24520004_-_STD_811_SB_Preference_and_Certification_Request.pdf

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

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