9._OBS_1000_Generative_AI_(GenAI)_Disclosure.pdf
PDF 492 KB Posted
- Attached to
- K9HA-10. 17. 2025
- Solicitation number
- 0000036993
- Issued by
- Trinity County, California
About this file
The document is a Generative Artificial Intelligence (GenAI) Reporting and Factsheet form issued by the State of California's Department of Corrections and Rehabilitation, Office of Business Services. The form (OBS 1000, dated 03/2025) is designed to capture detailed information about the potential use of GenAI technologies by contractors, requiring comprehensive disclosure about any AI models, applications, or systems that may be employed in contract performance. The form mandates contractors to provide specifics about their GenAI models, including model names, versions, parameters, product descriptions, use cases, and intended information domains.
The form emphasizes transparency and accountability in GenAI usage, requiring contractors to explain how their GenAI systems will not adversely impact critical decision-making areas such as housing, education, employment, credit, healthcare, and criminal justice. Contractors must sign the document, certifying that they have fully disclosed any current or future GenAI use in contract performance, and commit to updating the state with any new or previously unreported GenAI applications. The document serves as a regulatory mechanism to ensure responsible and ethical implementation of generative AI technologies in state contracts, with potential disqualification for incomplete or misleading submissions.
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Text version
STATE OF CALIFORNIA
GENAI REPORTING AND FACTSHEET
OBS 1000 (NEW 03/2025)
DEPARTMENT OF CORRECTIONS AND REHABILITATION
OFFICE OF BUSINESS SERVICES
Generative Artificial Intelligence (GenAI) Reporting and Factsheet
Section 1: Bidder/ Offerer I Contractor Information
Solicitation/ Contract Number Bidder ID/ Vendor ID (optional)
Business Name Business Telephone Number
Business Address City State Zip Code
Contract I 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
OBS 1000 (NEW 03/2025)
2. (GenAI powered, or driven), applications / product owner
3. Product Description
4. Use Case(s)
5. Intended Information Domain
DEPARTMENT OF CORRECTIONS AND REHABILITATION
OFFICE OF BUSINESS SERVICES
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
OBS 1000 (NEW 03/2025)
GenAI Reporting and Factsheet Instructions
DEPARTMENT OF CORRECTIONS AND REHABILITATION
OFFICE OF BUSINESS SERVICES
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 OBS 1000
| OBS 1000 - Solicitation Contract: |
| OBS - 1000 - Business Address: |
| OBS 1000 - Number Bidder ID Vendor ID optional: |
| OBS 1000 - Business Name: |
| OBS 1000 - Business Telephone Number: |
| OBS 1000 - City: |
| OBS 1000 - State: |
| OBS 1000 - Zip Code: |
| OBS 1000 - Contract / Description of Purchase: |
| OBS 1000 - Will you andor your subcontractors be using or offering GenAI technology model service or system collectively: Off |
| OBS 1000 - No If no skip to Signature section of this form: Off |
| OBS 1000 - GenAI Model Name: |
| OBS 1000 - GenAI Powered or Driven: |
| OBS 1000 - Product Description: |
| OBS 1000 - Use Cases: |
| OBS 1000 - Intended Information Domain: |
| OBS 1000 - Explain - Not Adversely Affecting: |
| OBS 1000 - Date: |
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