Attachment_14_-_Commercially_Useful_Function.pdf

California Department of Aging RFO Number: RFO-2526-04 MSSP – Organizational Change Management

ATTACHMENT 14

COMMERCIALLY USEFUL FUNCTION (CUF)

All new and renewing Small Business (SB) and Disabled Veteran Business Enterprise (DVBE) applicants must include this completed Commercially Useful Function (CUF) Certification with their submittal.

All certified Small Business, Microbusiness, and/or DVBE contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code § 14837(d)(4) (for SB) and/or Military and Veterans Code § 999(b)(5)(B) (for

DVBE).

Please answer the following questions, as they apply to your company for goods and services being acquired in this RFO.

Respondent Name: _____________________________________________________

Subcontractor Name (submit one form for each SB/DVBE prime and/or subcontractor(s)): ______________________________________________________

Mark all the apply: ___ DVBE ___ Small Business ___ Micro Business

1. A. The Respondent has indicated on the Bidder Declaration form1 (GSPD-05-105 or GSPD-05- 106) or within the Confirmation Letter/Form (signed by the Respondent and the subcontractor) that the following goods and/or services will be provided by the SB or DVBE company in relation to the scope of work (e.g.

training, transportation, installation, ordering, delivery, etc.).

B. Are the goods/services the Respondent is providing described in the scope of work and/or considered to be distinct elements of the contract work?

___ Yes ___ No

2. On the Bidder Declaration form (GSPD-05-105 or GSPD- 05-106) or within the Confirmation Letter/Form (signed by the prime and the subcontractor) does the Respondent commit to its obligation to actually performing, managing, and/or supervising the work?

___ Yes ___ No

3. Describe the supporting documentation either provided by the Respondent (Bidder’s Declaration, Confirmation Letter/Form, STD. Form 843) or from additional research (certifications, resumes, UNSPSC, website, marketing research, etc.) below that supports the Respondent is performing work that is normal for its business services and functions (Attach supporting documents).

Based on the information above, do the goods/services listed in question #1 appear to be consistent with this Respondent’s normal activities?

___ Yes ___ No

4. A. If this is a SERVICE with NO goods involved, check N/A and go to #5. If Goods are involved, proceed to b).

B. Will the Respondent provide products, inventories, materials and supplies required for the contract as well as perform ALL of the following duties related to the distinct element of work as stated in question #1?

1) Negotiating price

2) Determining quality and quantity

3) Ordering

4) Making payment

5) Installing (if applicable)

___ Yes ___ No

5. A. Is this Respondent a Prime performing all of the work?

If “Yes”, check the box and complete determine compliance. If “No”, proceed to question b)

B. Based on the percentage of goods or services that will be subcontracted as stated on the Bidders Declaration and/or Confirmation Letter/Form, is this amount normal per industry standards?

___ Yes ___ No

The Respondent must provide a written statement below detailing the role, services and goods the subcontractor(s) will provide to meet the commercially useful function requirement. At the State’s option prior to award, Respondents may be required to submit additional written clarifying information.

By signing this form, the undersigned Respondent 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.

Respondent Signature: ___________________________________________________

Respondent Printed/Typed Name and Title: __________________________________