attachment_15_dgs_pd_526_v2.pdf

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Report the projected contract labor hours for each contract activity for administration, receiving, order processing, order shipping preparation. and transportation to state delivery point (see reverse for additional information). Report all employee labor hours necessary to perform this contract. Do not include labor-free hours (automated processing/storage time, etc.).

Contract Quantity (Total Product

Units) ReceivingAdministration

Number Of Bidder Contract Labor Hours To Be Used For This Contract

Other*

Total Number Of Contract Labor Hours Per PS Type Or Line

Item

Product Type Or Line Item Transportation

Order Shipping

Preparation

Order Processing (pick/pull)

Section II

Section I

SOLICITATION NUMBER AGENCY/DEPT

To be eligible for the bidding preferences, the following data/information must be provided AND signed by the BIDDER. Any person furnishing false certifications, willfully providing false information, omitting information, or failing to comply with the preference requirements is subject to sanctions as set forth in statutes

BIDDER'S SUMMARY

Of Contract Activities and Labor Hours

DATE

I hereby certify under penalty of perjury that the information and labor hours reported on this form are accurate and complete. I understand that any person falsely certifying, willfully providing false information, omitting information, or failing to comply with the preference statutes may be subject to sanctions as set forth in the statutes.

(Employee Labor Hours) Grand Total

BIDDER'S NAME AND TITLE BIDDER'S SIGNATURE

FAX NUMBER

PHONE NUMBER

The "Bidder's Summary" of the contract activity and employee labor hours must be completed and signed by the Bidder. This form must accompany any bid preference request form STD 830 submittal to the designated contracting official at the awarding department.

STATE OF CALIFORNIA

DGS/PD 526

Rev. 0 /20

* EXPLAIN "OTHER" ACTIVITIES OF CONTRACT USED MUST BE DEFINED HERE: (Use additional sheets, if necessary)

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Empty Section III To be eligible the following certification statement must be read and signed by the Bidder.

RFP 24-3003 California Department of Social Services Attachment 15

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Product/Service Type or Line Item:

List the product/service type line item/s as specified on the solicitation. Separate each product/service type to match the line items on the solicitation.

Contract Quantity: List the product/service unit (i.e. # cases, lbs., hours, etc.). Use the same quantity and unit measure as specified in the solicitation.

Hours For This Contract:

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Solicitation Number: Enter the solicitation number identified on the front page of the Invitation For Bid for which this form is being submitted.

Grand Total: List the cumulative employee labor hours for the entire contract period.

Agency/Department:

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Target Area Contract Preferences Act, GC § 4530 et seq.

Section III must be completed and signed by the bidder.

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BIDDER'S SUMMARY

References and Instruction

Section II

The purpose of this section is to capture the bidder’s projected employee/s labor hours to perform this contract. Hours projected should only be those that the bidder itself will use and does not include manufacturing, or any other subcontracted hours.

The California Legislature has declared that it serves a public purpose and is a benefit to the state, to encourage business investment, promote job development, and to facilitate job maintenance in economically distressed areas of the state. It is the intent of the Legislature to further these goals by providing appropriate preferences to California based companies submitting bids or proposals for state contracts to be performed at worksites in economically distressed areas by persons with a high risk of unemployment, when the contract is for goods or services in excess of $100,000. To qualify for TACPA preference, the bidder must show that a minimum 50% (for Goods) or 90% (for Services) contracts of the projected employee/s labor hours necessary for the contract will be performed within the economically distressed area.

Section IIIEnter the name of the buying Agency and/or Department (e.g., State and Consumer Services Agency, Department of General Services)

If the bidder requests TACPA contract preference, GC § 4530 et seq., the Bidder’s Summary form must be completed and signed by the bidder for requested preference. The purpose of this form is to give the state contracting official, a tool to evaluate the total bidder employee labor hours required to complete this contract both inside and outside the preference areas.

Section I

Provide the projected number of employee labor hours to be used by the bidder in the performance of this contract. Hours may include, for example, Administrative, Logistics, Receiving, Warehousing, Shipping, Handling, and/or Other. Do not include labor hours for time the product is stationary.

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RFP 24-3003

California Department of Social Services

Attachment 15