4._25LS0002-_Required_Attachments.pdf
PDF 5 MB Posted
- Solicitation number
- 0000036160
About this file
This document is a compilation of required attachments for a California Department of Veterans Affairs solicitation (Solicitation Number 25LS0002), containing multiple forms related to contract compliance and bidding requirements. The documents include a rate sheet for services like monthly cooking oil pickup and quarterly grease trap pumping, payee data records, contractor certifications, civil rights law attachments, commercially useful function certifications, Darfur contracting act certifications, and a placeholder for certificates of insurance. The forms are standardized state procurement documents that contractors must complete to be eligible to bid on state contracts, with various compliance declarations covering areas such as labor codes, civil rights, disability accommodations, and business qualifications.
The attachments collectively outline strict requirements for potential contractors, including provisions for non-discrimination, drug-free workplaces, labor relations, and disclosures about business operations. Specific compliance areas include certification of commercially useful functions for small businesses and disabled veteran-owned businesses, declarations about business activities outside the United States, and acknowledgments of various California civil rights laws. While no specific pricing or contract value is detailed in these forms, they represent critical administrative documentation that must be accurately completed for a contractor to be considered for the state contract, with potential disqualification for incomplete or false information.
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Other files
| File | Type | Posted |
|---|---|---|
| 1._25LS0002-_SFQ.pdf | ||
| 2._25LS0002-_All_Exhibits.pdf | ||
| 5._25LS0002-_STD_213_SAMPLE.pdf | ||
| 3._25LS0002_Rate_Sheet-_Updated_from_home.xlsm | XLSM spreadsheet |
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STATE OF CALIFORNIA – DEPARTMENT OF FINANCE
PAYEE DATA RECORD
(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
California Department of Veterans Affairs CBO
1227 O Street 916-651-2159
Sacramento CA 95814 ophelia.deollas@calvet.ca.gov
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