Attachment 4 - SEI Certification.docx

DOCX document 46 KB Posted

Attached to
RFP 2025-19 Microsoft 365 and Related Cloud Services Development, Administration, and Support
Solicitation number
0000039683
Issued by
California

About this file

This is a Small Disadvantaged Business (SDB) and Emerging Small Business (ESB) Certification document for Covered California's RFP 2025-19 regarding Microsoft 365 and Related Cloud Services Development, Administration, and Support. The attachment serves as a certification form that proposers must complete to demonstrate their eligibility status as either a state-certified small disadvantaged business or emerging small business. The document requires applicants to provide documentation of their current certification from the California Department of General Services and includes attestations regarding the applicant's ownership structure, control, and operational status in compliance with state certification requirements. This certification is a mandatory submission requirement for proposers seeking consideration under small business set-asides or preferences associated with the solicitation.

The certification document does not contain pricing information, contract terms, or specific project requirements, as it functions solely as a verification mechanism for qualifying proposers. Proposers claiming SDB or ESB status must attach current and valid certification documentation as evidence of their eligible status. Failure to provide complete and accurate certification documentation may result in the proposer being deemed ineligible for any small business preferences or set-asides that may apply to this Microsoft 365 services contract opportunity with Covered California.

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Text version

Covered California RFP 2025-17 Health Program Consulting Pool California Health Benefit Exchange Budget Detail

ATTACHMENT 4 – STATEMENT OF ECONOMIC INTERESTS CERTIFICATION

In order to be deemed responsive, the Proposer must enter its information below where indicated with brackets and provide an authorized signature for certification.

[Month XX, 2026]

[Proposer Organization Name] [Address] [City, State Zip]

Covered California Attention: Miranda Wilson 1601 Exposition Blvd.

Sacramento, CA 95815

Upon award of the contract, [Proposer Organization Name] agrees to provide a completed Title 10, California Code of Regulations, Chapter 12, Article 1, Statement of Economic Interests (Form 700), if required.

[Proposer Representative Name]

File details come from the government source that posted it. Updated .