Attachements_C5603-119715_PEP.pdf

ATTACHMENT 1

BID SUBMISSION ATTACHMENT CHECKLIST

SB OPTION COMPETITIVE

A complete bid submission will consist of the items identified below. Complete this checklist to confirm the items in your bid. Place a check mark or “X” next to each item that you are submitting to the State. For your bid to be responsive, all required attachments must be returned. This checklist should be returned with your bid submission.

Attachment Required Attachment Name/Description

Attachment 1 YES Bid Submission Attachment Checklist

Attachment 2 YES Bidder Declaration

Attachment 3 YES Payee Data Record

Attachment 4 YES Contractors Certification Clause

Attachment 5 YES Darfur

Attachment 6 YES California Civil Rights Laws Attachment

Attachment 7 YES Proof of Insurance

Attachment 8 YES Cost Sheet (Exhibit B – Attachment 1)

Attachment 9 YES Bid Form

Attachment 10 YES Non-Collusion Affidavit

ATTACHMENT 2

BIDDER DECLARATION

A Bidder must complete the Bidder Declaration form GSPD-05-105, located at the following internet site: http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05- 105.pdf

If you do not have Internet access, a hard copy can be provided by contacting the Acquisition Analyst listed on the Notice to Prospective Bidders.

When completing the declaration, Bidders must identify all subcontractors proposed for participation in the contract. Bidders awarded a contract are contractually obligated to use the subcontractors for the corresponding work identified unless the State agrees to a substitution and it is incorporated by amendment to the contract.

The completed Bidder Declaration GSPD-05-105 must be included in the bid submission, noted as Attachment 2.

http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf

ATTACHMENT 3

PAYEE DATA RECORD

A Bidder must complete the Payee Data Record form STD 204, located at the following internet site:

http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf .

If you do not have Internet access, a hard copy can be provided by contacting the Acquisition Analyst listed on the Notice to Prospective Bidders.

The completed Payee Data Record STD 204 must be included in the bid submission, noted as Attachment 3.

Additional Remittance Address Information

PAYEE DATA RECORD SUPPLEMENT

If contractor obtains multiple active remittance address locations, a payee data record supplement STD 205 is required. Email the contract analyst for the form.

http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

ATTACHMENT 4

CONTRACTORS CERTIFICIATION CLAUSE

CERTIFICATION

I, the official named below, certify under penalty of perjury that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the state of California.

Contractor/Bidder Firm Name (Printed) Federal ID Number (must match STD 204)

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the Country of

CONTRACTOR CERTIFICATION CLAUSES

STATEMENT OF COMPLIANCE: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions:

a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations.

b. Establish a Drug-Free Awareness Program to inform employees about:

a. The dangers of drug abuse in the workplace;

b. The person’s or organized policy of maintaining a drug-free workplace;

c. Any available counseling, rehabilitation and employee assistance programs; and

d. Penalties that may be imposed upon employees for drug abuse violations.

c. Provide that every employee who works on the proposed agreement will:

a. Receive a copy of the company’s drug-free policy statement; and,

b. Agree to abide by the terms of the company’s statement as a condition of employment on the agreement.

Failure to comply with these requirements may result in suspension of payments under the agreement or termination of the agreement or both and contractor may be ineligible for award of any future State agreement if the department determines that any of the following has occurred: (1) the contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (GC 8350 et seq.)

NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one

(1) final unappealable finding of contempt of court by a Federal court has been issued against contractor within the immediately preceding two-year period because of the contractor’s failure to comply with an order of a Federal court which orders contractor to comply within a order of the National Labor Relations Board. (PCC 10296) (Not applicable to public entities)

CONTRACTOR FOR LEGAL SERVICES $50,000 OR MORE PRO BONO REQUIREMENT: Contractor hereby certifies that contractor will comply with the requirements Section 6072 of the Business and Professions Code, effective January 1, 2003.

Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State.

Failure to make a good faith effort may be cause for non-renewal of the a state contract for legal services, and may be taken into account when determining the award of future contracts with the State of legal services.

EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of the Public Contract Code (PCC) Section 10286 and 10286.1, and is eligible to contract with the State of California.

SWEATFREE CODE OF CONDUCT:

a. All contractors contracting for the procurement or laundering of apparel, garments, or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no procurement points underlined in this section have been laundered or produced in whole or in party by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov , and public Contract Code Section 6108.

b. The contractor agrees to cooperate fully in providing reasonable access to the contractor’s records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor’s compliance with the requirements under paragraph (a).

DOMESTIC PARTNERS: For contracts executed or amended after July 1, 2004, the contractor may elect to offer domestic partner benefits to the contractor’s employees in accordance with Public Contract Code section 10295.3. However, the contractor cannot require an employee to cover the costs of providing any benefits which have otherwise been provided to all employee regardless of marital or domestic partner status.

DOING BUSINESS WITH THE STATE OF CALIFORNIA

The following laws apply to persons or entities doing business with the State of California.

CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If contractor has any questions on the status of any person rendering services or involved with the agreement, the awarding agency must be contacted immediately for clarification.

a. Current State Employees (PCC 10410):

a. No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment.

http://www.dir.ca.gov/

b. No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services.

b. Former State Employees (PCC 10411):

a. For the 2-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision making process relevant to the contract while employed in any capacity by any state agency.

b. For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service.

If contractor violates any provisions of above paragraphs, such action by contractor shall render this agreement void. (PCC 10420)

Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of board or commission, payment for preparatory time and payment for per diem. (PCC 10430 (e))

LABOR CODE/WORKER’S COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker’s Compensation or to undertake self-insurance provisions before commencing the performance of the work of this agreement. (Labor Code Section 3700)

AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)

CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor’s name as listed on this agreement. Upon receipt of legal documentation of the name change, the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.

CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:

a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled.

b. “Doing business” is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial to pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax.

c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State.

RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement.

AIR OR WATER POLLUTION VIOLATION:

Under the State laws, the contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge prohibitions; or (3) finally determined to be in violation or provisions of federal law relating to air or water pollution.

PAYEE DATA RECORD FORM STD.204: This form must be completed by all contractors that are not another state agency or other government entity.

ATTACHMENT 5

DARFUR CONTRACTING ACT

Bidder must complete and submit the Darfur Contracting Act Certification with their bid submission as Attachment 6.

Effective January 1, 2009, a company will not bid on or submit a proposal for a contract for goods or services without addressing the requirements of the Darfur Contracting Act of 2008 (Act). The Act was passed to preclude State agencies generally from contracting with “scrutinized” companies that do business in the African nation of Sudan (of which the Darfur region is a part). Understand that a scrutinized company is a company doing business in Sudan as defined in Public Contract Code Section 10476. Scrutinized companies are ineligible to, and cannot, bid on or submit a proposal for a contract with a State agency for goods or services unless it has been granted permission by the Department of General Services. (Pub.

Contract Code § 10477, sub. (a)). The Department of General Services 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 interest of the State.

Public Contract Code Sections 10475-10481, applies to any company that currently or within the previous three (3) 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:

1. A contractor that has NOT had business activities or other operations outside of the United

States within the previous three (3) years;

or

2. A contractor that has had business activities or other operations outside of the United

States within the previous three (3) years, but is NOT a scrutinized company per Public Contract Code section 10476;

or

3. A contractor that is a scrutinized company as defined in Public Contract Code section 10476, but has received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477, subdivision (b).

Darfur Contracting Act Certification

1. I, the official named below who is authorized to legally bind the bid submission, Certify under Penalty of Perjury that the contractor listed below has NOT had, within the previous three (3) years, business activities or other operations outside of the United States.

Contractor/ Company Name (Printed) Federal ID Number

Printed Name and Title of Person Signing

2. I, the official named below who is authorized to legally bind the bid submission, Certify Under Penalty of Perjury that the contractor listed below has had, within the previous three (3) years, business activities or other operations outside of the United States, but is NOT a scrutinized company per Public Contract Code section 10476. This certification is made under the laws of the State of California.

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

OR

3. We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to public Contract Code section 10477, subdivision (b). A copy of the written permission from DGS is included with our bid submission.

ATTACHMENT 6

STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES

CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT OFFICE OF LEGAL SERVICES

DGS OLS 04 (Rev. 01/17)

Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or otherwise proposes to enter into or renew a contract with, a state agency with respect to any contract in the amount of $100,000 or above shall certify, under penalty of perjury, at the time the bid or proposal is submitted or the contract is renewed, all of the following:

1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed 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 executed or renewed 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

Executed in the County of Executed in the State of

Date Executed

ATTACHMENT 7

PROOF OF INSURANCE

A Bidder must submit current proof of insurance as Attachment 8 for the following:

• General Liability

• Commercial Automobile Insurance

• Worker’s Compensation

A certificate of insurance (COI) may be provided as proof of insurance. The COI and/or proof of insurance documents will be named Attachment 6 and be submitted with the bid submission. Endorsements to insurance policies are not required for bid submission.

Contact your insurance representative to ensure your insurance program satisfies the requirements of the sample contract, prior to bidding.

ATTACHMENT 8

BID-COST SHEET

Cost per Physical: $ __________________________

Includes cost of insurance, sales tax, and every other item of expense, direct or indirect, incidental to the Bid price.

The contract will be awarded based on the lowest cost per physicals

ATTACHMENT 9

BID FORM

EMAIL TO: Mujib.Sultani@ccc.ca.gov BEFORE 2:00 P.M., 08 07, 2025

FOR: CALIFORNIA CONSERVATION CORPS

CCC Los Padres Center, Pre-Enrollment Physicals Services PROJECT Location: 1530 Madera Ave, San Luis Obispo, CA 93401

CONTRACT #C5603-119715

Within the email subject line: enter "Bid For”; followed by the above title and Project Number.

The undersigned hereby proposes and agrees to furnish all labor, materials, and equipment, and to perform all work required for the above-named Project in the manner and time prescribed in the Drawings and Project Manual, dated April 2022 and such addenda thereto as may be issued prior to bid opening date and in accordance with prevailing wage rates ascertained by the Department of Industrial Relations and set forth on the DIR web site (Prevailing Wage Requirements) for General Prevailing Wage Rates as determined by the February 2023 DIR prevailing wage published rates. The Bid Price, set forth below in clear legible figures, includes the cost of Bonds, insurance, sales tax, and every other item of expense, direct or indirect, incidental to the Bid Price.

SEE ATTACHMENT 8 OF BID PACKET TO COMPLETE COST SHEET

IMPORTANT – READ BEFORE SIGNING: Bid Form must be executed in same name-style in which the bidder is licensed. Bidder bidding jointly or as a combination of several business organizations is specifically cautioned that such bidder must be jointly licensed in the same form and style in which the bid is executed. If making a bid as a joint venture, each person submitting the bid shall provide the information required below with respect to their licensure. The undersigned Bidder certifies and agrees to provide the information and comply with the requirements contained in Articles of Article 2; Article 4, Paragraph 4.2;Article 7and Article 9, Paragraph 9.2.1are true.

Legal Name of Bidder:________________________ Federal I.D No.:_____________

Contractor’s License No.:

License Expiration Date:

Licensee Classification:

THE STATE OF CALIFORNIA

CALIFORNIA CONSERVATION CORPS

BUSINESS SERVICES AND CONTRACTS

FROM: _____________________________

(Name of Bidding Firm)

Contractor’s Public Works Registration No. (Dept. of Industrial Relations): ________________ mailto:Mujib.Sultani@ccc.ca.gov

Business Address: ______________________________________________________ (Street and/or P.O Box) (City) (State) (Zip)

E-Mail Address: ________________________________________________________

Business Phone No.: ______________________ Facsimile No.:___________________

SIGN HERE ----à ________________________________________________

Signature of Bidder

Print Name and Title of Bidder

ATTACHMENT 10

NON-COLLUSION AFFIDAVIT

NONCOLLUSION DECLARATION TO BE EXECUTED BY BIDDER AND SUBMITTED

WITH BID

The undersigned declares:

I am the of , the party making the forgoing bid.

The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived or agreed with any bidder or anyone else to put in a sham bid, or refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on

[date], at

[city], [state].”

[Signature]