BID_DOC.pdf

SECTION F COVER SHEET 12/5/17

Section F

Attachments; Required Bid Documents For Bidding Purposes

INVITATION FOR BID NO. P2499012

MITIGATION PUMP REPAIR

AT

HONEY LAKE WILDLIFE AREA

LASSEN COUNTY, CALIFORNIA

3/19/2020

SECTION F

ATTACHMENT 1

REQUIRED ATTACHMENT CHECK LIST

A complete bid or bid package will consist of the items identified below.

Complete this checklist to confirm the items in your bid. Place a check mark or “X” next to each item that you are submitting to the State. For your bid to be responsive, all attachments must be completed and returned. This checklist shall be returned with your bid package also.

Attachment Attachment Name/Description Page #

Attachment 1 Required Attachment Check List ……………………………………...1

Attachment 2 Bid/Bidder Certification Sheet (Signed) ..................................... 2 - 3 Instructions**

Attachment 3 Bid Form (Cost Sheet)

Attachment 4 List of Proposed Subcontractors

Attachment 5 Bidder’s Prevailing Wage Requirement Attachment 6 Payee Data Record (STD 204) (Signed)

Instructions Attachment 7 Non-Collusion Declaration Attachment 8 Darfur Contracting Act (Signed) Attachment 9 California Public Contract Code Section10162 (Signed)

Attachment 10 Contractor Certification Clauses (CCC 04/2017) (Signed) ...... 13-16 Attachment 11 Surface Mining & Reclamation Act Certification Form

(Signed)

Attachment 12 Small Business Subcontractor Participation Worksheet

Attachment 13 Bidder Declaration Form GSPD-05-106 .................................. 19-21 The Bidder Declaration Form (GSPD-05-106) must be completed by the Prime Contractor. This form is used to document all DVBE Sub-contractors, vendors, and suppliers that are performing part of the work. DVBE must be listed on the GSPD-05-106.

Attachment 14 DVBE Declaration Use Form (STD 843) (Signed)

Attachment 15 Bidder’s Bond (Signed & Notarized)

Attachment 16 California Civil Rights Laws Attachment (Signed) (Bids over $ 90,000.00)

Attachment 17 GenAI Disclosure & Factsheet (Signed) .................................. 25-28

** Instruction and Information Sheets do not need to be returned with sealed bid, only attached forms as required.

ATTACHMENT 2

BID/BIDDER CERTIFICATION SHEET

This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as an entire package with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.

Please return only required attachments (Section F) when submitting bid.

A. Our all-inclusive bid is submitted as detailed in Attachment 3, BID FORM (Cost Sheet).

B. All required attachments are included with this certification sheet.

C. I have read and understand the DVBE participation requirements and have included documentation demonstrating that I have met the participation goals.

D. The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification.

An Unsigned Bid/Bidder Certification Sheet May Be Cause For Rejection

1. Company Name 2. Telephone Number 2a. Fax Number

3a. Address 3b. E-mail address:

Indicate your organization type: Social Security Number:

4. Individual Or Sole Proprietor

5. Partnership Federal Employer Identification Number (FEIN):

6. Corporation Federal Employer Identification Number (FEIN)

California Corporation Number:

7a. Indicate applicable license classification(s):

7b. CSLB License Number:

7c. DIR Number:

8. Bidder’s Name (Print) 9. Title

10. Signature (Required) 11. Date

12. Are you certified with the DGS, Office of Small Business or Requesting Non-Small Business Preference:

a. California Certified Small Business

Yes No

If yes, enter OSDS reference # and indicate if Small Business or Micro Business

b. California Certified Disabled Veteran Business Enterprise.

If yes, enter OSDS reference #

# SB or MB #

b. Non-Small Business Sub-Contracting 25% to California Certified Small Business.

If Yes, Complete Attachment 12

NOTE: A copy of your Certification is required to be included if a or b above is checked “Yes”.

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

13. Mandatory DVBE Participation (minimum 3%): Requirements documented on Bidder Declaration Form GSPD-05-106:

Name of Certified DVBE: __________________________________

DVBE Certification No: ___________________________________

Percent DVBE Participation*: % ____________

Contract Amount DVBE Participation: $ ___________

Document Verified By CDFW Engineer:

The DVBE Participation Percentage * shall be based on Total Bid Amount and/or any Additives.

ATTACHMENT 2

Completion Instructions for Bid/Bidder Certification Sheet

Complete the numbered items on the Bid/Bidder Certification Sheet by following the instructions below.

Item Numbers

Instructions

1, 2, 2a, 3

Must be completed. These items are self-explanatory.

Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business.

Enter Social Security Number.

Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit.

Enter Federal Employer Identification Number (FEIN).

Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.

Enter Federal Employer Identification Number (FEIN) & California Corporation Number.

Complete by indicating the type of license classification that is required for the type of construction, CSLB License Number, and DIR Number that your firm possesses. (Mandatory)

8, 9, 10, 11

Must be completed. These items are self-explanatory.

If certified as a California Small Business and/or DVBE, place a check in the "Yes" boxes, and enter your certification numbers on the line. If requesting non-small business preference utilizing 25% California Small Business, check the “yes” box and complete Attachment 12. If your certification is pending, enter the date your application was submitted to OSDS.

Enter the actual DVBE Participation Percentage shown on GSPD-05-106 (Attachment 13)

1/13/2020

ATTACHMENT 3 – BID FORM (Cost Sheet)

Having become completely familiar with all conditions affecting the cost of the work at the place where the work is to be done, and with the drawings, these special provisions, the Standard Specifications, and other contract documents prepared and issued therefore, the Contractor hereby proposes and agrees to perform everything required to be performed, and to include as well as furnish all labor, tools, equipment, materials, permits and taxes necessary to replace a mitigation pump and other miscellaneous improvements at Honey Lake Wildlife Area, Lassen County, California.

All work is to be complete in place, in strict accordance with these specifications, and as shown on the California Department of Fish and Wildlife Drawing No: W04-2024-001 Dated: 9/24/2024 Sheet(s): One (1) and the undersigned proposes and agrees that he/she will take in full payment therefore, the following unit prices, to with:

Item No.

Approx.

Quantity Items of Work Description Unit Price Item

Total

1. 1 Job Replace Mitigation Pump Lump Sum $

2. 1 Job Contingencies (See Below) As Determined by the Engineer

Lump Sum $ N/A

TOTAL BID #1: Sum of Item 1 and 2 $

Contingencies may or may not be added to the project. Actual Percentage Amount shall be determined at time of Contract Award and may be from zero to 10 percent as determined by the Engineer.

In case of a discrepancy between unit prices and item totals, the unit price shall prevail, however, if the amount set forth as a unit price is ambiguous, unintelligible or uncertain for any cause, or is omitted, the amount set forth in the “Item Total” column shall be divided by the quantity for the item and the price thus obtained shall be the unit price. In case of a discrepancy between item totals and bid total, the item totals shall prevail.

In the case of a tie bid, the determination of a successful bidder will be made by a coin toss in the presence of all interested bidders, at a time and date set by the “State."

The award, if there is an award, will be made on the basis of the Total Bid #1 indicated above.

ADDENDUM ACKNOWLEDGMENTS

Addendum # Date Received By

1.

2.

ATTACHMENT 4

LIST OF PROPOSED SUBCONTRACTORS

List below the name and business address of each subcontractor who will perform work or labor or render service in an amount in excess of one-half of one percent of the General Contractor's total bid, and the portion of work to be done by each subcontractor. (See Public Contract Code sections 4100-4114, inclusive.) Material Vendors are not required.

NOTE: In case more than one subcontractor is named for the same category of work, state the portion that each will perform. Include additional sheets if required.

SUBCONTRACTOR NAME

PORTION/DESCRIPTION OF WORK

ADDRESS CITY

STATE ZIP CODE

CSLB LICENSE

NUMBER

DIR NUMBER SMALL BUSINESS

CLASS EXPIRATION DATE DOLLAR AMOUNT

PERCENTAGE OF TOTAL BID PRICE

CLASSIFICATION EXPIRATION DATE DOLLAR AMOUNT

CLASSIFICATION EXPIRATION DATE DOLLAR AMOUNT

Subcontractor(s) must be registered with Department of Industrial Relations (DIR) and with Contractors State License Board (CSLB).

VERIFICATION OF CERTIFICATION NUMBERS:

CSLB LICENSE, DIR AND SMALL BUSINESS

VERIFIED BY CDFW ENGINEER:

COUNTY

COUNTY

COUNTY

ATTACHMENT 5

BIDDER’S ACKNOWLEDGEMENT OF PREVAILING WAGE REQUIREMENTS

Authorize Bidder’s Signature

Print Name of Company __________________________ acknowledges that State General Prevailing Wage Rates will apply for the County of Lassen, California. If awarded this Agreement, I, ______________________ acknowledge it will be my responsibility to ensure the payment Authorize Representative

(Print Name) of appropriate prevailing wages rates to all employees who participate on this Agreement throughout the duration of this Agreement.

Fish and Wildlife Wildlife and Fisheries Division/Facilities Engineering

1010 Riverside Parkway

West Sacramento 95605 scott.murata@wildlife.ca.gov

(916) 371-0349

CA

(916) 375-8340

ATTACHMENT 6

ATTACHMENT 6

ATTACHMENT 7

NON-COLLUSION DECLARATION TO BE EXECUTED BY

BIDDER AND SUBMITTED WITH BID FOR PUBLIC WORKS

(Rev 6/17)

The undersigned declares:

I am the ___________________ of _______________________, the party making the foregoing bid.

The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on ___________ (date), at __________________ (city), _________________ (state).

ATTACHMENT 8

DARFUR CONTRACTING ACT CERTIFICATION

Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.

OPTION #1 – NOT APPLICABLE

Check here if your company has not, within the previous three years, had any business activities or other operations outside of the United States.

Company/Vendor Name (Printed) Federal ID Number

Printed Name and Title of Person Signing By (Authorized Signature)

OPTION #2 - CERTIFICATION

If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

OPTION #3 – WRITTEN PERMISSION FROM DGS

Pursuant to Public Contract Code section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.

We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477(b).

A copy of the written permission from DGS is included with our bid or proposal.

Initials of Submitter

Printed Name and Title of Person Initialing

ATTACHMENT 9

State of California California Natural Resources Agency

California Department of Fish and Wildlife

CALIFORNIA PUBLIC CONTRACT CODE SECTION 10162

-- Questionnaire –

FACILITY NAME PROJECT NAME

NAME OF BUSINESS

In accordance with Section 10162 of the California Public Contract Code, bidders shall complete, under penalty of perjury, the question below. Please answer the following:

HAVE YOU, ANY OFFICER OF YOUR BUSINESS, OR ANY EMPLOYEE OF YOUR

BUSINESS WHO HAS PROPRIETRY INTEREST IN YOUR BUSINESS EVER BEEN

DISQUALIFIED, REMOVED, OR OTHERWISE PREVENTED FROM BIDDING ON, OR

COMPLETING A FEDERAL, STATE, OR LOCAL GOVERNMENT PROJECT BECAUSE OF

A VIOLATION OF LAW OR VIOLATION OF SAFETY REGULATIONS? Yes (Explain circumstances below. Attach additional pages if needed.) No

NOTICE TO BIDDERS

Bidders are cautioned that making false certification may subject the certifier to criminal prosecution.

The California Department of Fish and Wildlife (CDFW) reserves the right under California Public Contract Code Section 10162 to reject any bidder, any officer of such bidder, or any employee of such bidder who has a proprietary interest in such bidder who has been disqualified, removed or otherwise prevented from bidding on, or completing a federal, state or local government project because of a violation of law or violation of safety regulations.

Failure to return this form with the bid shall not be cause for rejection; however, bidders must furnish the completed form within the time frame prescribed by the CDFW. Failure to submit this form within the time frame prescribed by the CDFW may be deemed refusal of an award which shall be cause for forfeiture of bidder's security.

CERTIFICATION

By my signature, I certify under penalty of perjury under the laws of the State of California that the foregoing questionnaire and statements pursuant to California Public Contract Code Section 10162 are true and correct

BIDDER SIGNATURE

PRINTED NAME

DATE

ATTACHMENT 10

CCC 04/2017

CERTIFICATION

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California.

Contractor/Bidder Firm Name (Printed)

Federal ID Number

Date Executed Executed in the County of

CONTRACTOR CERTIFICATION CLAUSES

1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.)

2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions:

a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations.

b. Establish a Drug-Free Awareness Program to inform employees about:

1) the dangers of drug abuse in the workplace;

2) the person's or organization's policy of maintaining a drug-free workplace;

3) any available counseling, rehabilitation and employee assistance programs; and,

4) penalties that may be imposed upon employees for drug abuse violations.

c. Every employee who works on the proposed Agreement will:

1) receive a copy of the company's drug-free workplace policy statement; and,

2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement.

ATTACHMENT 10 (Cont.)

Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred:

the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.)

3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)

4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT:

Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003.

Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State.

Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services.

5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California.

6. SWEATFREE CODE OF CONDUCT:

a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.

b. The contractor agrees to cooperate fully in providing reasonable access to the contractor’s records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor’s compliance with the requirements under paragraph (a).

7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3.

8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35.

DOING BUSINESS WITH THE STATE OF CALIFORNIA

The following laws apply to persons or entities doing business with the State of California.

1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification.

Current State Employees (Pub. Contract Code §10410):

1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment.

2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services.

Former State Employees (Pub. Contract Code §10411):

1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency.

2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service.

If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))

2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700)

3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)

4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.

5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:

a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled.

b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax.

c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State.

6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement.

7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be:

(1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution.

8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity.

ATTACHMENT 11

SURFACE MINING AND RECLAMATION ACT (SMARA)

CERTIFICATION FORM

Pursuant to California Public Contract Code (PCC) Section 10295.5(a), a state agency shall not acquire or utilize sand, gravel, aggregates, or other minerals produced from a surface mining operation subject to the Surface Mining and Reclamation Act (SMARA) of 1975 (Chapter 9 (commencing with Section 2710) of Division 2 of the Public Resources Code), unless the operation is identified in the list published pursuant to subdivision (b) of Section 2717 of the Public Resources Code.

Please select one of the followings:

1. If no sand, gravel, aggregates or other minerals will be purchased for this project, please click the box below and sign at the bottom of this form.

This certifies that the SMARA does not apply to this project.

2. If sand, gravel, aggregates or other minerals will be used for this project, please click the box below, provide requested information below and sign at the bottom of the form.

This certifies that the SMARA does apply to this project and information identified below will be submitted during the life of the contract to the contract manager and/or engineer supervising this project.

Information to submit:

a. Vendor/Supplier Name

b. Street Address

c. City, State, Zip Code

d. Mine Name

e. Mine ID#

f. Operated by

g. County:

The vendor/supplier must meet the requirements of Public Resources Code Section 2710 et.

seg. and Public Contract Code Section 10295.5 as set forth by the Surface Mining and Reclamation Act (AB 3098) and is listed by the California Department of Conservation.

Authorized Bidder’s Signature

Print Name

9/12/2024

ATTACHMENT 12

SMALL BUSINESS SUBCONTRACTOR PARTICIPATION WORKSHEET

Non-small business contractors can receive a 5% Small Business Preference based on subcontracting their work to Certified Small Businesses. To receive the Small Business Preference contractors must subcontract a minimum of 25% of the total monetary amount of their bid to Certified Small Businesses.

CONTRACTOR NAME DATE

COMPLETION INSTRUCTIONS

COMPANY NAME: List the names of the subcontractors and suppliers proposed for the 25% Small Business (SB) subcontractor participation.

CONTRACTING WITH: Enter the name of the company with which the company listed its contracting.

NATURE OF WORK: Identify the proposed work (or materials or equipment) to be provided.

TIER: The Bidder may count toward its 25% Small Business participation goal, the dollar value of work and supplies to be obtained by its primary subcontractors and suppliers from SB subcontractor firms as second and third level tier subcontractors/suppliers. Using the following codes, indicate the contracting tier for each SB company listed for participation:

0 = Prime or Joint Contractor 1 = Primary Subcontractor or Supplier 2 = Subcontractor/Supplier of Level 1 Subcontractor/Supplier 3 = Subcontractor/Supplier of Level 2 Subcontractor/Supplier

DOLLAR VALUE: Enter the dollar amount of the bid to be performed by the listed company’s own forces.

PERCENTAGES OF BID: Enter the percentage of the total bid amount the dollar value represents.

CERTIFICATION: In order to claim the 25% Small Business participation credit, a printout from the Office of Small Business and DVBE Services (OSDS) website for each SB listed for participation must be furnished with the bidder's bid. Check the appropriate column below if a printout from the OSDS website is attached. If a printout is not included, the State will verify certification via the internet to facilitate the contract award.

COMPANY NAME CONTRACTING WITH NATURE OF WORK TIER DOLLAR

VALUE

% OF

BID

CERT.

ATTACHED

Total Small Business Subcontractor Dollar Value

Total Amount of Bid

TOTAL % OF BID FOR ALL SMALL BUSINESS

SUBCONTRACTORS

ATTACHMENT 13

Bidder Declaration Form GSPD-05-106: (ATTACHED)

All bidders must complete the Bidder Declaration GSPD-05-106 and include it with the bid response.

The form should be completed, and returned with your bid package.

ATTENTION

The Bidder Declaration form (GSPD-05-106) must be completed by the prime contractor. This form is used to document all DVBE sub-contractors, vendors, and suppliers that are performing part of the work.

DVBE must be listed on the GSPD-05-106.

In order to be responsive and eligible for award of the contract, bidder must attain the prescribed goals for the DVBE participation.

The DVBE participation requirement is mandatory by state law, whether you are conducting business as individual, partnership or corporation.

IMMEDIATE ACTION REQUIRED

THE DVBE PARTICIPATION REQUIREMENT FOR THIS

SOLICITATION IS 3%

FAILURE TO FULFILL THE DVBE REQUIREMENT WILL RENDER

YOUR BID NON-RESPONSIVE.

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If t h e co n tr ac t i n cl u d es e q u ip m en t r en ta l, d o es y o u r c o m p an y ow n a t l ea st

1% o f t h e eq u ip m t p ro vi d ed in th is c o n tr ac t ( q u an ti ty a n d v al u e)

Ye s

N o

N

/A

If n o s u b co n tr ac to rs w ill b e u se d, s ki p t o c er ti fic at io n b el o w . O th er w is e, li st a ll su b co n tr ac to rs f o r th is c o n tr ac t.

(A tt ac h a d d it io n al p ag es if n ec es sa ry

Su bc on tra ct or

N am e, Co nt ac t P er so n, on tra ct or A dd re ss

CA

Ce rti fic at io n (M

B, SB

W or k p er fo rm ed o r g oo ds p ro vid ed

Co rre sp on di ng

Go od

Ph on e N um be r & Fa x N um be r

Em ai l A dd

NV

SA

, D

VB

E o r N on e) fo r t hi s c on tra ct o f b id p ric e

St an di ng

Re nt al

C

ER

TI

FI

C A

TI

O

N

B y si g n in g t h is fo rm

, I c er ti fy u n d er p en al ty o f p er ju ry t h at t h e in fo rm at io n p ro vi d ed is t ru e an d c o rr ec t.

Pr in te d

N am e:

Si g n at u re

D e Si g n ed

St e o f C al ifo rn ia

D ep ar tm en t o f G en er al S er vi ce s, Pr o cu re m en t D iv is io n

G

SP

D –0

5–

(R

EV

8/

) V er b al

V er si o n

AT

TA

C H

M

EN

T

1/

/2

Pa g e_ o f _

ID

D

ER

D

EC

LA

R

A

TI

O N

In st ru ct io n s Al l p rim e bi dd er s ( th e fir m su bm itt in g th e bi d) m us t c om pl et e th e Bi dd er

D ec la ra ti on

1.

a.

I de nt ify al l c ur re nt ce rti fic at io ns is su ed b y t he St at e o f C al ifo rn ia . I f t he p rim e b id de r h as n o Ca lif or ni a ce rti fic at io n(

s) , c he ck th e l in e l ab ele d “ No ne ” a nd p ro ce ed to

It em

2.

If th e p rim e b id de r p os se ss es o ne or m e o f t he fo llo w in g ce rti fic at io ns

, e nt er th e a pp lic ab le ce rti fic at io n( s) o n th e l in e:

1.

b.

M ar k e ith er “Y es ” o r “ No

” t o i de nt ify w he th er su bc on tra ct or s w ill b e u se d fo r t he co nt ra ct

. I f t he re sp on se is

“N o”, p ro ce ed to

It em

1.

c.

If

“Y es

”, e nt er on th e l in e t he d ist in ct el em en t o f w or k c on ta in ed in th e c on tra to b e p er fo rm ed o r t he g oo ds to b e p ro vid ed b y t he p rim e b id de r.

Do n ot in clu de g oo ds o r s er vic es to b e pr ov id ed b y s ub co nt ra ct s.

Bi dd er s c er tifi ed as M

B, SB

, N

VS

A, an d/ or

D

VB

E m us t p ro vid e a co m m er cia lly u se fu l f un ct io n as d efi ne d

M ili ta ry an d V et er an s C od e S ec tio n fo r D

VB

Es an d

Go ve rn m en t C od e S ec tio n

7(

d) (4

)(A ) f or sm al l/ m icr ob us in es se

Bi ds m us t p ro po se th at ce rti fie d bi dd er s p ro vid e a co m m er cia lly u se fu l f un ct io n fo r t he re su lti ng co nt ra ct o r th e b id w ill b e d ee m ed n on -re sp on siv e a nd re je ct ed b y t he

St at e.

Fo r q ue st io ns re ga rd in g th e s ol ici ta tio n, co nt ac t t he p ro cu re m en t o ffi cia l id en tifi ed in th e s ol ici ta tio n.

No te : A su bc on tr ac to r i s a ny p er so n, fi rm , c or po ra tio n, o r o rg an iz at io n co nt ra ct in g to p er rm pa rt o f t he p rim e’s co nt ra ct

1.

c.

Th is

Ite m is on ly to b e c om pl et ed b y b us in es se s c er tifi ed b y C al ifo rn ia as a

DV

BE

(1

De cla re w he th er th e p rim e b id de r i s a b ro ke r o r a ge nt b y m ar ki ng ei th er

“Y es

” o r “

No ”. T he M ili ta ry an d Ve te ra ns Co de S ec tio n

9.

2 (

b) d efi ne s “ br ok er

” o r “ ag en t” as a ce rti fie d

DV

BE

co nt ra ct or o r s ub co n-tra ct or th at d oe s n ot h av e t itl e, po ss es sio n, co nt ro l, a nd ri sk o f l os s o f m at er ia ls, su pp lie s, se rv ice s, eq ui pm en t p ro vi de d to an aw ar di ng d ep ar tm en t, u nl es s o ne o r m or e o f t he d isa bl ed ve te ra n ow ne rs ha s a t l ea st

1-pe rce nt ow ne rs hi p of th e q ua nt ity an d va lu e o f t he m at er ia ls, su pp lie s, se rv ice s, an of ea ch p ie ce o f e qu ip m en t p ro vid ed u nd er th e c on tra ct

(2

If bi dd in g re nt al eq ui pm en t, m ar k e ith er “Y es ” o r “ No

” t o id en tif y i f t he p rim e b id de r o w ns at le as t 5

1% th e e qu ip m en t p ro vid ed (q ua nt ity an d va lu e)

. I f n ot b id di ng re nt al eq ui pm en t, m ar k “ N/

A” fo r” “n ot ap pl ica bl e.

no su bc on tra ct or s a re p ro po se d, do n ot co m pl et e t he ta bl e.

R ea d th e c er tifi ca tio n at th e b ot to m o f t he an d co m pl et e “

Pa ge o f _

” o n th e f or m su bc on tra ct or s w ill b e u se d, co m pl et e t he ta bl e l ist in g al l s ub co nt ra ct or s.

If n ec es sa ry , a tta ch ad di tio na l pa ge s a nd co m pl et e t he “P ag e _ o f _

” a cc or di ly.

(c on tin ue d)

C ol um n

La be ls on tr ac to r N am e, Co nt ac t P er so n, P ho ne

N um be r &

Fa x N um be r— Lis t e ac h el em en t f or al l su bc on tra ct on tr ac to r A dd re ss

E m ai l A dd re ss

En te r t he ad dr es s a nd if av ai la bl e, an

Em ai l a dd re

CA

Ce rt ifi ca tio n

(M B, SB

, N

VS

A, D

VB

E o r N on e)

If th e s ub co nt ra ct or p os se ss es a cu rre nt St at e o f Ca lif or ni a c er tifi ca tio n( s)

, v er ify on th is w eb sit e ( w w w.

ep ro cu re .d gs .ca

.g ov

W k pe rf or m ed o r g oo ds p ro vi de d fo r t hi s c on tr ac t—

Id en tif y t he d ist in ct el em en t o f w or k c on ta ed e c on tra ct to b e p er fo rm ed or th e g oo ds to b e p ro vi de d by ea ch su bc on tra ct or . C er tifi ed su bc on tra ct or s m us t p ro vid e a co m m er cia lly u se fu l f un ct io n fo r t he co nt ra ct

Se e p ar ag ra ph

.b ab ov e f or co de ci ta tio ns ga rd in g th e d efi ni tio n of co m m er cia lly u se fu l f un ct io n.

) I f a ce rti fie d su bc on tra ct or is fu rth er su bc on tra ct in g a g re at er p or tio n of th e w or k o r g oo ds p ro vid ed fo r t he re su lti ng co nt ra ct th an w ou ld b e e xp ec te by no al in du st ry p ra ct ice s, at ta ch a se pa ra te sh ee t o f p ap er ex pl ai ni ng th e s itu at io n.

Co rr es po nd in g o f b id p ric e— En te r t he co rre sp on di ng p er ce nt ag e o f t he to ta l b id p ric e f or th e g oo ds an d/ or se rv ice s t o b e p ro vid ed b y e ac h su bc on tra ct or

. D o no t e nt er a do lla r a m ou nt

Go od St an di ng

Pr ov id e a re sp on se fo r e ac h su bc on tra ct or lis te d.

En te r e ith er

“Y es

” o r “

No ” t o in di ca th e p rim e b id de r h as ve rifi ed th at th e s ub co nt ra ct or (s) is in g oo d st an di ng fo r a ll o f t he fo llo w g:

Ca lif or ni a S ec re ta ry o f S ta te to b e i n go od st an di

R en ta l?

Th is pe rta in s t o t he ap pl ica bi lit y o f r en ta l e qu ip m en t.

Ba se d on th e f ol lo w in g pa ra m et er s, en te r e ith er “N

/A no t a pp lic ab le

Ye s” or

“N o” fo r e ac h su bc on tra ct or lis d.

En r “

N/ A” if e:

su on tra ct or ) o r r “

Ye s” if th e s ub co nt ra ct or is a Ca lif or ni a c er tifi ed D

VB

E p ro vi di ng re nt al eq ui pm en t a nd th e su bc on tra ct or o w ns at le as t 5

1% o f t he re nt al eq ui pm en t ( qu an tit y a nd va lu e) it w ill b e p ro vi di ng fo r th e c on tra r “

No ” i f t he su bc on tra ct or is a

Ca lif or ni a c er tifi ed

D

VB

E p ro vi di ng re nt al eq ui pm en t b ut th e s ub

Re ad th e ce rt ifi ca tio n at th e bo tt om o f t he p ag e.

A n in di vi du al th at is a ut ho riz ed to b in d th e fir m co nt ra ct ua lly is to p rin t t he ir na m e, si gn a nd d at e th e fo rm

. A ls o, co m pl et e th e “

Pa ge a cc or di ng ly

St at e o f C al ifo rn ia

D ep ar tm en t o f G en er al S er vi ce s, Pr o cu re m en t D iv is io n

G

SP

D –0

5–

(R

EV

8/

) I n st ru ct io n s fo r V er b al V er si o n

AT

TA

C H

M

EN

T

3. 21 1/

/2

STATE�OF�CALIFORNIA�–�DEPARTMENT�OF�GENERAL�SERVICES�PROCUREMENT�DIVISION�

DISABLED�VETERAN�BUSINESS�ENTERPRISE�DECLARATIONS�

DGS�PD�843�(Rev.�9/2019) Formerly�STD.�843�� Instructions:�The�disabled�veteran�(DV)�owner(s)�and�DV�manager(s)�of�the�Disabled�Veteran�Business�Enterprise� (DVBE)�must�complete�this�declaration�when�a�DVBE�contractor�or�subcontractor�will�provide�materials,�supplies,�services� or�equipment�[Military�and�Veterans�Code�Section�999.2].��Violations�are�misdemeanors�and�punishable�by�imprisonment� or�fine�and�violators�are�liable�for�civil�penalties.��All�signatures�are�made�under�penalty�of�perjury.��

SECTION�1�

Name�of�certified�DVBE:� DVBE�Ref.�Number:�

Description�(materials/supplies/services/equipment�proposed):�

Solicitation/Contract�Number:� SCPRS�Ref.�Number:__________________________�

(FOR�STATE�USE�ONLY)�

SECTION�2�

APPLIES�TO�ALL�DVBEs.�Check�only�one�box�in�Section�2�and�provide�original�signatures.�

I�(we)�declare�that�the�DVBE�is�not�a�broker�or�agent,�as�defined�in�Military�and�Veterans�Code�Section�999.2�(b),�of� materials,�supplies,�services�or�equipment�listed�above.��Also,�complete�Section�3�below�if�renting�equipment.�

Pursuant�to�Military�and�Veterans�Code�Section�999.2�(f),�I�(we)�declare�that�the�DVBE�is�a�broker�or�agent�for�the� principal(s)�listed�below�or�on�an�attached�sheet(s).��(Pursuant�to�Military�and�Veterans�Code�999.2�(e),�State�funds� expended�for�equipment�rented�from�equipment�brokers�pursuant�to�contracts�awarded�under�this�section�shall�not�be� credited�toward�the�3-percent�DVBE�participation�goal.)�

All�DV�owners�and�managers�of�the�DVBE�(attach�additional�pages�with�sufficient�signature�blocks�for�each�person�to�sign):�

(Printed�Name�of�DV�Owner/Manager)������ (Signature�of�DV�Owner/�Manager)� (Date�Signed)�

(Printed�Name�of�DV�Owner/Manager)���� (Signature�of�DV�Owner/Manager)� (Date�Signed)�

Firm/Principal�for�whom�the�DVBE�is�acting�as�a�broker�or�age�nt:� �(If�more�than�one�firm,�list�on�extra�sheets.)����������� ��(Print�or�Type�Name)�

Firm/Principal�Phone:� Address:�

SECTION�3�

APPLIES�TO�ALL�DVBEs�THAT�RENT�EQUIPMENT�AND�DECLARE�THE�DVBE�IS�NOT�A�BROKER.�

Pursuant�to�Military�and�Veterans�Code�Section�999.2�(c),�(d)�and�(g),�I�am�(we�are)�the�DV(s)�with�at�least�51%� ownership�of�the�DVBE,�or�a�DV�manager(s)�of�the�DVBE.��The�DVBE�maintains�certification�requirements�in� accordance�with�Military�and�Veterans�Code�Section�999�et.�seq.���

The�undersigned�owner(s)�own(s)�at�least�51%�of�the�quantity�and�value�of�each�piece�of�equipment�that�will�be�rented� for�use�in�the�contract�identified�above.�I�(we),�the�DV�owners�of�the�equipment,�have�submitted�to�the�administering� agency�my�(our)�personal�federal�tax�return(s)�at�time�of�certification�and�annually�thereafter�as�defined�in�Military�and� Veterans�Code�999.2,�subsections�(c)�and�(g).�Failure�by�the�disabled�veteran�equipment�owner(s)�to�submit�their� personal�federal�tax�return(s)�to�the�administering�agency�as�defined�in�Military�and�Veterans�Code�999.2,�subsections�

(c) and�(g),�will�result�in�the�DVBE�being�deemed�an�equipment�broker.

Disabled�Veteran�Owner(s)�of�the�DVBE�(attach�additional�pages�with�signature�blocks�for�each�person�to�sign):�

(Printed�Name)��� (Signature)� (Date�Signed)�

(Address�of�Owner)������������ (Telephone)� (Tax�Identification�Number�of�Owner)�

Disabled�Veteran�Manager(s)�of�the�DVBE�(attach�additional�pages�with�sufficient�signature�blocks�for�each�person�to�sign):

(Printed�Name�of�DV�Manager)����� (Signature�of�DV�Manager)� (Date�Signed)�

ATTACHMENT 14

must be properly acknowledged.

NOTE: Signatures of those executing for the Surety

__________________________________(Seal) SURETY

__________________________________(Seal)

__________________________________(Seal)

PRINCIPAL

__________________________________(Seal)

__________________________________(Seal)

__________________________________(Seal) this_________________________day of _______________________, 20_____.

IN WITNESS WHEREOF, we have hereunto set our hands and seals on be fixed by the court.

shall pay all costs incurred by the Obligee in such suit, including a reasonable attorney's fee to In the event suit is brought upon this bond by the Obligee and judgment is recovered, the Surety be null and void; otherwise, it shall be and remain in full force and virtue.

other to guarantee payment for labor and materials, as required by law, then this obligation shall bid, and files the two bonds with the Department, one to guarantee faithful performance and the him for signature, enters into a written contract, in the prescribed form, in accordance with the time and manner required under the specifications, after the prescribed forms are presented to

NOW; THEREFORE, if the aforesaid Principal is awarded the contract and, within the

(INCLUDING THE LOCATION AS IT APPEARS ON THE PROPOSAL)

(INSERT DATE OF BID OPENING) (COPY HERE THE CONTRACT NUMBER AND THE EXACT DESCRIPTION OF WORK,) on_____________________________for___________________________________________________

(INSERT PLACE WHERE BIDS WILL BE OPENED)

at______________________________________________ for certain construction specifically described as follows, for which bids are to be opened the abovementioned bid to the State of California, California Department of Fish and Wildlife, THE CONDITION of this obligation is such that: WHEREAS, the Principal has submitted heirs, executors, administrators and successors, jointly and severally, firmly by these presents.

sum in lawful money of the United States, well and truly to be made, we bind ourselves, our California Department of Fish and Wildlife for the work described below, for the payment of which of the bid of the Principal above named, submitted by said Principal to the State of California, California, hereinafter called the State, in the penal sum of ten percent (10%) of the total amount ________________________________________as Surety, are held firmly bound unto the State of ________________________________________as Principal, and______________________________ KNOW ALL MEN BY THESE PRESENTS: THAT we,______________________________________

BIDDER'S BOND

CALIFORNIA DEPARTMENT OF FISH AND WILDLIFE

STATE OF CALIFORNIA

ATTACHMENT 15

ATTACHMENT 16

STATE OF CALIFORNIA

CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT

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.

Proposer/Bidder Firm Name (Printed) Federal ID Number

Executed in the County of Executed in the State of

Date Executed

DEPARTMENT OF GENERAL SERVICES

OFFICE OF LEGAL SERVICES

Attachment 17

GenAI Disclosure & Factsheet

STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES

GENAI REPORTING AND FACTSHEET PROCUREMENT DIVISION

STD 1000 (REV. 07/2024)

Generative Artificial Intelligence (GenAI) Reporting and Factsheet

Section 1: Bidder / Offeror / Contractor Information

Solicitation / Contract Number Bidder ID / Vendor ID (optional)

Business Name Business Telephone Number

Business Address City State Zip Code

Contract / Description of Purchase

Section 2: Disclosure and Factsheet

Will you and/or your subcontractor(s) be using or offering GenAI technology, model, service, or system (collectively, “product”)? £ Yes £ No (If no, skip to Signature section of this form.)

If yes, provide details regarding the GenAI system. See GenAI Reporting and Factsheet Instructions at the end of this form for more information.

Failure to provide information requested on this form may result in disqualification or may void any resulting contract.

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

STD 1000 (REV. 07/2024)

2. (GenAI powered, or driven), applications / product owner

3. Product Description

4. Use Case(s)

5. Intended Information Domain

6. Explain how the GenAI system is not adversely affecting decisions that materially impact access to, or approval for, housing or accommodations, education, employment, credit, health care, and criminal justice.

Signature

By signing this document, I have identified and reported any GenAI use in the performance of this contract. If any new or previously unreported GenAI use is identified in the future in the performance of this contract, we will complete and submit to the State an updated STD 1000.

Signature Date

Submit completed form to the awarding department

STD 1000 (REV. 07/2024)

GenAI Reporting and Factsheet Instructions Please use the following definitions and instructions to complete the GenAI Reporting and Factsheet:

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

a. Definition: The unique identifier or…