24WS0035_-_STD_1000_GENAI_Reporting_and_Factsheet.pdf

PDF 213 KB Posted

Attached to
24WS0035 - TEMPORARY/RELIEF PHARMACY TECHNICIAN REGISTRY SERVICES
Solicitation number
0000034017
Issued by
Los Angeles County, Orange County, Riverside County, San Bernardino County, Orange Cove City, East Los Angeles CDP, Lake Los Angeles CDP, Los Angeles City, Orange City, Lake Riverside CDP, Riverside City, Orangevale CDP, San Bernardino City, Orange Blossom CDP, California

About this file

This is a GenAI Reporting and Factsheet (STD 1000) form from the California Department of General Services Procurement Division, revised for July 2024. The form requires bidders, offerors, and contractors to disclose whether they or their subcontractors will be using or offering Generative Artificial Intelligence (GenAI) technology, models, services, or systems in the performance of their contract. The form includes sections for business information, detailed GenAI disclosure requirements, and a signature section.

The form requires specific information about any GenAI implementation, including model names, LLM versions, parameter counts, product owners, descriptions, use cases, and intended information domains. A key requirement is explaining how the GenAI system will not adversely affect decisions regarding housing, education, employment, credit, healthcare, and criminal justice. The form must be signed and submitted to the awarding department, with an obligation to submit updated forms if new GenAI use is identified during contract performance.

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24WS0035_-_Additional_Forms.pdf PDF
24WS0035_-_SFQ_Question_and_Answers.pdf PDF
24WS0035_-_Addendum_1.pdf PDF
24WS0035_-_Exhibits_A-E.pdf PDF
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STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES

GENAI REPORTING AND FACTSHEET PROCUREMENT DIVISION

STD 1000 (REV. 07/2024)

Generative Artificial Intelligence (GenAI) Reporting and Factsheet

Section 1: Bidder / Offeror / Contractor Information

Solicitation / Contract Number Bidder ID / Vendor ID (optional)

Business Name Business Telephone Number

Business Address City State Zip Code

Contract / Description of Purchase

Section 2: Disclosure and Factsheet

Will you and/or your subcontractor(s) be using or offering GenAI technology, model, service, or system (collectively, “product”)? Yes No (If no, skip to Signature section of this form.)

If yes, provide details regarding the GenAI system. See GenAI Reporting and Factsheet Instructions at the end of this form for more information.

Failure to provide information requested on this form may result in disqualification or may void any resulting contract.

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

STD 1000 (REV. 07/2024)

2. (GenAI powered, or driven), applications / product owner

3. Product Description

4. Use Case(s)

5. Intended Information Domain

6. Explain how the GenAI system is not adversely affecting decisions that materially impact access to, or approval for, housing or accommodations, education, employment, credit, health care, and criminal justice.

Signature

By signing this document, I have identified and reported any GenAI use in the performance of this contract. If any new or previously unreported GenAI use is identified in the future in the performance of this contract, we will complete and submit to the State an updated STD 1000.

Signature Date

Submit completed form to the awarding department

STD 1000 (REV. 07/2024)

GenAI Reporting and Factsheet Instructions

Please use the following definitions and instructions to complete the GenAI Reporting and Factsheet:

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

a. Definition: The unique identifier or name assigned to the specific GenAI model or service.

b. Purpose: Allows users to refer to and distinguish between different GenAI models.

2. (GenAI powered, or driven), applications/product owner:

a. Definition: The name of the organization or entity responsible for creating or deploying the GenAI model or service.

b. Purpose: Helps identify the source and accountability for the GenAI system.

3. Product Description:

a. Definition: A concise summary of the GenAI model’s purpose, functionality, and key characteristics.

b. Purpose: Provides a high-level understanding for users and stakeholders.

4. Use Case(s):

a. Definition: The intended use or goal of the GenAI model (e.g., image recognition, natural language processing, text summarization).

b. Purpose: Helps users assess whether the GenAI model aligns with their needs.

5. Intended Information Domain:

a. Definition: The context, subject matter, or domain for which the GenAI model is designed to operate effectively.

b. Purpose: Helps users determine if the GenAI model is suitable for their specific use case.

6. Adverse Impact:

a. Explain below how you are ensuring the GenAI system is not adversely affecting decisions that materially impact access to, or approval for, housing or accommodations, education, employment, credit, health care, and criminal justice.

7. Signature:

a. The signatory for the Contract shall also sign the STD 1000

Solicitation Contract:
Number Bidder ID Vendor ID optional:
Business Name:
Business Telephone Number:
Business Address:
City:
State:
Zip Code:
Yes: Off
No If no skip to Signature section of this form: Off
1 GenAI Model Name LLM Version including number of parameters list ALL model namesowners for the solution or offering:
2 GenAI powered or driven applications product owner:
3 Product Description:
4 Use Cases:
5 Intended Information Domain:
6 Explain how the GenAI system is not adversely affecting decisions that materially impact access to or approval for housing or accommodations education employment credit health care and criminal justice:
Date:
Contract / Description of Purchase:

File details come from the government source that posted it. Updated .