Bid_Forms_C24864050.pdf

NATURAL RESOURCES AGENCY OF CALIFORNIA

DEPARTMENT OF PARKS AND RECREATION

SAN CLEMENTE STATE BEACH

Replace Combination Building #6

Orange County, California Bid Number: C24864050

Bidder’s Checklist

Items below must be submitted with your bid.

Public Works Bid Form (DPR 482B) and subsequent pages

DVBE Notice (DPR 479IP)

__ Bidder Declaration (GSPD 05-105)

DVBE Declarations (DGS PD 843) for each listed DVBE on Bidder’s DVBE Participation Form

__ Printout(s) from the eProcurement website http://www.caleprocure.ca.gov showing each DVBE’s supplier ID and status of certification

__ Commercially Useful Function – Bidder Certification (DPR 87)

__ Non-Collusion Affidavit (DPR 837)

__ Bidder’s Bond (DPR 495)

Printout from the eProcurement website http://www.caleprocure.ca.gov showing each Small Business’ supplier ID and status of certification, if applicable

__ California Public Contract Code Section 10162 Questionnaire (DPR 20)

__ Darfur Contracting Act Form (DPR 74), if applicable

__ Fair Chance Employment Act (DPR 282PW)

__ California Civil Rights Law Certification (DGS OLS 04)

__ Contractor and Subcontractor registration with the Department of Industrial Relations pursuant to Labor Code section 1725.5 http://www.dir.ca.gov/Public- Works/SB854.html

Bid Date: Tuesday, May 13, 2025 at 2:00 PM

Bids will be submitted via email to DPR.PWBids@parks.ca.gov http://www.caleprocure.ca.gov/ http://www.caleprocure.ca.gov/ http://www.dir.ca.gov/Public-Works/SB854.html http://www.dir.ca.gov/Public-Works/SB854.html mailto:DPR.PWBids@parks.ca.gov

2:00 P.M. May 13, 2025

Nondiscrimination Compliance Statement: The prospective contractor's signature affixed hereon and dated shall constitute a certification under penalty of perjury under the laws of the State of California that the bidder has, unless exempted, complied with the nondiscrimination program requirements of Government Code Section 12990 and Title 2, California Code of Regulations, Section 8103.

Verification: By signing this Bid Form, the bidder assures the state that it has not been convicted of violating a state or federal law regarding the employment of undocumented aliens, in the preceding five years.

The prospective contractor's signature affixed hereon and dated shall constitute a certification that the representations made by the prospective contract in the bid are made under penalty of perjury under the laws of the State of California.

Important: Pursuant to Title 2, California Code of Regulations, Section 8103 and Business and Professions Code Section 7028.15, no bid will be considered unless it contains the certifications and license information requested on this form. The State reserves the right to waive any irregularity in any bid or to reject any or all bids.

LICENSE NO.

DPR 482B (Rev. 10/2003)(Excel 10/15/2003)

C24864050 Replace Combination Building #6

KIND OF WORK NAME AND ADDRESS

SAN CLEMENTE STATE BEACH

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

PUBLIC WORKS BID FORM

PROJECT LOCATION

PROJECT NAME

STATUS OF BUSINESS (Check appropriate box.)

Individual.

Corporation. State in which incorporated:

Partnership. Full names of partners:

Listed hereinafter are the names, addresses and contractor's license numbers of all subcontractors who will perform work or labor or render services in an amount in excess of one-half of one percent of the general contractor's total bid if this bid is accepted and the portion of the work that each will perform. Material vendors are not included.

FAX NO.

BY (Authorized Signature)

EMAIL

PRINTED NAME AND TITLE OF PERSON SIGNING

CONTRACTOR/BIDDER FIRM NAME (Printed) - AS IT APPEARS ON LICENSE

MAILING ADDRESS CITY/STATE/ZIP CODE

LICENSE CLASSIFICATION

DATE

BID DATEBID TIME

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 above. This certification is made under the laws of the State of California. I understand that failure to submit the Public Works Bid Form with the appropriate bidder signature will result in rejection of the bid.

LICENSE EXPIRATION DATELICENSE NO.

Exhibit B, Attachment 1

PHONE NO.

BID FORM

Bid Number: C24864050 Contractor / Bidder Firm Name: ____________________________________

The bidder hereby proposes to furnish all labor, materials, tools and equipment necessary to demolish existing combination building and construct a new 984 SF combination building to include six accessible unisex showers, three standard unisex restrooms, and three accessible restrooms. Scope includes removal of existing block retaining wall and cutting back a portion of landscape island to widen asphalt road pavement. Install new utility services for water sewer electric. Also includes accessible updates to existing site plan at SAN CLEMENTE STATE BEACH in Orange County, California, complete and ready for use in accordance with the contract documents therefore, for the following lump sum which shall include all applicable taxes and other expenses:

Base Bid Lump Sum Total: $___________________

Base Bid Lump Sum Total Written Out:

ADDENDUM ACKNOWLEDGEMENT (Please initial for Addenda received)

Addendum #1 ____________ Addendum #4 ____________

Addendum #2 ____________ Addendum #5 ____________

Addendum #3 ____________ Addendum #6 ____________

The bidder agrees to complete all work within TWO HUNDRED SEVENTY (270) calendar days from the date of written notice to commence work. This time includes ten (10) calendar days allowed for the contractor to begin work.

Participation in Disabled Veteran Business Enterprise Program (DVBE): The minimum DVBE participation percentage goal is 6%. Failure to fulfill the DVBE requirement will render your bid non-responsive. DVBE Incentive: For evaluation purposes only, an incentive will be given to bidders who exceed the 6% DVBE participation requirements. Refer to the DVBE forms beginning with DPR 479IP.

SMALL BUSINESS PREFERENCE (GSPD 05-105 form): To assist the Department in a timely evaluation of bids received, any bidder requesting the small business preference on this project is encouraged to submit along with signed GSPD 05-105, a copy of each Small Business’ small business certification approval letter from the Office of Small Business and Disabled Veteran Business Enterprise Certification.

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 1 of 6)

Disabled Veteran Business Enterprise (DVBE) Notice

1. Bidder’s attention is directed to the Disabled Veteran Business Enterprise (DVBE) Participation Requirement for bidders, as outlined in the accompanying bid package.

2. 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 for this solicitation is 6%.

Failure to fulfill the DVBE requirement will render your bid non-responsive.

3. It is essential that you commence the required participation process immediately, to allow adequate response time for potential DVBE participants.

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

IMMEDIATE ACTION REQUIRED

DVBE Participation Requirement and Incentive for Invitation For Bids (IFB)

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 2 of 6)

5. What is a Disabled Veteran Business Enterprise (DVBE)?

a) For a business to be considered a Disabled Veteran Business Enterprise (DVBE), they must be certified with the State of California - Department of General Services in accordance with California Code of Regulations, Title 2, Section 1896.94. Please see the following website for more information about DVBE certification benefits and eligibility requirements:

www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Certify-or- Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise

b) Only DVBEs who perform a commercially useful function relevant to this solicitation, may be used to satisfy the DVBE participation and/or incentive program requirements.

6. Commercially Useful Function Definition

a) California Code of Regulations, Title 2, § 1896.61(l): The term "DVBE contractor, subcontractor or supplier" means any person or entity that satisfies the ownership (or management) and control requirements of §1896.61(f); is certified in accordance with §1896.70; and provides services or goods that contribute to the fulfillment of the contract requirements by performing a commercially useful function.

b) A person or entity must perform a commercially useful function (CUF) as defined under Military and Veterans Code (MVC) §999.

c) A contractor, subcontractor, or supplier will not be considered to perform a commercially useful function if the contractor's, subcontractor's, or supplier's role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of disabled veteran business enterprise participation.

7. What is the DVBE participation requirement?

a) Bidders must commit at minimum 6% of their total bid to currently certified and registered DVBE companies for this solicitation. All bidders must meet the full participation requirement based on the total bid amount in order to be considered a responsive bidder.

b) Reporting Requirement: If, for this agreement and pursuant to Military & Veterans Code (MVC) 999.5 (d), a contractor made a commitment to achieve disabled veteran business enterprise (DVBE) participation, within 60 days of receiving final payment under this agreement (or within such other time period as may be specified elsewhere in this agreement) the contractor must certify in a report to the awarding department:

1. the total amount the prime contractor received under the contract

2. the name and address of the DVBE(s) that participated in the performance of the contract

3. the amount each DVBE received from the prime contractor

4. that all payments under the contract have been made to the DVBE(s)

5. the actual percentage of DVBE participation that was achieved

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 3 of 6)

c) You will be required to report to DPR the actual dollars spent with each DVBE subcontractor on a STD. 817. If awarded the contract you will receive this form at the completion of the contract. A person or entity that knowingly provides false information shall be subject to a civil penalty for each violation. (Military & Veterans Code (M&VC) § 999.5(d))

8. What is the DVBE Incentive Program?

a) The DVBE Incentive Program was established by statute and applies to contracts solely financed by State funds. This program is separate from the DVBE Participation Program. The incentive is designed to encourage bidders to partner with DVBE subcontractors.

b) DVBE incentive will be given to bidders who provide DVBE participation above 6%.

c) The incentive may be combined with other incentives and preferences up to an established cap of $100,000.00. The incentive is used only for evaluation purposes and does not alter the amounts of the actual bids.

9. Who is eligible to receive the incentive?

a) Any responsive bidder who has attained more than the required amount (6%) of DVBE participation per the solicitation instructions.

10. Documentation

a) To be considered a reponsive bidder, bidders must document at least 6% DVBE participation commitment by completing and submitting the following forms:

1. GSPD 05-105, Bidder Declaration

2. DGS PD 843, DVBE Declaration

b) GSPD 05-105, Bidder Declaration: The GSPD 05-105 is used to document the proposed prime contractor and subcontractors, including their roles and responsibilities. The form must be submitted with the bid package. If there is a discrepancy between the dollar amount and percentage of bid for DVBE participation then the percentage shall prevail.

c) DGS PD 843,DVBE Declaration: All disabled veteran owners and disabled veteran managers of the DVBE must complete the form and submit it with the bid package.

A DGS PD 843 needs to be submitted by every DVBE supplier who is part of a bid whether they are the prime contractor or subcontractor .

d) Bids that fail to submit the completed required forms to confirm the level of DVBE participation will not be eligible to receive the DVBE incentive and may be declared unresponsive due to DVBE participation requirements. Clerical and typographical errors on these forms may be corrected at the State’s sole discretion.

e) Information submitted by the bidders to claim the DVBE incentive(s) will be verified by the State. If evidence of an alleged violation is found during the verification process, the State shall initiate an investigation, in accordance with the requirements of the PCC §10115, et seq., and MVC §999 et seq., and follow the investigatory procedures required by the 2 CCR §1896.80. Contractors found to be in violation of certain provisions may be subject to loss of certification, penalties and/or contract termination.

c) Table A – Invitation For Bid (IFB) (aka Low Price Method)

Low Price Method

A B C

$98,000.00 $102,100.00 $100,000.00

4% 8% 6%

Unresponsive 2 1 n/a 3% n/a n/a $3,000.00

(3% x $100,000) n/a n/a $99,100.00

($102,100 - $3,000) n/a

Unresponsive 1 2

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 4 of 6)

Bidder Name

Original Bid Price

DVBE Participation for certified DVBE Prime or Subcontractors

Initial Ranking

Final Rank:

DVBE Incentive (from Table A)

Incentive Amount (% x Lowest Responsive and Responsible Bid Price)

Evaluated Bid Price (Bidder's Price - Bidder's Incentive Amount)

7% - 7.99%

6.01% - 6.99%

5% of lowest responsive and responsible bid

4% of lowest responsive and responsible bid

3% of lowest responsive and responsible bid

2% of lowest responsive and responsible bid

1% of lowest responsive and responsible bid

Confirmed DVBE Participation of DVBE Incentive Amount for IFB

10% or more

9% - 9.99%

8% - 8.99%

11. How does the DVBE Incentive Program Work?

a) The DVBE incentive is used only for evaluation purposes to determine the successful bidder and does not alter the amounts of the actual bids. A dollar cap of $100,000.00 is set for all combined incentives and preferences.

b) For contracts to be awarded based on the Low Price Method, the incentive amount is equal to a percentage of the lowest responsive and responsible bid based on the amount of DVBE participation in the bid being evaluated per Table A below. The Computation Method does not include the small business preference; however, the small business preference may be applied and may affect the application of the incentive and the outcome of the ranking.

d) Computation Method

The State of California www.dgs.ca.gov/PD Department of General Services Receptionist: (916) 375-4940 Office of Small Business and DVBE Services 24-hour recording: (916) 322-5060 707 Third Street, First Floor – Room 400 FAX: (916) 375-4950 West Sacramento, CA 95605 OSDSHelp@dgs.ca.gov

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 5 of 6)

12. Substitution of Proposed DVBE

a) If awarded the contract, the DVBE subcontractors and/or contractors proposed by bidder must be used unless prior written notice of substitution is provided to the state and the state approves such substitution.

b) The notice must include a minimum of: (1) a written explanation of the reason for the substitution; and (2) an updated GSPD 05-105 must be submitted to the award office of Department of Parks and Recreation. The substitution request must before approved before the substitution can take place.

c) Failure to adhere to at least the DVBE participation proposed by the successful bidder may be cause for contract termination and recovery of damages under the rights and remedies due the state under the default section of the contract.

d) Contractor understands and agrees that should award of this contract be based in part on their commitment to use the Disabled Veteran Business Enterprise (DVBE) subcontractor(s) identified in their bid or offer, per Military and Veterans Code 999.5 (e), a DVBE subcontractor may only be replaced by another DVBE subcontractor and must be approved by the State. Changes to the scope of work that impact the DVBE subcontractor(s) identified in the bid or offer and approved DVBE substitutions will be documented by contract amendment.

e) Failure of Contractor to seek substitution and adhere to the DVBE participation level identified in the bid or offer may be cause for contract termination, recovery of damages under rights and remedies due to the State, and penalties as outlined in M&VC § 999.9;

Public Contract Code (PCC) § 10115.10, or PCC § 4110 (applies to public works only).

13. To locate DVBE contractors:

a) Contact the department’s contracting official named in this solicitation for any DVBE contractors who may have identified themselves as potential subcontractors, and to obtain suggestions for search criteria to possibly identify DVBE contractors for the solicitation. You may also contact the department’s SB/DVBE Advocate for assistance:

b) Access the list of all certified DVBEs by using the Department of General Services, Procurement Division (DGS-PD) online certified firm database at:

https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx?psNewWin=true

Search by “Keywords” or United Nations Standard Products and Services Codes (UNSPSC), that apply to the elements of work you want to subcontract to a DVBE.

c) Check for subcontractor ads that may be placed on the California State Contracts Register (CSCR) for this solicitation prior to the closing date. You may access the CSCR at:

www.Caleprocure.ca.gov

d) The State of California, Department of General Services (DGS), Procurement Division, Office of Small Business and DVBE Services (OSDS) offers many services that assist contractor/business owners with a variety of information designed to streamline the State contracting process. OSDS also certifies DVBE contractors. For more information, please

b) DGS PD 843, DVBE Declaration

DPR 479IP (Rev. 12/2022)(Excel 12/20/2022)(Page 6 of 6)

a) GSPD 05-105, Bidder Declaration

DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)

DVBE Documentation Checklist

1. The State of California acknowledges the service and sacrifice of its disabled veterans, in part, through the “Disabled Veteran Business Enterprise (DVBE) Participation Program.” As mandated by law, state agencies have a goal to award at least 3% of their annual contract dollars to certified DVBE’s.

2. When a firm bids on a state DPR contract that contains DVBE participation, the the dollar amount of the bid must meet the 6% participation requirement set by DPR.

3. INCOMPLETE DOCUMENTATION (GSPD 05-105 AND DGS PD 843) MUST RESULT IN

DISQUALIFICATION FROM FURTHER PARTICIPATION IN THE SELECTION PROCESS FOR

THE CONTRACT.

4. The following checklist is provided to assist bidders with their DVBE participation documentation:

All DVBE participation is indicated.

The names of each participating DVBE company is listed with the dollar value and applied percentage of the bid.

A copy of the printout from eProcurement system showing the company’s DVBE certification status.

The DVBE participation percentage listed agrees with the dollar value claimed.

A completed and signed DGS PD 843 is included with the bid for every DVBE (whether prime contractor or subcontractor) included.

DPR 837 (Rev. 6/21) THIS FORM MUST REMAIN WITH THE BID

DEPARTMENT OF PARKS AND RECREATION

NON-COLLUSION DECLARATION TO BE EXECUTED

BY BIDDER AND SUBMITTED WITH BID FOR PUBLIC WORKS

The undersigned declares:

I am the of , the party (Position Title) (Company Name) 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

, at , (Date) (City) (State/Zip Code)

(Print or Type Name)

(Signature)

That we, , as Principal, and as Surety, are held and firmly bound unto the State of California, hereinafter called the State, in the penal sum of ten percent (10%) of the total amount of the bid of the Principal above named, submitted by said Principal to the State of California, Department of Parks and Recreation for the work described below, for the payment of which sum in lawful money of the United States, well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents.

WHEREAS, the Principal has submitted the above-mentioned bid to the State of California, Department of Parks and Recreation, for certain construction specifically described as follows, for which bids are to be opened at for

NOW, THEREFORE, If the aforesaid Principal is awarded the contract and, within the time and manner required under the specifications, after the prescribed forms are presented to him or her for signature, enters into a written contract, in the prescribed form, in accordance with the bid, and files the two bonds with the Department, one to guarantee faithful performance and the other to guarantee payment for labor and materials, as required by law, then this obligation shall be null and void; otherwise, it shall be and remain in full force and virtue.

In the event suit is brought upon this bond by the Obligee and judgment is recovered, the Surety shall pay all costs incurred by the Obligee in such suit, including a reasonable attorney's fee to be fixed by the court.

IN WITNESS WHEREOF, We have hereunto set our hands and seals on this day of , 20

(SEAL)

(SEAL)

(SEAL)

(SEAL)

(SEAL)

(SEAL)

NOTE: Signatures of those executing for the Surety must be properly acknowledged.

County of ss

On this day of before me, a notary public in and for the county and state aforesaid, personally appeared, known to me to be the person whose name is subscribed to the within instrument and known to me to be the attorney-in-fact of and acknowledged to me that he subscribed the name of the said company thereto as surety, and his own name as attorney-in-fact.

DPR 495 (Rev. 11/2002)(Excel 11/8/2002)

KNOW ALL PEOPLE BY THESE PRESENTS:

CERTIFICATE OF ACKNOWLEDGEMENT

BIDDER'S BOND

State of California - The Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

THE CONDITION of this obligation is such that:

Surety

Principal

State of California

(SEAL)

Notary Public

(Insert date of bid opening)

(Insert place where bids will be opened)

(Copy here the exact description of work, including location, as it appears on the proposal) in the year of 20 on

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

The Department of Parks and Recreation (DPR) 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 govern-ment 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 DPR. Failure to submit this form within the time frame prescribed by the DPR may be deemed refusal of an award which shall be cause for forfeiture of bidder's security.

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

DPR 20 (New 10/2003)(Excel 10/24/2008)

NOTICE TO BIDDERS

CERTIFICATION

State of California - The Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

CALIFORNIA PUBLIC CONTRACT CODE SECTION 10162

PARK UNIT NAME

In accordance with Section 10162 of the California Public Contract Code, bidders shall complete, HAVE YOU, ANY OFFICER OF YOUR BUSINESS, OR ANY EMPLOYEE OF YOUR BUSINESS WHO HAS PROPRIETARY 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

BIDDER SIGNATURE PRINTED NAME DATE

under penalty of perjury, the question below. Please answer the following:

— Questionnaire —

PROJECT NAME

NAME OF BUSINESS

DPR 74 (Rev. 5/2013)(Excel 5/16/2013)

DO NOT COMPLETE THIS FORM UNLESS YOUR COMPANY MEETS THE CRITERIA OF OPTION #1 OR OPTION #2.

FOR DEPARTMENT USE ONLYState of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

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.

DO NOT COMPLETE OR RETURN THIS FORM IF: Within the previous three years, your company HAS NOT had any business activities or other operations outside of the United States.

AGREEMENT/PAPO NO.

OPTION #1 - 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.

COMPANY/VENDOR NAME (Printed)

BY (Authorized Signature)

PRINTED NAME AND TITLE OF PERSON SIGNING

DATE EXECUTED EXECUTED IN THE COUNTY AND STATE OF

FEDERAL ID NUMBER

OPTION #2 - 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.

COMPANY/VENDOR NAME (Printed)

INITIALS OF SUBMITTER

PRINTED NAME AND TITLE OF PERSON INITIALING

FEDERAL ID NUMBER

All other companies, complete Option #1 or Option #2 and return:

CALIFORNIA DEPARTMENT OF PARKS AND RECREATION

FAIR CHANCE EMPLOYMENT ACT

Public Contract Code 10186:

(a) This section shall be known, and may be cited, as the "Fair Chance Employment Act."

(b) Any person submitting a bid to the state on a contract involving onsite construction-related services shall certify that the person will not ask an applicant for onsite construction-related employment to disclose orally or in writing information concerning the conviction history of the applicant on or at the time of an initial employment application.

(c) This section shall not apply to a position for which the person or the state is otherwise required by state or federal law to conduct a conviction history background check or to any contract position with a criminal justice agency, as that term is defined in Section 13101 of the Penal Code.

(d) This section shall not apply to a person to the extent that he or she obtains workers from a hiring hall pursuant to a bona fide collective bargaining agreement.

CERTIFICATION

By my signature, I certify under penalty of perjury under the laws of the State of California that I have read, understand and will abide by California Public Contract Code Section 10186.

DPR 282PW (New 8/2016)(Word8/11/2016)

Contractor/Bidder Firm Name (Printed)

Federal ID Number

By (Authorized Bidders Signature)

Printed Name and Title of Person Signing

Date Executed

Executed in the County of