attachment_12_-_california_civil_rights_law_certification.pdf
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- Solicitation number
- 0000040419
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- California
About this file
This is a California Civil Rights Laws Certification form required by the California Department of General Services, Office of Legal Services, for the California Department of Social Services RFP 27-3001 regarding a Workers Compensation Third Party Administrator contract. The certification form applies to any bid or proposal submitted for state contracts valued at $100,000 or above. Bidders and proposers must certify under penalty of perjury at the time of bid or proposal submission, or upon contract renewal, compliance with two primary requirements: adherence to the Unruh Civil Rights Act (California Civil Code Section 51) and the Fair Employment and Housing Act (California Government Code Section 12960), both effective for contracts executed or renewed after January 1, 2017.
The form requires the authorized representative of the proposing firm to execute the certification by providing their signature, printed name, title, the county and state where the document is executed, execution date, the firm name, and federal identification number. Additionally, contractors must certify that any internal policies regarding sovereign nations or peoples recognized by the United States government are not being applied in violation of either the Unruh Civil Rights Act or the Fair Employment and Housing Act. Failure to provide this certification as part of the bid submission may result in disqualification from the procurement process.
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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.
By (Authorized Signature)
Printed Name and Title of Person Signing
Executed in the County of Executed in the State of
Date Executed
Proposer/Bidder Firm Name (Printed) Federal ID Number
RFP 27-3001
California Department of Social Services
STATE OF CALIFORNIA
Attachment 12
| ProposerBidder Firm Name Printed: |
| Federal ID Number: |
| Printed Name and Title of Person Signing: |
| Executed in the County of: |
| Executed in the State of: |
| mm/dd/yyyy: |
| Signature: |
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