ARTIFICAL INTELLIGENCE USE.docx
DOCX document 39 KB Posted
- Attached to
- TRAFFIC COUNT COLLECTION SERVICES
- Solicitation number
- 5400029736
- Issued by
- Richland County, South Carolina
About this file
This is an Artificial Intelligence Use Disclosure Questionnaire required for the Traffic Count Collection Services contract opportunity in South Carolina. The questionnaire serves as a mandatory disclosure document for contractors proposing solutions that incorporate artificial intelligence, machine learning, generative AI, or algorithmic decision-making capabilities. Contractors must complete the form to detail all AI technologies embedded within their proposed solutions, including specific business processes, workflows, features, and decision points where AI will be utilized. The document requires identification of the purpose of AI functionality, such as data analysis, predictive analytics, natural language processing, image or video analytics, recommender systems, automated decision-making, and workflow automation.
The questionnaire mandates comprehensive disclosure of AI model sources, training methodologies, datasets used, and data protection measures, with particular emphasis on safeguards for personally identifiable information, protected health information, and sensitive data. Contractors must confirm that Agency data will not be shared, repurposed, or added to any training corpus without express written authorization. The form requires contractors to disclose the level of explainability and auditability available for AI model decisions, identify known limitations, bias risks, and accuracy constraints, and describe mitigation and testing plans. Additionally, contractors must outline ongoing monitoring and governance procedures and acknowledge a requirement to notify the Agency at least 60 days in advance of any new AI capabilities, model updates, or material changes to data sources or usage. Authorized representatives must certify that all disclosures are accurate, complete, and made in good faith, with full compliance to all AI Use Disclosure Requirements outlined by the contracting Agency.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 1.pdf | ||
| Amendment 2.pdf | ||
| Solicitation.pdf | ||
| Pricing Proposal.xlsx | XLSX spreadsheet | |
| Excel Spreadsheet for TMC data.xlsm | XLSM spreadsheet | |
| Traffic Count Survey Worksheet.doc | DOC document |
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Text version
Artificial Intelligence Use Disclosure Questionnaire
SECTION 1 - GENERAL INFORMATION
Contractor:
Date:
Solicitation/Job Order:
Primary Contact:
Title:
Email:
Phone:
Does the proposed solution use any form of AI, ML, GenAI, or algorithmic decision-making?
If “No,” skip to Section 10 (Certification)
| Yes: |
| ⃣ |
| No: |
| ⃣ |
SECTION 2 – FUNCTION AND PURPOSE OF AI
Describe all areas where AI will be incorporated into the solution:
(Include specific business processes, workflows, features, evaluation modules, automation functions, and decision points.)
Purpose of AI functionality (check all that apply):
| ⃣ |
| Data analysis / classification |
| ⃣ |
| Predictive analytics |
| ⃣ |
| Natural language processing |
| ⃣ |
| Image / video analytics |
| ⃣ |
| Recommender systems |
| ⃣ |
| Automated decision-making |
| ⃣ |
| Workflow automation |
| ⃣ |
| Other (describe): |
SECTION 3 - TYPE & SOURCE OF AI MODELS
Identify the source of AI technology used (check all that apply):
| ⃣ |
| Developed in-house by Contractor |
| ⃣ |
| Provided by a third party |
| ⃣ |
| Open-source model(s) |
| ⃣ |
| Commercial model(s) |
List all AI/ML/GenAI models used within the solution:
| Model Name |
| Version |
| Source/Vendor |
| Licensing |
| Open-Source (Y/N) |
SECTION 4 - MODEL TRAINING & DATA SOURCES
Describe how each AI model was trained, including:
(training methodology, whether pre-trained or proprietary, any fine-tuning applied for the proposed solution.)
List ALL datasets used for model training:
| Dataset Name |
| Origin |
| Ownership |
| Public/Private |
| Synthetic Data Used? |
Did you use Agency data to train, fine-tune, or improve any model?
If “Yes,” provide written documentation of Agency’s express authorization (required).
| Yes: |
| ⃣ |
| No: |
| ⃣ |
SECTION 5 - DATA USAGE & PROTECTIONS
Describe the data inputs used by AI within the solution (types of data, source, ownership):
| Does the AI process any form of PII, PHI, or sensitive information? If yes, describe safeguards: |
| Yes: |
| ⃣ |
| No: |
| ⃣ |
Describe how data is stored, transmitted, anonymized, or protected during AI processing:
Confirm that Agency data will not be shared, repurposed, or added to any training corpus:
| ⃣ |
| Confirmed |
| ⃣ |
| Not Confirmed (explain) |
SECTION 6 - TRANSPARENCY & EXPLAINABILITY
To what extent can the AI model’s decisions be explained or audited?
| ⃣ |
| Full explainability |
| ⃣ |
| Partial explainability |
| ⃣ |
| Limited explainability |
| ⃣ |
| No explainability |
Describe available explainability or audit features, including logs, model outputs, rationale, or traceability:
SECTION 7 - LIMITATIONS, RISKS & BIASES
Identify any known limitations, bias risks, accuracy constraints, or edge cases associated with the AI model(s):
Describe mitigation plans, bias testing methods, or risk management processes:
SECTION 8 - ONGOING AI MONITORING & GOVERNANCE
Describe your ongoing monitoring approach, including performance checks, drift detection, retraining, patching, and compliance with laws/policies:
Identify who is responsible for AI governance and oversight:
SECTION 9 - FUTURE AI UPDATES OR CHANGES
Contractor must notify the Agency at least 60 days in advance of:
(Introduction of any new AI capabilities, updates to existing models, material changes to data sources or usage)
| ⃣ |
| Acknowledged |
| ⃣ |
| Not acknowledged (explain) |
SECTION 10 - CONTRACTOR CERTIFICATION
By signing below, the Contractor certifies that all disclosures provided in this attachment are accurate, complete, and made in good faith. The Contractor further certifies compliance with all requirements outlined in the Agency’s AI Use Disclosure Requirements.
Authorized Representative
Legal Company Name:
Signature:
Printed Name:
Title:
Date:
Artificial Intelligence Use Disclosure Questionnaire Page 1 of 3
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