9._STD_816_-_DVBE_Exemption_Request.pdf
PDF 120 KB Posted
- Attached to
- NCR-HQ-RFQ-25-E0009 Live Sacramento Perch
- Solicitation number
- 0000036997
- Issued by
- Sacramento County, California
About this file
The document is a State of California Disabled Veteran Business Enterprise (DVBE) Exemption Request form (STD 816) issued by the Department of General Services. The form provides a mechanism for state departments to request exemption from standard DVBE program requirements and/or DVBE incentives for specific procurement activities. The form offers three primary exemption options: exempting DVBE program requirements while including the DVBE incentive, exempting the DVBE incentive while maintaining program requirements, or exempting both program requirements and incentives.
The form requires detailed documentation, including department information, procurement identifiers, contact details, and a comprehensive justification for the requested exemption. Two levels of signature approval are required: one from the department designee completing the form and another from the highest-ranking executive or their designated representative. The form is designed to ensure transparency and provide a structured process for departments seeking modifications to standard DVBE procurement guidelines, with the understanding that each exemption request must be thoroughly explained and individually submitted for each solicitation.
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Text version
STATE OF CALIFORNIA
DVBE EXEMPTION REQUEST
STD 8 16 (Rev. 09/20)
INSTRUCTIONS
Department of General Services
DEPARTMENT INFORMATION
DEPARTMENT (includes Boards, Commissions, and Associations)
PROCUREMENT IDENTIFIER(S) (include requisition number a nd estimated amount of purchase if applicable)
CONTACT NAME
BUSINESS STREET ADDRESS
BUSINESS MAILING ADDRESS (if different from Street Address)
BUSINESS PHONE BUSINESS EMAIL
THE DEPARTMENT REQUESTS TO:
EXEMPT the DVBE Program Requirements and INCLUDE the DVBE Incentive. Please ensure that:
• The reason for exempting the DVBE Program Requirements is provided in the Exemption Justification section below.
• The purchase indicates the DVBE Program Requirements have been exempted, but the DVBE incentive applies.
EXEMPT the DVBE Incentive and INCLUDE the DVBE Program Requirements. Please ensure that:
• The reason for e xempting the DVBE Incentive is provided in the Exemption Justification section below.
• The purchase indicates the DVBE Incentive has been exempted, but the DVBE Program Requirements apply.
EXEMPT the DVBE Program Requirements and the DVBE Incentive. Please ensure that:
• The reason for exempting the DVBE Program Requirements and the DVBE Incentive is provided in the Exemption Justification section below.
EXEMPTION JUSTIFICATION
Reason(s) f or excluding the DVBE Program Requirements and/or D VBE Incentive for this purchase:
SIGNATURE APPROVAL (Department designee completing the Std. 816)
PRINTED
NAME
TITLE
SIGNATURE
(Please click here to sign with a Digital ID) DATE
Use this form to request approval to exempt the Disabled Veteran Business Enterprise (DVBE) Program Requirements and/or DVBE Incentive. Submit one form per solicitation. Do not bundle multiple solicitations together. For additional information, see the State Contracting Manual.
SIGNATURE APPROVAL (Highest ranking executive or designee only)
PRINTED NAME TITLE
SIGNATURE (Please click here to sign with a Digital ID) DATE
Accessibility Report
Filename:
STD 816 Draft 5.pdf
Report created by:
Kevin Vang, IT Person, Kevin.Vang@dgs.ca.gov
Organization:
DGS, DGS
[Personal and organization information from the Preferences > Identity dialog.]
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| CONTACT NAME: |
| BUSINESS STREET ADDRESS: |
| BUSINESS MAILING ADDRESS if different from Street Address: |
| BUSINESS PHONE: |
| BUSINESS EMAIL: |
| PROCUREMENT IDENTIFIERS include requisition number and estimated amount of purchase if applicable: |
| Department: |
| Text1: |
| Exempt: Off |
| DATE: |
| TITLE: |
| PRINTED NAME: |
| PRINTED NAME1: |
| TITLE1: |
| DATE1: |
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