Attachment_1_Proposal_Checklist.docx

Attachment 1 – Proposal Requirement Checklist The purpose of Attachment 1 – Proposal Requirement Checklist is to ensure that the Proposer has adhered to all requirements of this RFP solicitation. This attachment is to be completed, signed, and included with your proposal submission in order to be eligible for evaluation. Failure to include this attachment or adhere to the requirements set forth may result in disqualification.

Attachments with an asterisk (*) next to it indicates that it is required to be submitted with your proposal. Some attachments can be found online. For those attachments, a hyperlink has been provided. Other attachments have been included in this document for Proposers to review and complete.

Letter of Commitment: A Letter of Commitment was submitted by the due date and time identified in the Key Dates Table of this RFP solicitation. The letter included:

· Minimum one (1) page but no more than two (2) pages typed on company letterhead

· Size 12 font for body text. Times New Roman, Arial, or Calibri for typeface.

· The name and address of your organization (NOTE: You may use a Post Office box, but also provide your company’s physical street address for our records)

· The name, title, email, and signature of a company official who has the authority to sign a legal binding contract

· A brief synopsis of your organization’s interest in doing this project

· Confirmation that your company plans to submit a proposal in response to this solicitation

Submission Format: Proposal was submitted in the format requirement below:

Size 12 font for body text. Times New Roman, Arial, or Calibri for typeface.

The pages of the proposal shall include a header in the top righthand corner of each page. The name of the proposer on the top line; the solicitation number on the middle line; and the page count on the bottom line. See the following example:

ABC Consulting Company

RFP #SPPD12345

Proposals must be written from a third person point of view. Do not use first person terminology including, but not limited to: my, I, mine, our, we, we’re, we’ve, us. Instead, be more exact and use specific terms such as [the Governor’s Office of Land Use and Climate Innovation] or [LCI], or the [Proposer’s Name] or [Proposer’s Acronym] to clearly distinguish who it is that is being mentioned.

Proposal was submitted with attachments in the following order:

· Title Page*

· Table of Contents*

· Proof of Minimum Qualifications*

· Personnel Resumes/CVs/Biosketches*

· Attachment 1: Proposal Requirement Checklist*

· Attachment 4: Contractor Scope of Work Response*

· Attachment 5: Contractor Cost Worksheet Response*

· Attachment 6: Proposal Certification Sheet*

· Attachment 7: Proposer References Form*

· Attachment 8: Bidder Declaration GSPD 05-105*

· Attachment 9: DVBE Subcontractor Agreement*, (if applicable)

· Attachment 10: Commercially Useful Function Certification* (if applicable)

· Attachment 11: Payee Data Record STD 204*

· Attachment 12: Contractor Certification Clauses CCC 04/2017*

· Attachment 13: CA Civil Rights Law Certification DGS OLS 04* (if applicable)

· Attachment 14: Darfur Contracting Act Certification DGS PD 1*

· Attachment 15: Iran Contracting Act Certification* (if applicable)

· Attachment 16: DVBE Declaration STD 843* (if applicable)

· Attachment 17: TACPA Preferences Request STD 830* (if applicable)

· Attachment 18: TACPA Manufacturer’s Summary DGS PD 525* (if applicable)

· Attachment 19: TACPA Bidder’s Summary DGS PD 526* (if applicable)

· Attachment 20: Conflict of Interest and Confidentiality Statement*

· Secretary of State Status Verification Printout*

· Franchise Tax Board Status Verification Printout*

· CA Department of Tax and Fee Status Verification Printout*

· Small Business / Disabled Veterans Business Enterprise Certification Printouts*

Title Page*: The purpose of the title page is to provide in one location, information needed by LCI administrative staff. It must contain the following information:

· Request For Proposal Solicitation Number

· Project Name

· Date of Submission

· Proposer Name

· Subcontractor Names, if applicable

· Proposer Address

· Proposer Email

· Proposer Phone

Attachment 1: Proposal Requirement Checklist* This attachment serves as a checklist for proposers to ensure they have completed all the requirements and attachments that are needed to respond to this solicitation.

Attachment 2: Request For Proposals - Notice to Bidders.

This attachment is provided with the RFP solicitation for information only and is not required to be returned with proposals.

N/A

Attachment 3: Draft Standard Agreement This Draft Standard Agreement includes a STD 213 Standard Agreement Form as well as the Exhibits that will be used in the awarded contract.

· STD 213 Standard Agreement Form

· Exhibit A – Scope of Work

· This attachment serves as the scope of work for this solicitation. Its purpose is to identify in detail the services to be provided, tasks, and deliverables that are required of this project.

· Attachment A1 (Awarded Contractor’s Scope of Work Response)

· Exhibit B – Budget Detail and Payment Provisions

· Attachment B1 (Awarded Contractor Cost Worksheet Response)

· Exhibit C – General Terms and Conditions (GTC 04/2017)

· Exhibit D – Special Terms and Conditions

· Exhibit E – Resumes/CVs/Biosketches This attachment is provided with the RFP solicitation for information only and is not required to be returned with proposals.

N/A

Attachment 4: Contractor Scope of Work Response* Attachment 4 serves as the required template to build your proposal in response to this solicitation. Here is where you will identify how you plan to accomplish the goals, tasks, and deliverables identified in the Exhibit A - Scope of Work.

You may add additional sections in the template if necessary. When an award has been made from this solicitation, the awarded Contractor’s response will be made a part of the contract agreement as Attachment A1.

Format:

· Written in the 3rd person point of view

· Size 12 font for body text. Times New Roman, Arial, or Calibri for typeface.

· Includes a header with company name, solicitation number, and page count The Proposal Response identifies all 7 components:

1. Summary

2. Project/Team Management Plan

3. Scope of Work

4. Methodology/Approach to Work

5. Tasks

6. Work Plan

7. Work Schedule/Timeline

Attachment 5: Contractor Cost Worksheet Response* Attachment 5 serves as the required template to build your budget in response to this solicitation. Ensure that all budget categories are accounted for. Note that this template has two worksheets.

When an award has been made from this solicitation, the awarded Contractor’s cost sheet will be made a part of the contract agreement as Attachment B1 – Contractor Cost Worksheet.

Attachment 6: Proposal Certification Sheet* This attachment summarizes the proposer’s information and is required to be submitted as a part of your proposal. An unsigned Proposal Certification Sheet may cause the proposal to be deemed nonresponsive.

Attachment 7: Proposer References Form* This attachment serves as a reference form for LCI staff. LCI may conduct a reference check after the submission deadline has passed. Failure to fully complete and return this attachment may cause your proposal to be rejected and deemed non-responsive.

Attachment 8: Bidder Declaration GSPD 05-105* This attachment serves as a summary of who is working on this project and identifies any certifications that may be held by either the prime proposer or any of its subcontractors. If subcontractors are being used on this project, they must be listed on this document. The Proposer must complete, sign, and submit this attachment with their proposal.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/en/PD/Forms.

Proposal will not be accepted if this required form is not included with the proposal submission.

Failure to fully complete and return this attachment with your proposal will cause your proposal to be rejected and deemed non-responsive.

Attachment 9: DVBE Subcontractor Agreement* (if applicable) This attachment is required to be filled out for each DVBE Subcontractor the proposer will be subcontracting with.

Attachment 10: Commercially Useful Function Certification* (if applicable) This attachment is required to be filled out for each contract and subcontractor(s) that are a certified Small Business, Micro Business, or Disabled Veteran Business-Owned Enterprise (DVBE) to ensure that they meet the CUF requirements under Government Code (GC) 14837(d) (4)(A) (i-v) (for SB) and Military and Veterans Code section 999(b)(5)(B) (i) (I-V) (for DVBE).

After the proposal receipt deadline has concluded, LCI staff will review proposals and conduct an evaluation to ensure that the certified contractor and subcontractor(s) are performing a commercially useful function.

Proposal will not be accepted if this required form is not included with the proposal submission.

Failure to fully complete and return this attachment with your proposal will cause your proposal to be rejected and deemed non-responsive.

Attachment 11: Payee Data Record STD 204* This attachment serves as the standard form to add vendors to the Financial Information System for the State of California to receive payments.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/en/PD/Forms.

Attachment 12: Contractor Certification Clauses CCC 04/2017* This attachment serves as a statement of compliance with the requirements of contractors who are entering into agreements with the State of California.

The form can be obtained via the internet by visiting the following online hyperlink:

Contractor Certification Clauses

Attachment 13: CA Civil Rights Law Certification DGS OLS 04* (if applicable) This attachment serves as a statement of compliance with the California Civil Rights Laws and Employer Discriminatory Policies pursuant to Public Contract Code section 2010. This attachment is required in response to solicitations valued at $100,000 or above. Required if applicable.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/OLS/Forms.

Attachment 14: Darfur Contracting Act Certification DGS PD 1* This attachment serves as a statement of compliance pursuant to Public Contract Code section 10478 when engaging in business activities or other operations outside of the United States.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/en/PD/Forms.

Attachment must be filled out completely and signed if applicable for this project.

Attachment 15: Iran Contracting Act Certification* (if applicable) This attachment serves as a statement of compliance pursuant to Public Contract Code section 2202-2208. This attachment is required in response to solicitations valued at $1,000,000 or above. Required if applicable.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/en/PD/Forms.

Attachment 16: DVBE Declaration STD 843* (if applicable) This attachment serves as the standard form for DVBE declarations. The owner(s) and manager(s) of the DVBE must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, services, or equipment pursuant to Military and Veterans Code Section 999.2. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. Required if applicable.

Attachment must be filled out completely and signed if this form is applicable for this project.

The form can be obtained via the internet by visiting the following online hyperlink:

https://www.dgs.ca.gov/en/PD/Forms.

Attachment 17: TACPA Preferences Request STD 830* (if applicable) Target Area Contract Preference Act (TACPA) preferences are available only if the lowest responsible bid and resulting contract exceeds $100,000. The STD 830 form is the request form for worksite or workforce and will be submitted to the Department of General Services’ Procurement Division for review and approval. Required if applicable.

Attachment must be filled out completely and signed if this form is applicable for this project.

The form can be obtained via the internet by visiting the following online hyperlink:

TACPA Preferences Request

Attachment 18: TACPA Manufacturer’s Summary DGS PD 525* (if applicable) This attachment serves as the Manufacturer’s Summary of Contract Activities and Labor Hours as it relates to the TACPA preference. Proposers claiming the TACPA preference must also fill out and return this DGS PD 525 form. Required if applicable.

Attachment must be filled out completely and signed if this form is applicable for this project.

The form can be obtained via the internet by visiting the following online hyperlink:

MANUFAC Summary Form DGSPD 525 (ca.gov)

Attachment 19: TACPA Bidder’s Summary DGS PD 526* (if applicable) This attachment serves as the Bidder’s Summary of Contract Activities and Labor Hours as it relates to the TACPA preference. Proposers claiming the TACPA preference must also fill out and return this DGS PD 526 form. Required if applicable.

Attachment must be filled out completely and signed if this form is applicable for this project.

The form can be obtained via the internet by visiting the following online hyperlink:

DGS PD 526 (ca.gov)

Attachment 20: Conflict of Interest and Confidentiality Statement* The Proposer must agree to LCI’s conflict of interest clauses and confidentiality requirements by submitting a signed and dated Conflict of Interest and Confidentiality Statement.

This attachment is required to be completed, signed and included with your proposal submission.

Secretary of State Status Verification Printout* The Proposer must be in good standing in order to be qualified to do business in California.

Secretary of State

Franchise Tax Board Status Verification Printout* The Proposer must not be listed as a top 500 with the Franchise Tax Board.

Franchise Tax Board

CA Department of Tax and Fee Status Verification Printout* The Proposer must not be listed as a top 500 with the CA Department of Tax and Fee. Provide a printout of your company’s status.

CDTFA

N/A

SB/DVBE Status Certification Printouts* A printout of the DGS certification for SB or DVBE for the Proposer and each subcontractor.

CaleProcure

Small Business (SB) Participation of 25%* (if applicable) Refer to the Attachment 2 Request For Proposals Notice to Bidders to identify if this RFP solicitation requires a minimum of 25% Small Business Participation.

Disabled Veterans Business Enterprise (DVBE) Participation of 3%* (if applicable) Refer to the Attachment 2 Request For Proposals Notice to Bidders to identify if this RFP solicitation requires a minimum of 3% DVBE Participation.

By signing below, I certify that the above is true and accurate.

RFP Solicitation #:

Organization Name:

Print Name / Title:

Phone:

E-mail:

Signature:

Attachment 1 – Proposal Requirement Checklist

ATTACHMENT 6: PROPOSAL CERTIFICATION SHEET

Only an individual who is authorized to contractually bind the proposing firm shall sign the Proposal Certification Sheet. The signature must indicate the title or position that the individual holds in the firm. This Proposal Certification Sheet must be signed and returned along with all “required attachments” as an entire package with signatures. The proposal must be submitted in accordance with the instructions for this solicitation.

An Unsigned Proposal Certification Sheet may cause the proposal to be deemed nonresponsive

4. Address

Type of organization:

5. ☐ Sole proprietorship

8. ☐ Limited Liability Company

6. ☐ Partnership

9. ☐ Other:

7. ☐ Corporation

12. Indicate applicable license and/or certification information:

17. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as:

a. Small Business Enterprise Yes ☐ No ☐

b. Disabled Veteran Business Enterprise Yes ☐ No ☐

A copy of your Certification is required to be included if either of the above items is checked “Yes”.

Date application was submitted to OSDS, if an application is pending: __________________

THE REMAINDER OF THIS PAGE WAS INTENTIONALLY LEFT BLANK

ATTACHMENT 7: PROPOSER REFERENCES FORM

Submission of this form is mandatory. Failure to complete and return this attachment with your proposal may cause your proposal to be rejected and deemed non-responsive. By furnishing the references, the proposer authorizes the State to contact the named company, person or entity to discuss the Contractor’s past performance.

Complete the below table listing information for three references that can speak to how the Proposer could fulfill the goals of the program.

REFERENCE 1

Name of Firm:

E-Mail:

Brief Description of Service Provided

REFERENCE 2

Name of Firm:

E-Mail:

Brief Description of Service Provided

REFERENCE 3

Name of Firm:

E-Mail:

Brief Description of Service Provided

ATTACHMENT 9: DVBE SUBCONTRACTOR AGREEMENT

PART A: NAMED PARTIES

This Agreement is entered into between Contractor: ____________________________, hereinafter (Contractor Name) referred to as Proposer, and DVBE subcontractor: _______________________________________________, (DVBE Subcontractor Name) hereinafter referred to as Subcontractor, on: ___________________, consisting of the following conditions:

(Date)

1) Proposer has proposed or intends to submit a proposal on a solicitation issued by the State of California, Governor’s Office of Land Use and Climate Innovation, hereinafter referred to as LCI. LCI will enter into a contract (the primary agreement) with the Proposer if the Proposer is awarded the contract.

2) Proposer has proposed the Subcontractor as a disabled veteran business enterprise subcontractor in the proposal; and Proposer intends to employ the subcontractor to perform certain work or services under the primary agreement if the Proposer is awarded contract agreement from LCI.

3) Subcontractor intends to provide certain work or services or products/goods under the primary agreement if the contract is awarded to the Proposer.

PART B: AGREEMENT

LCI requires the Proposer to provide, prior to the contract award, a written agreement signed by the Proposer and each disabled veteran business enterprise subcontractor proposed by the Proposer in the proposal submitted to LCI, to include certain terms and conditions specified below. These written agreements shall become null and void if the Proposer is not awarded a contract as result of this proposal request.

Proposer and the Subcontractor agree that, in the event LCI awards the primary agreement to the Proposer, the Proposer will employ the Subcontractor to provide goods and/or services in accordance with the following terms and conditions:

1) The term of this Agreement is: _______________________________________. The parties estimate that the goods and/or services will be provided/performed by the Subcontractor within the contract term.

2) The parties estimate that the goods and/or services will be provided/performed by the Subcontractor commencing on: ____________ and completed by: ___________________

3) The rate and conditions of payment by the Bidder to the Subcontractor are: _______________________________________________________________

4) The percentage of the entire primary contract to be awarded to the Subcontractor is: _____%.

(Must commit at least 3% of the entire bid amount unless otherwise specified within the solicitation.)

5) Description of services and/or goods to be performed/supplied by the DVBE Subcontractor:

(Attach Additional Sheets If Necessary) This Agreement has been executed by the parties identified below:

DVBE PROGRAM REQURIEMENTS SUPPLIER CHECKLIST

Please do not submit this checklist with your proposal. It is provided for your use only. Checking every box of your elected compliance option does not guarantee that your proposal will be evaluated compliant.

☐ Attachment 8 – Bidder Declaration

☐ Attachment 10 – CUF Certification Note: This is applicable if you are a certified DVBE bidder or subcontractor

☐ Attachment 16 – DVBE Declaration (STD 843) Note: This is applicable if you are a certified DVBE bidder or subcontractor

☐ Attached completed DVBE Subcontractor Agreement(s) Note This is only applicable if you intend to utilize a DVBE subcontractor

☐ Provide proof of DVBE certification for each DVBE identified via a printout from the DGS/OSDS Cal eProcure website.

ATTACHMENT 10: COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION

THE BIDDER MUST COMPLETE AND SUBMIT WITH ITS PROPOSAL.

(submit one form for each SB/DVBE (prime and/or subcontractor(s))

Mark all that apply:

☐ DVBE

☐ Small Business or Micro Business ☐ N/A Mark all that apply:

☐ DVBE

☐ Small Business or Micro Business ☐ N/A

All certified small business (SB), micro business (MB), and/or DVBE Contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code Section 14837 (for SB), Military and Veterans Code Section 999 (for DVBE), and Title II California Code of Regulations, Section 1896.4 and 1896.62.

Answer questions 1-5 below, as they apply to your company for the goods and/or services being acquired in this solicitation. A California certified SB, MB, or DVBE business must be deemed to perform a Commercially Useful Function (CUF) by meeting ALL of the following CUF requirements for Contract award consideration.

☐N/A

If the answer to any of the five (5) questions is “NO” (except for #4 when marked with “N/ A”), may result in your proposal being deemed non-responsive.

The Bidder must provide a written statement below detailing the role, services, and goods the subcontractor(s) will provide to meet the commercially useful function requirement. If the Bidder is not claiming a SB or DVBE, indicate “Not claiming a preference” in the box below.

Written Statement or Statement of No Claim

At the State’s option prior to award, the Bidder may be required to submit additional written clarifying information. By signing this form, the undersigned Bidder certifies that the Certified Small Business or DVBE satisfies the Commercially Useful Function requirement, and will provide the role, services, and/or goods stated above.

Bidder Signature

Bidder Printed/Typed Name and Title

ATTACHMENT 20: CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT

As an authorized representative or corporate officer of the company name below, I have the authority to bind the company contractually, and I agree that all persons employed by this company will adhere to the following policy:

All information belonging to the Governor’s Office of Land Use and Climate Innovation (LCI) or its affiliated agencies is considered sensitive and confidential and cannot be disclosed to any person or entity that is not directly approved to participate in the work required to execute this Agreement.

I certify that I has no personal or financial interest and no present or past employment or activity which would be incompatible with my participation in any activity related to the planning or procurement processes for the project or procurement. I agree that no gift, benefit, gratuity or consideration will be accepted and there is no personal or financial interest, or association initiated on a project or procurement.

I certify that I will keep all project information including (but not limited to) information concerning the planning, processes, development or procedures of the project, and all communication with LCI or its affiliates related to any procurement process, confidential and secure. I will not copy, give or otherwise disclose such information to any other person unless LCI has on file a Conflict of Interest and Confidentiality Statement signed by the other person(s), and the disclosure is authorized and necessary for the project. I understand that the information to be kept confidential includes, but is not limited to, specifications, administrative requirements, terms and conditions, concepts and discussions, as well as written and electronic materials. I further understand that if I leave this project before it ends, I must still keep all project information confidential. I agree to follow any instructions provided by the project relating to the confidentiality of project information.

I fully understand that any unauthorized disclosure I make may be basis for civil and/or criminal penalties. I agree to advise the Contract Manager immediately in the event of an unauthorized disclosure, inappropriate access, misuse, theft or loss of data.

I warrant that if my company is awarded the Contract, it will not enter into any agreements or discussions with a third party concerning such materials prior to receiving written confirmation from LCI that such third party has an agreement with the State similar in nature to this one. All materials provided for this project, except where explicitly stated will be promptly returned or destroyed, as instructed by an authorized LCI representative. If the materials are destroyed and not returned, a letter attesting to their complete destruction, which documents the destruction procedures, must be sent to the Contract Manager before payment can be made for services rendered. In addition, all copies or derivations, including any working or archival backups of the information, will be physically and/or electronically destroyed within five (5) calendar days immediately following either the end of the Contract period or the final payment, as determined by the Contract Manager.

All personnel assigned to this project shall be provided a Conflict of Interest and Confidentiality Statement and will be expected to sign and return it to the Contract Manager before beginning work on this project.

Representative Name / Title:

Company Name:

Address:

Telephone / Fax Number:

Email Address:

Signature/Date: