest.

(1) For Major Information Technology Acquisition protests, the Detailed Written Statement of Protest must specify each and every Solicitation procedure which was violated and the manner of such violation by specific references to the parts of the Solicitation attached as exhibits and why, but for that violation, Protestant would have been selected.

(2) For other acquisition protests, the Detailed Written Statement of Protest must specify each and every selection criterion on which Protestant bases the protest by specific references to the parts of the Solicitation attached as exhibits.

(3) For all protests, Protestant must specify each and every reason that all other Bidders who may be in line for the contract award should not be awarded the contract.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1414. Review by Coordinator.

(1) If Protestant withdraws the protest within 2 working days after the notification by the Coordinator of a preliminary determination of Frivolousness, the Coordinator shall withdraw the preliminary finding of Frivolousness and refund Protestant's deposit and filing fee.

(2) If the Protestant previously filed two protests under the Alternative Protest Pilot Project preliminarily determined Frivolous by the Coordinator but then withdrew or waived them before the arbitration decision, the Coordinator shall make final the preliminary determination of Frivolousness for the Department of General Services.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1416. Review and Response by Contracting Department and Awardee.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1418. Bond Requirement.

(1) If the arbitrator determines that the protest is Frivolous, the bond shall be forfeited to Procurement and the Coordinator will impose Sanctions.

(2) If the arbitrator determines that the protest is not Frivolous, the bond will be returned to the Protestant and no Sanctions imposed.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 995.010 et. seq., Code of Civil Procedure; and Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

Article 3. Arbitration Procedure §1420. Arbitration Process.

Within 19 calendar days after the Notice of Intent to Award has been posted, the Coordinator shall consolidate all remaining protests under the Solicitation, and send to OAH:

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New article 3 (sections 1420-1440) and section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1422. Selection of Arbitrator.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1424. Authority of Arbitrator.

(a) Arbitrators are authorized to:

(1) Administer oaths and affirmations;

(2) Make rulings and orders as are necessary to the fair, impartial, and efficient conduct of the hearing; and

(3) Order additional deposits from Protestant(s) to cover additional estimated costs. If OAH does not receive the required deposit(s) in the time specified, the right to protest will be deemed waived.

(1) Conduct a prehearing conference; and/or

(2) Permit cross-examination and, if so, to what extent; and/or

(3) Review documents alone for all or part of the protest.

(d) It shall be in the arbitrator's exclusive discretion to determine whether additional responses and rebuttals are to be submitted, and the timelines and page limits to be applied.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1426. Decision Based in Whole or in Part on Documents Alone.

Any Party may request that the arbitrator base the arbitrator's decision on documents alone. It shall be the arbitrator's exclusive discretion to do so.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1428. Prehearing Conference.

(1) Clarification of factual and legal issues in dispute as set forth in the Detailed Written Statement of Protest.

(2) The extent to which testimony shall be permitted and the extent to which cross-examination will be allowed.

(3) Identity of and limitations on number of witnesses, need for interpreters, scheduling and order of witnesses, etc.

(4) Any other matters as shall promote the orderly and efficient conduct of the hearing.

(c) At the prehearing conference, Protestant(s), the Awardee, and Procurement shall deliver a written statement which contains the name of each witness a party wishes to call at hearing along with a brief written statement of the subject matter of the witness's expected testimony. If the arbitrator, in his or her exclusive discretion, allows an expert witness to be called, the party calling the witness shall provide the name and address of the expert along with a brief statement of the opinion the expert is expected to give. The party shall also attach a statement of qualifications for the expert witness.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1430. Scheduling the Hearing.

The arbitrator shall schedule the date, time, and place of hearing and notify all Parties.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1432. Discovery.

The arbitrator has exclusive discretion to issue subpoenas and/or subpoena duces tecum. There shall be no right to take depositions, issue interrogatories, or subpoena persons or documents.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1434. Attendance at Hearings.

The Arbitration hearings shall be open to the public unless the arbitrator, in his or her exclusive discretion, determines that the attendance of individuals or groups of individuals would disrupt or delay the orderly conduct or timely completion of the proceedings.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1436. Arbitrator's Decision.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1437. Costs.

(a) For protests not determined Frivolous by Procurement:

(1) If the arbitrator denies the protest, Protestant(s) will be liable for all costs of the arbitration.

(2) If the arbitrator upholds the protest, the Contracting Department shall pay for all costs of the arbitration and Protestant(s) will be refunded the deposit by OAH.

(1) If the arbitrator denies the protest, Protestant(s) shall be liable for half of the costs of the arbitration. The Contracting Department shall pay the remaining half of the arbitration costs.

(2) If the arbitrator upholds the protest, the Contracting Department shall pay for all costs of the arbitration and Protestant(s) will be refunded the deposit by OAH.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1438. Judicial Review.

The grounds for judicial review shall be as set forth in Chapter 4 of Title 9 of Part III of the Code of Civil Procedure (commencing with section 1285).

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

§1440. Transcripts.

Authority cited: Section 12126, Public Contract Code. Reference: Sections 12125-12130, Public Contract Code.

1. New section filed 8-18-98; operative 8-18-98 pursuant to Government Code section 11343.4(d) (Register 98, No. 34).

INTENT TO BID

Department of Technology Statewide Technology Procurement Division

P. O. BOX 1810, MS Y12

Rancho Cordova, CA 95741 Phone: 916.431.5063 E-mail address: Robin.Filpula@state.ca.gov

We: (select one)

The individual to whom all information regarding this IFB shall be transmitted is:

Name:

Address:

City, State and ZIP Code:

Telephone:

FAX:

E-Mail:

Sincerely, Name (Signature)

Name and Title

Email

Company

Telephone

FAX

CONFIDENTIALITY STATEMENT

As an authorized representative and / or corporate officer of the company named below, I agree that all persons employed by this company will adhere to the following policy:

All information belonging to the Department of Technology or its affiliated agencies is considered sensitive and / or confidential and cannot be disclosed to any person or entity that is not directly approved to participate in the work required to execute this Agreement.

I certify that I will keep all project information, including, but not limited to information concerning the planning, processes, development or procedures of the Project, and all communication with Department of Technology or its affiliates derivate of any procurement process, confidential and secure. I will not copy, give or otherwise disclose such information to any other person unless the Department of Technology has on file a Confidentiality Statement signed by the other persons, and the disclosure is authorized and necessary for the Project. I understand that the information to be kept confidential includes, but is not limited to, specifications, administrative requirements, terms and conditions, concepts and discussions, as well as written and electronic materials. I further understand that if I leave this project before it ends, I must still keep all project information confidential. I agree to follow any instructions provided by the Project relating to the confidentiality of project information.

I fully understand that any unauthorized disclosure I make may be basis for civil or criminal penalties and / or disciplinary action (for state employees). I agree to advise the contract manager immediately in the event of an unauthorized disclosure, inappropriate access, misuse, theft or loss of data.

All materials provided for this Project, except where explicitly stated will be promptly returned or destroyed, as instructed by an authorized Department of Technology representative. If the materials are destroyed and not returned, a letter attesting to their complete destruction which documents the destruction procedures must be sent to the contract manager at the Department of Technology before payment can be made for services rendered. In addition, all copies or derivations, including any working or archival backups of the information, will be physically and / or electronically destroyed within five (5) calendar days immediately following either the end of the contract period or the final payment, as determined by the Department of Technology.

All personnel assigned to this project shall be provided a Confidentiality Statement and will be expected to sign and return it to the representative listed below before beginning work on this project.

Representative Name

Title

Phone Number

Company Name

Street Address

City/State/Zip Code

Signature

Date

RESPONSE TO ADMINISTRATIVE REQUIREMENTS

Bidder shall indicate agreement to each of the Administrative Requirements as presented in IFB 2015-01911, Section 5.1 in the Table below. By indicating “Yes” the Bidder affirms that it understands the requirement and agrees to comply with it.

General Administrative Requirements (M)

WORKERS’ COMPENSATION CERTIFICATION

The undersigned in submitting this document hereby certifies the following:

I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with such provisions before commencing the performance of the work of this contract.

Signature Date

Name and Title (Print or Type) Street Address

Firm Name City, State, ZIP

LIST OF PROPOSED SUBCONTRACTORS (PUBLIC WORKS)

Listed hereinafter is the name and address of each subcontractor who will be employed and the kind of work which each will perform if the contract is awarded to the aforesigned. I understand that under Government Code Section 4100 through 4113* (See Note Below) I must here clearly set forth the name and address of each subcontractor who will perform work or labor or render service to me in or about the construction of the work in an amount in excess of one-half of one percent (1/2 of 1%) of my total proposal and that as to any work in which I fail to do so, I agree to perform that portion myself or be subject to penalty under the act.

(NOTE: IF MORE THAN ONE SUBCONTRACTOR IS LISTED FOR THE SAME TYPE OF WORK, STATE THE PORTION OF THAT TYPE OF WORK THAT THE INDIVIDUAL SUBCONTRACTOR WILL BE PERFORMING. LIST THE SUBCONTRACTORS’ APPLICABLE CONTRACTORS LICENSE NUMBER(S), IF AVAILABLE. VENDORS OR SUPPLIERS OF MATERIALS ONLY, NEED NOT BE LISTED.)

If additional space is required for the listing of proposed subcontractors, reproduced additional sheets showing the required information, as indicated below, shall be attached hereto and made a part of the Final Bid proposal.

SUBCONTRACTOR

NAME AND ADDRESS

NOTE: The above listing requirement will for purposes of this proposal be construed in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (“The Act”) as set forth in Government Code Sections 4100 through 4113. Also, for purposes of this proposal and interpretation of The Act, a vendor will be considered to be a prime contractor regardless of whether such vendor is or is not a licensed contractor.

CONTRACTOR’S LICENSE INFORMATION

(Installation Services Only)

Bidder shall complete the applicable contractor’s license information below in accordance with the Contractor’s State License Board, Department of Consumer Affairs. A Contractor’s license of appropriate Class {Agency conducting the bid must specify the Class of license required for the specific solicitation} is required before any Bidder can contract business (e.g. submit a proposal) which includes the installation of cable and wiring, electrical modification. In addition, if structural modifications are required, a Class B license is required.

CONTRACTOR:

Class _________________________________ License No: _________________________

Licensee: _________________________________ Expiration Date: _________________________ Note: Bidder (Firm’s Name or a Responsible Managing Employee) must be licensed in addition to all subcontractor(s) performing under this contract.

SUBCONTRACTOR 1

Class _________________________________ License No: ______________________

Licensee: _________________________________ Expiration Date: ______________________

Relationship of Licensee to Contractor:_______________________________________________

SUBCONTRACTOR 2

Class _________________________________ License No: ______________________

Licensee: _________________________________ Expiration Date: _______________________

Relationship of Licensee to Contractor:_______________________________________________

(Use additional sheets if necessary.)

PAYEE DATA RECORD

ATTACH A COPY OF THE BIDDERS STD 204, PAYEE DATA RECORD TO THIS EXHIBIT.

Refer to the following website link to obtain the appropriate form. Payee Data Record (STD 204) for information: http://www.documents.dgs.ca.gov/osp/pdf/std204.pdf

SELLER’S PERMIT CERTIFICATION

ATTACH A COPY OF THE BIDDERS CALIFORNIA SELLERS PERMIT TO THIS EXHIBIT.

For more information on seller’s permit or certification of registration, refer to the following link: http://boe.ca.gov/pdf/pub73.pdf

EXHIBIT 9: SECRETARY OF STATE CERTIFICATION

ATTACH A COPY OF THE BIDDERS SECRETARY OF STATE CERTIFICATION TO THIS EXHIBIT.

For more information on seller’s permit or certification of registration, refer to the following website link: http://kepler.sos.ca.gov/

1. IRAN CONTRACTING ACT OF 2010

IRAN CONTRACTING ACT

(Public Contract Code sections 2202-2208) Prior to bidding on, submitting a proposal or executing a contract or renewal for a State of California contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services (“DGS”) pursuant to Public Contract Code section 2203(b) and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d).

To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made; contract termination; and three-year ineligibility to bid on contracts. (Public Contract Code section 2205.)

OPTION #1 - CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.

Vendor Name/Financial Institution (Printed):

Federal ID Number (or n/a):

By (Authorized Signature):

Printed Name and Title of Person Signing:

OPTION #2 – EXEMPTION

Pursuant to Public Contract Code sections 2203(c) and (d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services.

If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.

Vendor Name/Financial Institution (Printed):

Federal ID Number (or n/a)

By (Authorized Signature)

BIDDING PREFERENCES AND INCENTIVES

ALL BIDDERS: COMPLETE ALL SECTIONS BELOW AND SUBMIT WITH YOUR PROPOSAL.

1. SMALL BUSINESS PREFERENCE

Bidder must check the appropriate box from the choices below.

My DGS Small Business certification number is:

Bidder must complete and submit Exhibit 12: GSPD-05-105 Bidder Declaration, indicating the percentage of the revenue that will be received by each DGS certified Small Business Subcontractor. The form can also be found at the following link: http://www.documents.dgs.ca.gov/pd/poliproc/Master-BidDeclar08-09.pdf

2. DVBE INCENTIVE

Bidder must check the appropriate box from the choices below.

Bidder must submit a complete Exhibit 12: GSPD-05-105, Bidder Declaration, indicating the percentage of the revenue that will be received by each DGS certified DVBE Subcontractor. Bidder must also submit an Exhibit 13, STD 843 DVBE Declarations, for each DVBE Subcontractor, signed by the DVBE owner/manager. The form can be found on the following link:

http://www.documents.dgs.ca.gov/pd/poliproc/STD-843FillPrintFields.pdf

3. ADDITIONAL BIDDING PREFERENCES

The Bidder shall check the appropriate box or boxes from the choices below.

Bidder must submit Exhibit 14: STD 830 TACPA Preference Request.

Name of Bidder:

Signature and Date:

GSPD 05-105 BIDDER DECLARATION

A copy of the GSPD-05-105 Bidder Declaration and its instructions is available as a fill and print PDF at: http://www.documents.dgs.ca.gov/pd/poliproc/Master-Biddeclar08-09.pdf

DVBE DECLARATIONS

A copy of the STD. 843, Disabled Veteran Business Enterprise Declarations and its instructions is available as a fill and print PDF at:

http://www.documents.dgs.ca.gov/pd/poliproc/STD-843FillPrintFields.pdf

STD 830 TACPA PREFERENCE REQUEST

A copy of the STD 830 TACPA Preference Request and its instructions is available as a fill and print PDF at: http://www.documents.dgs.ca.gov/osp/pdf/std830.pdf

STD 213, STANDARD AGREEMENT

The STD 213, Standard Agreement must be signed by a party authorized to bind the firm contractually per Section 2.4.5 of IFB.

The Bidder shall only complete the “CONTRACTOR’S NAME” in block 1, and all of the information required for the “CONTRACTOR” block in the lower part of the form.