Addendum_No._4_56A0819.pdf
PDF 2 MB Posted
- Attached to
- Underwater Bridge Inspection Services
- Solicitation number
- 56A0819
- Issued by
- Contra Costa County, Imperial County, Los Angeles County, Marin County, Merced County, Modoc County, Monterey County, Orange County, Placer County, Sacramento County, San Diego County, San Francisco County, San Joaquin County, Santa Barbara County, Santa Cruz County, Tulare County, Contra Costa Centre CDP, Placerville City, Orange Cove City, San Joaquin City, Imperial City, East Los Angeles CDP, Lake Los Angeles CDP, Los Angeles City, Marina Del Rey CDP, Monterey Park City, San Marino City, Lucas Valley-Marinwood CDP, Marin City CDP, Merced City, University of California-Merced CDP, Marina City, Monterey City, Orange City, Orangevale CDP, Sacramento City, Imperial Beach City, Rancho San Diego CDP, San Diego City, San Diego Country Estates CDP, San Francisco City, South San Francisco City, Santa Barbara City, University of California-Santa Barbara CDP, Santa Cruz City, Monterey Park Tract CDP, Orange Blossom CDP, East Tulare Villa CDP, Tulare City, West Sacramento City, California
About this file
This document is Addendum No. 4 to Invitation for Bid (IFB) #56A0819 issued by the California Department of Transportation (Caltrans) for Underwater Bridge Inspection Services. The project requires the contractor to furnish all labor, equipment, traffic control, and other necessary materials to provide periodic safety inspections of the underwater elements of state and local agency bridges in California. Key details include that Caltrans will provide traffic control on state-owned bridges, but the contractor is responsible for traffic control on locally-owned bridges. The contractor and any subcontractors must have valid ADCI certifications, but ADCI membership is preferred but not required. The anticipated contract value is $2,070,000, and the contractor will be required to adjust labor rates annually per prevailing wage increases.
The document also includes instructions and forms for submitting Disadvantaged Business Enterprise (DBE) participation information and documenting good faith efforts if the DBE goal is not met. The contractor must also submit certifications regarding California civil rights laws, the Darfur Contracting Act, and the Iran Contracting Act.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Addendum_No._1_56A0819.pdf | ||
| Addendum_No._2_56A0819.pdf | ||
| Solictation_Package_56A0819.pdf | ||
| Addendum_No._3_56A0819.pdf | ||
| Addendum_No._5_56A0819.pdf |
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DEPARTMENT OF TRANSPORTATION
ADMINISTRATION
DIVISION OF PROCUREMENT AND
CONTRACTS
1727 30th STREET, MS-65
SACRAMENTO, CA 95816
PHONE (916) 227-6000
TTY 711
https://dot.ca.gov/programs/procurement-and-contracts/
November 8, 2024
Addendum No. 4 Invitation for Bid (IFB) #56A0819
Underwater Bridge Inspection Services
NOTICE TO ALL PROSPECTIVE BIDDERS:
Addendum No. 4 is being issued for the above-referenced IFB. Bid Proposals for this work shall be with the full understanding of this Addendum.
The following represents questions submitted for this IFB and the Department’s responses:
Question 1:
In previous years for this bridge inspection package, CalTrans provided Traffic Control services when required. For this 2024 RFP, section A.1 Purpose and Description of Services indicates that Traffic Control is on the bidder to provide this service. Please confirm that CalTrans will not provide Traffic Control services for this RFP, and the bidder is to include Traffic Control in their price.
Answer 1:
Caltrans will provide traffic control on State owned bridges on State routes.
Caltrans will not supply traffic control on bridges not owned by the State. These bridges may be owned by local agencies (town, city, or county). Traffic Control on these local bridges are the responsibility of the bidder and should be included in the bid price.
Question 2:
Page 2 Section B 22. Bidder and/or subcontractor shall have a valid and current Association of Diving Contractors International (ADCI) certification. Additional requirements include but are not limited to current diver certifications for the work being conducted, current First Aid/CPR/AED and O2 Administration, and a current fit-to-dive medical statement.
Please clarify That this requires the Contractor/Bidder, and any Subcontractor companies must be a member of ADCI in good standing and have completed an ADCI audit. Please reach out to me you have any questions.
Answer 2:
Diving personnel, training, and diving procedures shall follow the International Consensus Standards for Commercial Diving and Underwater Operations, 6.4 edition. Diver personnel must hold current ADCI certification. It is preferred, but not required, that the Contractor/Bidder and any subcontractor companies be a member of ADCI in good standing and have completed an ADCI Audit.
Question 3:
What is the anticipated contract value for IFB #56A0819?
Answer 3:
$2,070,000.00
Question 4:
Will the Contractor be required to adjust their labor rates in accordance with annual prevailing wage increases from the California Department of Industrial Relations over the life of IFB #56A0819, or will the labor rates current at the time of bidding be locked in for the duration of IFB #56A0819?
Answer 4:
Contractor will be required to adjust their labor rates in accordance with the annual prevailing wage increases from the California Department of Industrial Relations (DIR) over the life of IFB #56A0819.
Question 5:
The document links in Attachment 5: Required Documents do not appear to be active links.
Please provide a revised attachment 5 with working links or provide the documents in their entirety.
Answer 5:
Please see the attached documents at the end of this addendum.
All other terms and conditions set forth in the IFB remain in full force and effect.
Sincerely, Christian Miller Contract Analyst
“Provide a safe, sustainable, integrated and efficient transportation system to enhance California’s economy and livabilit
(CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISADVANTAGED BUSINESS ENTERPRISE (DBE) INFORMATION
DOT ADM-0227F (REV 08/2024)
PART A — CONTRACTOR INFORMATION (Refer to Instructions on Page 2 of this form. Bidder/Proposer shall ensure all information provided is complete and accurate.)
CONTRACTOR'S BUSINESS NAME AGREEMENT NUMBER CONTRACT DOLLAR AMOUNT DATE
CONTRACTOR'S BUSINESS ADDRESS CITY STATE ZIP CODE
CONTACT PERSON BUSINESS PHONE
FAX NUMBER
EMAIL ADDRESS
PART B — DBE INFORMATION AND DOCUMENTATION (Refer to Instructions on Page 2 of this form. Bidder/Proposer shall verify DBE certifications.) Contractor shall attach a copy of the bid (or price quote) from the DBE (on the DBE's Letterhead) for all DBEs listed below.
(1) Prime and Subcontractors: List Name(s) and addresses of all DBEs that will participate in this Agreement
(2) Area Code & Phone Number
(3) Tier
(4) Description of Work, Service, or Materials Supplied
(5) DBE or UCP Certification
Number
(6) Ownership
Code
(7) DBE
$ Amount Claimed
(8) % of $ Value
Claimed
(9) Caltrans Use Only %
PART C — FOR CALTRANS USE ONLY (Verification Completed by Office of Civil Rights)
PRINT VERIFIER'S NAME AND TITLE
DBE PARTICIPATION YES ( %) NO
SIGNATURE
{{Sig1_es_:signer1:signature }}
DATE STAMP OF APPROVAL
{{Dte1_es_:signer1:date:
format(mm/dd/yyyy)}}
DISADVANTAGED BUSINESS ENTERPRISE (DBE) INFORMATION
DOT ADM-0227F (REV 08/2024)
AUTHORITY: Title 49, Code of Federal Regulations, Part 26 (49 CFR 26) INSTRUCTIONS FOR COMPLETING FORM ADM-0227F (Please Type or Print Legibly)
PART A — CONTRACTOR INFORMATION
Contractor's Business Information: Bidder’s/Proposer’s Business Name, Address, City, State, Zip Code, Contact Person, Business Phone, Fax Number, and Email Address.
Agreement Number: The Agreement number is the same number as the Invitation for Bid (IFB) or Request for Proposal (RFP) number.
Contract Dollar Amount: Total dollar amount that Contractor proposes to accomplish the Agreement.
Date: Completion date.
PART B — DBE INFORMATION AND DOCUMENTATION
Prime: Complete if Prime is a certified DBE.
Subcontractor: Complete if the Subcontractor(s)/Supplier(s) are certified DBE. Please make and attach additional copies of page 1 if needed. Attach a copy of the bid (or price quote) from the DBE (on the DBE’s Letterhead) for all DBEs listed.
Column 1 Enter the names (includes all certified DBE Prime and Subcontractors) and complete addresses of all certified DBE Contractor/ Subcontractor(s)/Supplier(s) that will be used in the Agreement.
Column 2 Enter the area code and phone number of the corresponding certified DBE listed in Column 1.
Column 3 Enter the Contracting Tier number for each DBE correspondingly listed in Column 1:
0 = Prime or Joint Consultant 1 = Primary Subcontractor 2 = Subcontractor/Supplier of level 1 Primary Subcontractor
Column 4 Enter a description that briefly captures the work to be performed or supplies to be provided by each corresponding DBE firm listed in Column 1.
Column 5 Enter the DBE or California Unified Certification Program (UCP) Certification Number for the corresponding DBE listed in Column
1. Self-certification is NOT acceptable. DBEs must be certified by the submittal date identified in the IFB or RFP. For more certification and verification information, refer to the IFB’s or RFP’s Notice to Bidders/Proposers Disadvantaged Business Enterprise Program Goal.
Column 6 Enter the correct Ownership Code number below for the corresponding DBE listed in Column 6.
1 = Black American 4 = Asian-Pacific American 7 = Woman 2 = Hispanic American 5 = Subcontinent Asian American 8 = Other 3 = Native American 6 = Caucasian 9 = Not Applicable
Column 7-8 Enter the dollar and/or percentage (%) of the dollar ($) value claimed for each corresponding DBE listed in Column 1.
EXAMPLE
(1) Prime and Subcontractors: List Name(s) and addresses of all DBEs that will participate in this Agreement
(2) Area Code & Phone Number
(3) Tier
(4) Description of Work, Service, or Materials
Supplied
(5) DBE or
UCP
Certification Number
(6) Ownership
Code
(7) DBE
$ Amount Claimed
(8) % of $ Value
Claimed
(9) Caltrans Use Only
Jane Prime Inc., 1234 Jane’s Street Jane’s City, CA 04321
(XXX) 000-1111 0 Project Management XXXXXXXX 7, 5 $48,000 48%
Joe Subcontractor Inc, 4567 Joe’s Street, Joe’s City, CA 07654
(XXX) 111-0000 1 Design, surveys, environmental testing
000000000000 6 $42,000 42%
Supplier International LLC 1100 X Street Supplier’s City, CA 45670
(111) XXX-0001 2 Survey instruments, testing materials
111111111111 3 $10,000 10%
ADDITIONAL INFORMATION
• Form DOT ADM-0312F should be submitted with the DOT ADM-0227F to demonstrate good faith efforts (GFE) AND protect bidder's/ proposer's eligibility for contract award in the event Caltrans determines the bidder/proposer failed to meet the UDBE goal.
• A DBE/UDBE joint venture partner shall submit the joint venture agreement with the form DOT ADM-0227F.
ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
BIDDER/PROPOSER DISADVANTAGED BUSINESS ENTERPRISE (DBE)
GOOD FAITH EFFORTS DOCUMENTATION
DOT ADM-0312F (REV 07/2024) (CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)
ADA Notice
CONTRACTOR'S NAME IFB OR RFP OR RFQ NUMBER DATE
BIDDER/PROPOSER INSTRUCTIONS: Submittal of only the Disadvantaged Business Enterprise (DBE) Information form, ADM-0227F, may not provide sufficient documentation to demonstrate that adequate good faith efforts (GFE) were made by the bidder/proposer. Bidder/proposer should always submit documentation for making GFE to protect its eligibility for award should Caltrans, in its evaluation, find that the bidder/proposer did not meet the DBE goal. If a bidder/proposer does not meet the DBE goal, a bidder/proposer must make an adequate GFE to be responsive.
Bidder/proposer shall complete this Bidder/Proposer Disadvantaged Business Enterprise (DBE) Good Faith Efforts Documentation form, ADM-0312F, and submit the requested information below with its bid by the bid due date and time.
1. OUTREACH DOCUMENTATION
Describe the bidder’s/proposer’s outreach efforts to identify and solicit the interest of all certified DBEs that have the capability to perform the work of the contract. Provide copies of supporting documentation.
DESCRIPTION OF OUTREACH DATE(S) LOCATION (IF APPLICABLE) RESULTS
2. DBE DOCUMENTATION
a. List the names of certified DBEs and all dates on which they were solicited to bid on the contract.
b. Include the items of work offered and the dates and methods used for initial and follow-up solicitations to determine with certainty whether the DBEs were interested.
c. Attach copies of solicitations, e-mail messages, telephone records, fax confirmations, etc.
Check the appropriate box: IFB RFP RFQ
SOLICITATIONS
NAME OF DBE SOLICITED DATE OF INITIAL SOLICITATION ITEM(S) OF WORK OFFERED FOLLOW-UP METHODS AND DATES
GOOD FAITH EFFORTS DOCUMENTATION
DOT ADM-0312F (REV 07/2024) (CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)
ADA Notice
CONTRACTOR'S NAME IFB OR RFP OR RFQ NUMBER DATE
2. DBE DOCUMENTATION (Continued)
SOLICITATIONS
NAME OF DBE SOLICITED DATE OF INITIAL SOLICITATION ITEM(S) OF WORK OFFERED FOLLOW-UP METHODS AND DATES
3. ITEMS OF WORK
List the items of work made available to DBE firms. Identify items of work the bidder/proposer might otherwise perform with its own forces; items that have been broken down into economically feasible units to facilitate DBE participation; and items for which the bidder/proposer has established flexible timeframes for performance and delivery schedules in a manner that encourages and facilitates DBE participation. For each item listed, show the dollar value and percentage of the total contract. The bidder/proposer must demonstrate that sufficient work to meet the goal was made available to DBE firms.
ITEMS OF WORK OFFERED,
SERVICES OFFERED, OR
MATERIALS SUPPLIED
BIDDER/PROPOSER
NORMALLY PERFORMS ITEM
(Y/N)
ITEM BROKEN DOWN TO
FACILITATE PARTICIPATION
(Y/N)
ESTABLISHED FLEXIBLE
TIMEFRAMES FOR
PERFORMANCE AND
DELIVERY SCHEDULES
(Y/N)
AMOUNT
PERCENTAGE OF
CONTRACT
GOOD FAITH EFFORTS DOCUMENTATION
DOT ADM-0312F (REV 07/2024) (CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)
ADA Notice
CONTRACTOR'S NAME IFB OR RFP OR RFQ NUMBER DATE
ITEM(S) OF WORK
PROVIDE
PLANS/SPECIFICATIONS
FOR WORK OFFERED
(Y/N)
NAME OF
SELECTED FIRM DBE or non-DBE
NAME OF
REJECTED FIRM
QUOTE
PRICE DIFFERENCE
4. DBE RESPONSES
For each item of work made available, indicate whether the bidder/proposer provided plans and specifications specific to the item(s) of work being offered; list the selected firm and its status as a DBE; the DBEs that provided quotes; the price quote for each firm; and the price difference for each DBE if the selected firm is not a DBE. Provide copies of each DBE and non-DBE quote submitted to the bidder/proposer when a non-DBE firm was selected over a DBE for work on the contract.
5. ASSISTANCE TO DBEs - Plans/Specifications/Contract requirements Describe the bidder's/proposer’s efforts made to provide interested DBEs with adequate information about the plans, specifications, and requirements of the contract to assist them in responding to a solicitation. Identify the DBEs assisted, the type of information provided, and the date of the contacts. Provide copies of supporting documents.
6. ASSISTANCE TO DBEs - Bonding/Lines of Credit/Insurance Describe the bidder’s/proposer’s efforts made to assist interested DBEs in obtaining bonding, lines of credit, or insurance. Identify the DBEs assisted, the type of assistance offered, and the dates. Provide copies of supporting documents.
GOOD FAITH EFFORTS DOCUMENTATION
DOT ADM-0312F (REV 07/2024) (CONTRACTS FEDERALLY FUNDED IN WHOLE OR IN PART)
ADA Notice
CONTRACTOR'S NAME IFB OR RFP OR RFQ NUMBER DATE
7. ASSISTANCE TO DBEs - Equipment/Supplies and Materials/Related Assistance or Services Describe the bidder's/proposer’s efforts made to assist interested DBEs in obtaining necessary equipment, supplies, materials, or related assistance or services, excluding supplies and equipment the DBE purchases or leases from the prime contractor or its affiliate. Identify the DBEs assisted, the type of assistance offered, and the dates. Provide copies of supporting documents.
8. ASSISTANCE RECRUITING AND PLACING DBEs List the names of agencies and the dates on which they were contacted to provide assistance in contacting, recruiting, and using DBE firms. If the agencies were contacted in writing, provide copies of supporting documents.
NAME OF AGENCY/ORGANIZATION METHODS/DATE OF CONTACT RESULTS
9. ADDITIONAL DATA TO SUPPORT A GOOD FAITH EFFORT
Include additional data to support a demonstration of good faith efforts.
SUBCONTRACTING PROVISIONS/LIST
DOT ADM-1511 (REV 07/2024)
ATTACHMENT
ADA Notice
List all Subcontractors that will be used in this Agreement. All Subcontractors listed below must be used in accordance with the Agreement. This includes, if applicable, compliance with the subcontracting provisions and any Disabled Veteran Business Enterprise (DVBE), Small Business (SB), Micro Business (MB), and Disadvantaged Business Enterprises (DBE) Subcontractors.
Attach a copy of the quote on the letterhead of the certified SB, MB, DVBE, or DBE Subcontractor to this form. The quote will serve as written confirmation that the certified SB, MB, DVBE, or DBE is participating in the contract. If none, bidder to write "NONE” in this space.
NAME BUSINESS ADDRESS
DESCRIPTION OF PORTION OF WORK WHICH WILL BE DONE BY
EACH CONTRACTOR
CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION
DOT ADM-0076 (REV 07/2024)
ATTACHMENT
IFB Number
ADA Notice This document is available in alternative accessible formats. For more information, please contact the Forms Management Unit at (279) 234-2284, TTY 711, in writing at Forms Management Unit, 1120 N Street, MS-89, Sacramento, CA 95814, or by email at Forms.Management.Unit@dot.ca.gov.
CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION
Instructions: Complete as applicable, and submit with bid, proposal, contract, or amendment when the total contract value is one hundred thousand dollars ($100,000) or more.
Pursuant to Public Contract Code section 2010, if a bidder or proposer executes, renews, or amends a contract one hundred thousand dollars ($100,000) or more on or after January 1, 2017, the bidder or proposer hereby certifies, under the penalty of perjury, compliance with the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts one hundred thousand dollars ($100,000) or more executed, renewed, or amended after
January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts one hundred thousand dollars ($100,000) or more executed, renewed, or amended 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 are not 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.
PROPOSER/BIDDER FIRM NAME (PRINTED)
FEDERAL ID NUMBER (OR N/A)
PRINTED NAME AND TITLE OF PERSON SIGNING
DATE EXECUTED/SIGNED EXECUTED/SIGNED IN THE COUNTY AND STATE OF
BY (AUTHORIZED SIGNATURE)
I agree that by providing my electronic signature for this form, I agree to conduct business transactions by electronic means and that my electronic signature is the legal binding equivalent to my handwritten signature. I hereby agree that my electronic signature represents my execution or authentication of this form, and my intent to be bound by it.
DARFUR CONTRACTING ACT CERTIFICATION
ADM-0077 (REV 05/2020)
Darfur Contracting Act Certification
Instructions: Complete, as applicable, and submit with bid.
Public Contract Code Sections 10475-10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services ("DGS") to submit a proposal.
OPTION #1 - CERTIFICATION
If your company has not, within the previous three years, had any business activities or other operations outside of the United States, complete and sign this section and submit with bid package.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below has not, within the previous three years, had any business activities or other operations outside of the United States; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.
Company/Vendor Name (Printed) Federal ID Number
By (Authorized Signature)
Printed Name and Title of Person Signing
OPTION #2 - CERTIFICATION
If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code Section 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.
Company/Vendor Name (Printed) Federal ID Number
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
OPTION #3 - WRITTEN PERMISSION FROM DGS
Pursuant to Public Contract Code Section 10477(b), the Director of the DGS may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.
We are a scrutinized company as defined in Public Contract Code Section 10476, but we have received written permission from the DGS to submit a bid or proposal pursuant to Public Contract Code Section 10477(b). A copy of the written permission from DGS is included with our bid or proposal.
Company/Vendor Name (Printed) Federal ID Number
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
IRAN CONTRACTING ACT CERTIFICATION
ADM-0078 (REV 06/2022)
ATTACHMENT
Contract Number
ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Iran Contracting Act Certification
Instructions: Complete, as applicable, and submit with proposal.
Prior to bidding on, submitting a proposal or executing a contract or renewal for a State of California contract for goods or services of one million dollars ($1,000,000) or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code Section 2203(b) and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code Section 2203(c) or (d). The DGS list of entities prohibited from contracting with public entities in California per the Iran Contracting Act, 2010, can be found at: Department of General Services, Procurement Division, Iran Contracting Act List (
To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note, California law establishes penalties for providing false certifications, including civil penalties equal to the greater of two hundred fifty thousand dollars ($250,000) or twice the amount of the contract for which the false certification was made; contract termination; and three (3) year ineligibility to bid on contracts (Public Contract Code Section 2205).
OPTION #1 - CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor for 45 days or more if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.
https://www.
dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/List-of-Ineligible-Businesses
Print Vendor Name Financial Institution Federal ID Number (or N/A)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
OPTION #2 - EXEMPTION
Pursuant to Public Contract Code Sections 2203(c) and (d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran on a case-by-case basis to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.
Print Vendor Name Financial Institution Federal ID Number (or N/A)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed
| Addendum No. 4 56A0819.pdf |
| ADM-0227F.pdf |
| ADM-0312F.pdf |
| ADM-1511.pdf |
| STD-1000.pdf |
| ADM-0076.pdf |
| ADM-0077.pdf |
| ADM-0078.pdf |
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