C24690026_-_Bid_Documents.pdf

EMPLOYEE SCHEDULING SOFTWARE

APPLICATIONS SERVICES

Folsom Sector

Bid Package

STATE OF CALIFORNIA

THE RESOURCES AGENCY

DEPARTMENT OF PARKS AND RECREATION

GOLD FIELDS DISTRICT

7806 FOLSOM-AUBURN ROAD

FOLSOM, CALIFORNIA 95630-1797

EMPLOYEE SCHEDULING SOFTWARE

APPLICATION SERVICES

Folsom Sector

Table of Contents

BID PACKAGE: NUMBER OF PAGES:

Bidder’s Declaration (GSPD-05-105)……………………………………………………………2 Current Department of General Services’ (DGS) SB/MB Certification+*………………1 Current DGS DVBE Certification+*…………………………………………………………...1 DVBE Declarations (DGS PD 843)* Commercially Useful Function - Bidder Certification (DPR 87)* Target Area Contract Preference Area (TACPA) Preference Request for Goods &

Services Solicitations (STD 830)* Manufacturer’s Summary of Contract Activities & Labor Hours (DGS PD 525)* Bidder’s Summary of Contract Activities & Labor Hours (DGS PD 526)* Employee Scheduling Software Application Services Bid Form, Exhibit B, Attachment 1

Darfur Contracting Act Certifications (DPR 74) Generative Artificial Intelligence (GenAI) Reporting and Factsheet (STD 1000) Russia & Russian Entity & Individual Sanction Certification California Civil Rights Laws Certification (DGS OLS 4) Contractor Certification Clauses (CCC 04/2017) Payee Data Record (STD 204) Payee Date Record Supplement (STD 205)……………………………………………………2 Payee Data Record Supplement (DPR 88) Current Business License for County or City of Business’ Location+

+ AS SUPPLIED BY CONTRACTOR

*IF CLAIMING PREFERENCE

C24690026

BIDDER'S SIGNATURE: _________________________________ DATE: __________________

REPLACE THIS PAPER

WITH VALID

DEPARTMENT OF

GENERAL SERVICES

IF CLAIMING

STATE OF CALIFORNIA – DEPARTMENT OF GENERAL SERVICES PROCUREMENT DIVISION

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS

(Rev. /20 )

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)

Page of

PRINT CLEAR

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

COMMERCIALLY USEFUL FUNCTION - BIDDER CERTIFICATION

All California Certified Small Business (SB), Micro Business (MB), and Disabled Veteran

Business Enterprise (DVBE) suppliers contracting and subcontracting must complete this certification form.

SUPPLIER NAME

SUPPLIER TYPE

DPR REFERENCE/AGREEMENT NUMBER

C24690026

DGS CERTIFICATION NUMBER (OSDS)

D Small Business D Micro Business □ DVBE

Government Code Section 14837 and Military and Veterans Code Section 999 require all California Certified Small Businesses (SB), Micro Businesses (MB), and Disabled Veteran Business Enterprises (DVBE) to perform a "commercially useful function" in any contract they perform for the State.

A business that is performing a commercially useful function is one that does all of the following:

1. Is responsible for the execution of a distinct element of the work of the contract.

2. Carries out its obligation by actually performing, managing, or supervising the work involved.

3. Performs work that is normal for its business services, and functions.

4. Is responsible, with respect to products, inventories, materials, and supplies required for the contract, for negotiating price, determining the quality and quantity, ordering, installing, if applicable, and making payment.

5. Is not further subcontracting a portion of the work that is greater than that expected to be subcontracted by normal industry practices.

Note: 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 small business or microbusiness participation.

BIDDER'S CERTIFICATION

I certify that my company meets all five of the criteria listed above and therefore performs a commercially useful function as defined by California Code.

SIGNATURE DATE

PRINTED NAME AND TITLE OF AUTHORIZED SIGNER

DPR 87 (New 2/2022)(Word to PDF 2/28/2022)

STD. 830 (REV. 05/2022) (FRONT)

TARGET AREA CONTRACT PREFERENCE ACT

STATE OF CALIFORNIA- DEPARTMENT OF GENERAL SERVICES

DISPUTE RESOLUTION UNIT AND PREFERENCE PROGRAMS

PREFERENCE REQUEST FOR GOODS AND SERVICES SOLICITATIONS

SOLICITATION NUMBER AGENCY/DEPT

Complete this form to request TACPA preferences for this bid.

C24690026 DPR/3790

Target Area Contract Preference Act (TACPA) preferences are available only if the lowest responsible bid and resulting contract exceeds $100,000. Your firm must be California based. You must certify, under penalty of perjury, to perform either 50% of the labor hours required to complete a contract for GOODS, or 90% of the labor hours required to complete a contract for SERVICES in the Target Area Contract Preference Act zone(s) you identify in Section I. The TACPA provides bid selection preferences of 5% for eligible worksites (Section I), and 1 % to 4% for hiring eligible workforce employees (Section II). To identify Census Tract and Block Group numbers contact the city or county Planning and Development Commission for the intended worksite or visit the U.S. Census Bureau website (www.census.gov).

Section I. 5% WORKSITE(S) PREFERENCE ELIGIBILITY AND LABOR HOURS

To the Bidder: Preference may be denied for failure to provide the following required information:

(1) Identify each firm in the supply chain, including yours, that will perform any of the contract labor hours required to complete this contract. Identify your role in the distribution process. Transportation hours performed by each carrier must be reported separately.

(2) List complete addresses for each firm named below.

(3) Report projected number of labor hours required to perform the contract for each firm.

(4) Enter the CENSUS TRACT number.

(5) Enter the BLOCK GROUP number.

(6) Identify the California designated TACPA worksite(s) by entering the proper Criteria letter A, B, C, D, E, F (see reverse for instructions) in the Criteria column.

(1) FIRM NAME and CONTRACT FUNCTION:

(Manufacturing, transportation, shipping, warehousing, admin., etc.)

Use additional pages, as needed, to fully report worksite information.

Section II. 1% TO 4% WORKFORCE PREFERENCE

(2) (3)

WORKSITE ADDRESS PROJECTED

Street Address, City, County, State, Zip Code, Phone Number LABOR HOURS

TOTAL PROJECTED LABOR HOURS: 0.00

Bidders must qualify their firm's work site eligibility to request an additional 1 % to 4% workforce preference in Section II.

D I request a 1 % preference for hiring eligible persons to perform 5 to 9% of the total contract labor hours.

□ I request a 2% preference for hiring eligible persons to perform 10 to 14% of the total contract labor hours.

□ I request a 3% preference for hiring eligible persons to perform 15 to 19% of the total contract labor hours.

□ I request a 4% preference for hiring eligible persons to perform 20% or more of the total contract labor hours.

Section Ill. CERTIFICATION FOR WORKSITE AND WORKFORCE PREFERENCES

To receive TACPA preferences, the following certification must be completed and signed by the Bidder.

COMPLETE FOR ALL SITES LOCATED WITHIN A TACPA

PREFERENCE AREA(S)

(4) (5) (6)

TRACT NUMBER BLOCK NUMBER CRITERIA (A - F)

I hereby certify under penalty of perjury that the bidder (1) is a California based company as defined in the TACPA regulations; (2) shall ensure that at least 50% of the labor hours required to complete a contract for Goods, or 90% of the labor hours to complete a Services contract shall be performed at the designated TACPA worksite(s) claimed in Section I; (3) shall hire persons who are TACPA eligible employees to perform the specified percent of total contract labor hours as claimed in Section II; (4) has provided accurate information on this request. I understand that any person furnishing false certification, willfully providing false information or omitting information, or failing to comply with the TACPA requirements is subject to sanctions as set forth in the statutes.

BIDDER'S NAME & TITLE BIDDER'S SIGNATURE PHONE NUMBER EMAIL ADDRESS

FAX NUMBER DATE

DGS/PD 525 (Rev. 0 / ) MANUFACTURER’S SUMMARY Section I

SOLICITATION NUMBER

Of Contract Activities and Labor Hours To be eligible for bidding preferences, the following data/information must be provided AND signed, as indicated, by both the Manufacturer and 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 the statutes.

Section II Manufacturer’s Information: Must be completed by the Manufacturer

Report the projected production capacity of the facility for each product type/solicitation line item. This form must accompany any bid preference request form(s) (STD 830) submittal to the designated contracting official at the awarding department. Enter the number of all employee labor hours in an 8-hour shift at this site required and necessary to perform the contract. Employee labor hours may cover such activities as manufacturing, packaging, handling, warehousing and/or shipping the product (see reverse for additional information). Do not include labor-free time (automation or machine hours /storage/etc). If additional lines are needed, copies of this form may be used.

Contract Total Employee Contract Number Of Employees Used In 8-Hr Shift

Product Type Or Line Item Quantity Production Capacity Labor Hours Per (Of The Product Production Cycle)

(Manufactured At This Site) (Include (Units Per 8-Hr Shift) Product Type Or Line Item Product Units) Manufacturing Packaging Handling Warehousing Shipping Other *

1.

2.

3.

4.

5.

6.

7.

GRAND TOTAL

(Employee labor hours) *EXPLAIN “OTHER” ACTIVITIES OF THE MANUFACTURING CYCLE MUST BE DEFINED HERE, IF USED: (Use additional sheets, if necessary)

Section III Manufacturer’s Information and certification: Must be completed and signed by the Manufacturer

Separate “Manufacturer’s Summaries” are required for each site that is identified as a manufacturer of the contract goods.

MANUFACTURER’S NAME AND ADDRESS NAME AND TITLE OF PERSON SIGNING AS MANUFACTURER PHONE NUMBER

DATE

MANUFACTURER’S SIGNATURE FAX NUMBER

Section IV Bidder’s Certification: Must be completed and signed by the Bidder to be eligible for bidding preferences

I hereby certify under penalty of perjury that the manufacturer provided the above information to me. The proposed employee labor hours indicated above correlate with the hours reported on the preference request form(s) [STD 830] that accompany this bid.

BIDDER'S NAME AND TITLE BIDDER’S SIGNATURE PHONE NUMBER

DATE

FAX NUMBER

AGENCY/DEPT

MANUFACTURER’S SUMMARY

References and Instructions

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 when the contract is for goods or services in excess of $100,000. To obtain preferences, the bidder must demonstrate that a minimum 50% (for goods contracts) or 90% (for services contracts) of the projected employee labor hours necessary for the contract will be performed within the economically distressed area. This includes manufacturer’s employee labor hours.

Section I To be completed by the Bidder

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

Agency/Dept: Enter the name of the buying Agency and/or Department (e.g., State and Consumer Services Agency, Department of General Services)

Section II To be completed by the Manufacturer

This section identifies the projected production capacity of the manufacturer’s facility; number of employees used for each type of the bid product and total of the projected employee contract labor hours used to manufacturer the bid product for the entire contract period.

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

2 The State considers the manufacturer to be the company or companies that add value to the product by converting or transforming it from the raw or bulk product into the final bid product.

Product Type or Line Item: List the product type or line item as specified on the solicitation. Identify each product type or match the line items on the solicitation.

Contract Quantity: List the number of product unit(s) (i.e. # cases, pounds, etc.). Use the same quantity and unit of measure used in the state’s solicitation.

Production Capacity: Indicate the manufacturing capacity for each product type/line item in an 8-hour period.

Employees Used In 8-Hr Period: Indicate the number of employees used for the various production segments during an 8-hour period (example: .5, 1.5, 2). List only the production processes pertaining to the production of the bid product/line item.

Production tasks may include: manufacturing, packaging, handling, shipping, and/or other.

Production hours listed under “other” must be defined.

Total Hours: For each product type/line Item, identify the total number of employee contract labor hours projected to be used for the entire contract period.

Section III To be completed by the Manufacturer

Firm & address:

Authorized Representative:

Contact phone number:

Date:

Signature:

Section IV To be completed by the Bidder

Section IV must be completed and signed by the bidder to be eligible for the bidding preference.

Enter the manufacturer’s name & address.

Type or print the name and title of the person signing the form.

Enter the telephone number and fax number for the manufacturer.

Enter the date the form is completed and signed by the manufacturer

Sign y the manufacturer

1.

2.

3.

4.

5.

6.

7.

8.

9.

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

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

Empty Empty

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:

Empty Empty

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:

Empty

Empty

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

Section III must be completed and signed by the bidder.

Empty

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.

Empt

Contractor’s Name:

Agreement Number: C24690026

Employee Scheduling Software Application Services Bid Form Exhibit B, Attachment 1

Contractor hereby proposes to provide all labor, tools, equipment, materials and supplies necessary to provide employee scheduling software application services for the Gold Fields District Aquatics Program at the Folsom Sector. The employee scheduling software application service shall provide secure web and mobile access to allow approximately 100 users to create individual accounts, to check schedules, pick up shifts and request leave time as further described below.

Services shall be provided 24 hours a day, 7 days a week, 365 or 366 days per year which shall include weekends and holidays.

The term of this agreement will be June 17, 2025, or upon DPR Approval, whichever is later, through June 16, 2028, or three years from DPR Approval, whichever is later. The employee scheduling software application system shall be developed and available for use at the time the contract commences.

Contract Year

Inclusive Dates # of Users x Cost per User

= Total Annual Cost

1 June 17, 2025 – June 16, 2026 100 $ $

2 June 17, 2026 – June 16, 2027 100 $ $

3 June 17, 2027 – June 16, 2028 100 $ $

TOTAL CONTRACT PRICE (Total Annual Cost Contract Year 1-3) $

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 ONLY

C24690026

State 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:

GENAI REPORTING AND FACTSHEET

STD 1000 (REV. 07/2024)

DEPARTMENT OF GENERAL SERVICES

PROCUREMENT DIVISION

Generative Artificial Intelligence (GenAI) Reporting and Factsheet

Section 1: Bidder/ Offerer I Contractor Information

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

Business Name Business Telephone Number

Business Address City State Zip Code

Contract I 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

C24690026 - Employee Scheduling Software Application Services

Contractor shall provide all labor, tools, equipment, materials and supplies necessary to provide an employee scheduling software application service for the Gold Fields District Aquatics Program at the Folsom Sector. The employee scheduling software application service shall provide secure web and mobile access to allow approximately 100 users to create individual accounts, to check schedules, pick up shifts and request leave time.

Contractor shall provide services 24 hours a day, 7 days a week, 365 or 366 days per year which shall include weekends and holidays.

STD 1000 (REV. 07/2024)

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

3. Product Description

4. Use Case(s)

5. Intended Information Domain

DEPARTMENT OF GENERAL SERVICES

PROCUREMENT DIVISION

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)

DEPARTMENT OF GENERAL SERVICES

PROCUREMENT DIVISION

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 name assigned to the specific GenAI model or service.

b. Purpose: Allows users to refer to and distinguish between different GenAI models.

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

a. Definition: The name of the organization or entity responsible for creating or deploying the GenAI model or service.

b. Purpose: Helps identify the source and accountability for the GenAI system.

3. Product Description:

a. Definition: A concise summary of the GenAI model's purpose, functionality, and key characteristics.

b. Purpose: Provides a high-level understanding for users and stakeholders.

4. Use Case(s):

a. Definition: The intended use or goal of the GenAI model (e.g., image recognition, natural language processing, text summarization).

b. Purpose: Helps users assess whether the GenAI model aligns with their needs.

5. Intended Information Domain:

a. Definition: The context, subject matter, or domain for which the GenAI model is designed to operate effectively.

b. Purpose: Helps users determine if the GenAI model is suitable for their specific use case.

6. Adverse Impact:

a. Explain below how you are ensuring 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.

7. Signature:

a. The signatory for the Contract shall also sign the STD 1000

Russia & Russian Entity & Individual Sanction Executive Order N-6-22

On March 4, 2022, Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals was signed by the Governor of the State of California.

“Economic Sanctions” refers to sanctions imposed by the U.S. government in response to Russia’s actions in Ukraine, as well as any sanctions imposed under state law.

Should the State determine Contractor is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that shall be grounds for rejection of the Contractor’s bid/proposal any time prior to contract execution, or, if determined after contract execution, shall be grounds for termination by the State.

Contractor has read/understands the foregoing, and hereby certifies that it is not a target of Economic Sanctions pursuant to EO N-6-22.

COMPANY/VENDOR NAME (Printed)

BY (Authorized Signature)

EXECUTED IN THE COUNTY AND STATE OF

FEDERAL ID NUMBER

PRINTED NAME OF PERSON SIGNING ABOVE

DATED

TITLE OF SIGNATORY

CALIFORNIA CIVIL RIGHTS LAWS CERTIFICATION

Pursuant to Public Contract Code section 2010, if a bidder or proposer executes or renews a contract over $100,000 on or after January 1, 2017, the bidder or proposer hereby certifies compliance with the following:

1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts over $100,000 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 over $100,000 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

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

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

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed

Executed in the County and State 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.

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.

Print Form I Reset Form I

STATE OF CALIFORNIA- DEPARTMENT OF FINANCE

PAYEE DATA RECORD

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

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Section 1 - Payee Information NAME (This is required. Do not leave this line blank. Must match the payee's federal tax return)

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above)

MAILING ADDRESS (number, street, apt. or suite no.) (See instructions on Page 2)

CITY, STATE, ZIP CODE I E-MAIL ADDRESS

Section 2 - Entity Type Check one (1} box only that matches the entity type of the Payee listed in Section 1 above. (See instructions on oaoe 2)

□ SOLE PROPRIETOR/ INDIVIDUAL CORPORATION (see instructions on page 2)

□ SINGLE MEMBER LLC Disregarded Entity owned by an individual □ MEDICAL (e.g., dentistry, chiropractic, etc.)

□ PARTNERSHIP □ LEGAL (e.g., attorney services)

□ ESTATE OR TRUST □ EXEMPT (e.g., nonprofit)

□ ALL OTHERS

Section 3 - T a x Identification Number

Enter your Tax Identification Number (TIN) in the appropriate box. The TIN must match the name given in Section 1 of this form. Do not provide more than one (1) TIN. Social Security Number (SSN) or The TIN is a 9-digit number. Note: Payment will not be processed without a TIN. Individual Tax Identification Number (ITIN)

• For Individuals, enter SSN.

• If you are a Resident Alien, and you do not have and are not eligible to get an

SSN, enter your ITIN.

• Granter Trusts (such as a Revocable Living Trust while the granters are alive) may not have a separate FEIN. Those trusts must enter the individual grantor's SSN.

• For Sole Proprietor or Single Member LLC (disregarded entity), in which the sole member is an individual, enter SSN (ITIN if applicable) or FEIN (FTB prefers SSN).

• For Single Member LLC (disregarded entity), in which the sole member is a business entity, enter the owner entity's FEIN. Do not use the disregarded entity's FEIN.

• For all other entities including LLC that is taxed as a corporation or partnership, estates/trusts (with FEINs), enter the entity's FEIN.

OR

Federal Employer Identification Number

(FEIN)

Section 4 - Payee Residency Status (See instructions)

□ CALIFORNIA RESIDENT - Qualified to do business in California or maintains a permanent place of business in California.

□ CALIFORNIA NONRESIDENT - Payments to nonresidents for services may be subject to state income tax withholding.

□ No services performed in California □Copy of Franchise Tax Board waiver of state withholding is attached.

Section 5 - Certification I hereby certify under penalty of perjury that the information provided on this document is true and correct.

Should my residency status change, I will promptly notify the state agency below.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE E-MAIL ADDRESS

SIGNATURE

Please return completed form to:

STATE AGENCY/DEPARTMENT OFFICE

Department of Parks & Recreation

MAILING ADDRESS

7806 Folsom-Auburn Road

CITY STATE

Folsom CA

DATE I TELEPHONE (include area code)

Section 6 - Paying State Agency

UNIT/SECTION

Gold Fields District FAX TELEPHONE (include area code)

(916) 988-9062 (916) 988-0205

ZIP CODE E-MAIL ADDRESS

95630 goldfields.billing@parks.ca.gov

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STATE OF CALIFORNIA- DEPARTMENT OF FINANCE

PAYEE DATA RECORD

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6.

Prompt return of this fully completed form will prevent delays when processing payments.

Information provided in this form will be used by California state agencies/departments to prepare Information Returns (Form1099).

NOTE: Completion of this form is optional for Government entities, i.e. federal, state, local, and special districts.

A completed Payee Data Record, STD 204 form, is required for all payees (non-governmental entities or individuals) entering into a transaction that may lead to a payment from the state. Each state agency requires a completed, signed, and dated STD 204 on file; therefore, it is possible for you to receive this form from multiple state agencies with which you do business.

Payees who do not wish to complete the STD 204 may elect not to do business with the state. If the payee does not complete the STD 204 and the required payee data is not otherwise provided, payment may be reduced for federal and state backup withholding. Amounts reported on Information Returns (Form 1099) are in accordance with the Internal Revenue Code IRC and the California Revenue and Taxation Code R&TC .

Se c tion 1 - Pa e e Information Name - Enter the name that appears on the payee's federal tax return. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

• Sole Proprietor/Individual/Revocable Trusts - enter the name shown on your federal tax return.

• Single Member Limited Liability Companies (LL Cs) that is disregarded as an entity separate from its owner for federal tax purposes - enter the name of the individual or business entity that is tax liable for the business in section 1. Enter the DBA, LLC name, trade, or fictitious name under Business Name.

• Note: for the State of California tax purposes, a Single Member LLC is not disregarded from its owner, even if they may be disregarded at the Federal level.

• Partnerships, Estates/Trusts, or Corporations - enter the entity name as shown on the entity's federal tax return. The name provided in Section 1 must match to the TIN provided in section 3. Enter any DBA, trade, or fictitious business names under Business Name.

Business Name - Enter the business name, DBA name, trade or fictitious name, or disregarded LLC name.

Mailing Address - The mailing address is the address where the payee will receive information returns. Use form STD 205, Payee Data Record Supplement to provide a remittance address if different from the mailing address for information returns or make subseauent changes to the remittance address

S e c tion 2 - Entitv Type

If the Payee in Section 1 is a(n) ... THEN Select the Box for ...

Individual • Sole Proprietorship • Granter (Revocable LivinQ) Trust disreQarded for federal tax purposes Sole Proprietor/Individual Limited Liability Company (LLC) owned by an individual and is disreQarded for federal tax purposes SinQle Member LLC-owned by an individual Partnerships • Limited Liability Partnerships (LLP) • and LLC treated as a Partnership Partnerships Estate• Trust (other than disreaarded Granter Trust) Estate or Trust Corporation that is medical in nature (e.g., medical and healthcare services, physician care, nursery Corporation-Medical care dentistry etc. • LLC that is to be taxed like a Corporation and is medical in nature Corporation that is legal in nature (e.g., services of attorneys, arbitrators, notary publics involving legal Corporation-Legal or law related matters etc.) • LLC that is to be taxed like a Corooration and is leaal in nature Corporation that qualifies for an Exempt status, including 501 (c) 3 and domestic non-profit corporations.