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This document is a California Department of General Services, Office of Legal Services Civil Rights Laws Certification form for state contracts. The form is applicable to any state contract valued at $100,000 or above, and requires contractors to certify compliance with California civil rights laws for contracts executed or renewed after January 1, 2017. Specifically, contractors must affirm adherence to the Unruh Civil Rights Act and the Fair Employment and Housing Act.

The certification requires contractors to confirm they do not have internal policies discriminating against sovereign nations or peoples recognized by the United States government, and that any such policies would not violate civil rights legislation. The form is part of a standardized procurement process, identified by the solicitation number 25FS0032, and must be signed under penalty of perjury by an authorized representative of the bidding or proposing firm. The document provides spaces for the firm's name, federal ID number, authorized signature, printed name and title of the signatory, execution location, and date of execution.

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DEPARTMENT OF GENERAL SERVICES

OFFICE OF LEGAL SERVICES

STATE OF CALIFORNIA

CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION

DGS OLS 04 (Rev. 01/17)

Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or otherwise proposes to enter into or renew a contract with, a state agency with respect to any contract in the amount of $100,000 or above shall certify, under penalty of perjury, at the time the bid or proposal is submitted or the contract is renewed, all of the following:

1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of theCivil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and

2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies arenot used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of the Government Code).

CERTIFICATION

I, the official named below, certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

By (Authorized Signature)

Printed Name and Title of Person Signing

Executed in the County of Executed in the State of

Date Executed

Proposer/Bidder Firm Name (Printed) Federal ID Number

Solicitation: 25FS0032

ProposerBidder Firm Name Printed:
Federal ID Number:
Printed Name and Title of Person Signing:
Executed in the County of:
Executed in the State of:
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