C25925038.OCD.REBID_I_-_NorthSector.Bid_Packet.pdf

State of California • Natural Resources Agency Gavin Newsom, Governor

DEPARTMENT OF PARKS AND RECREATION Armando Quintero, Director

P.O. Box 942896 • Sacramento, CA 94296-0001

BID DOCUMENT CHECKLIST – C25925038 North Sector Lifeguard Boat

Maintenance Rebid I

IMPORTANT: If any line items are not applicable or have no cost, they must be marked accordingly (e.g. $0.00) instead of being left blank. If any of the documents are not applicable, return documents marked “N/A.” Please use this Checklist to check for Bid responsiveness. Bid documents must be returned via email to OCD.bids@parks.ca.gov

Bid document checklist

Service Bid Form DPR 325B / Service Contract Bid Form DPR 940B

Exhibit B, Attachment 1, Bid Form Worksheet

Exhibit B, Attachment 2, Bid Summary Form

Vendor Contact Information

Darfur Contracting Act Certification (DPR 74)

***Disabled Veteran Business Enterprise*** Please note. The DVBE requirement has been waived; however, the 6% DVBE incentive is still available.

DVBE Documentation Checklist (DPR 479IW)

Bidder’s DVBE Participation (DPR486)

DVBE Declarations (DGS PD 843)

Small Business Preference (if applicable) (DPR 85)

Contractor Certification Clause (CCC 04/2017)

Artificial Intelligence (AI) Disclosure Form (DPR 97B)

Bidder Declaration (GSPD-05-105)

Commercially Useful Function (Bidder Certification) (if applicable) (DPR 87)

Signed Addenda/Addendum (if applicable)

Note: Certificate of Insurance & Payee Date Record will be required after the award of contract. Reference Exhibit D, item 1 and STD 204, STD 205 /

DPR 88

Submit to:

OCD.Bids@parks.ca.gov

BID- CONFIDENTIAL

Orange Coast District Contract# C25925038 – North Sector Lifeguard Boat Maintenance Rebid I

March 19, 2026, at 2 PM mailto:OCD.bids@parks.ca.gov mailto:OCD.Bids@parks.ca.gov

SAN CLEMENTE, CA 92672

DPR 325B (Rev. 10/2008)(Excel 10/10/2008) Page 1

DEPARTMENT OF PARK AND RECREATION

ORANGE COAST DISTRICT

3030 AVENIDA DEL PRESIDENTE

BID OPENING

FOR DEPARTMENT USE ONLY

C25925038

DATE

DISTRICT NAME AND ADDRESS

State of California - The Resources Agency

DEPARTMENT OF PARKS AND RECREATION

NAME OF BUSINESS EMAIL ADDRESS

BUSINESS ADDRESS

SMALL BUSINESS PREFERENCE

Not eligible for SB preference

Partnership. Full names of partners:

Corporation. State in which incorporated:

Individual

I hereby propose to provide all labor, materials, tools, and equipment necessary to furnish and/or maintain portable chemical toilet units, complete and ready for use as specified on the back of this form, in accordance with the bid documents and such addenda thereto as may be issued prior to bid opening date.

BIDDER'S SIGNATURE DATE PRINTED NAME TITLE

TIME

A five percent preference will be granted to bidders properly approved as a Certified Small Business (SB) or a Certified Microbusiness (MB), or to a non-small business subcontracting 25% or more of the total monetary amount of the bid in supplies and/or labor costs with Certified Small Business subcontractors in accordance with Title 2, California Code of Regulations, Section 1896, et seq. To qualify as a Certified Small Business, the business must have an approved certification on file with the Office of Small Business and DVBE Services (OSDS), 707 Third Street, First Floor - Room 400, West Sacramento, CA 95605, by 5:00 p.m. on bid opening day.

Claiming preference as a Certified Small Business

STATUS OF BUSINESS (Check appropriate box.)

CONTRACTOR NAME

AGREEMENT NO. PAGE

of Exhibit B, Attachment 1

SERVICE BID FORM

(Attach a copy of the SB certification printout from OSDS' website) Claiming 25% SB subcontractor participation (Attach form DPR 85, Small Business Subcontractor Participation Worksheet)

PHONE NO.

FAX NO.

CITY/STATE/ZIP CODE

03/19/26 2:00pm

DPR 940B (Rev. 5/2011)(Excel 5/5/2011)

Orange Coast District

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

SERVICE CONTRACTS BID FORM

DATE

March 19, 2026

UNIT

PROJECT: North Sector Lifeguard Boat Maintenance Rebid I

BID OPENING

2:00pm on March 19, 2026

FIRM NAME FAX NO.

ADDRESS CITY/STATE/ZIP CODE

STATUS OF BUSINESS (check appropriate box.)

Individual.

Corporation. State in which incorporated:

Partnership. Full names of partners:

DEPARTMENT OF PARKS AND RECREATION

TITLE

DATE

BIDDER'S PRINTED NAME

LICENSE CLASSIFICATION ARE YOU CLAIMING PREFERENCE AS A SMALL BUSINESS?

NoYes. Small Business Certification No.

THE STATE RESERVES THE RIGHT TO WAIVE ANY IRREGULARITY IN ANY BID OR TO REJECT ANY OR ALL BIDS.

The undersigned hereby proposes to furnish services, materials, or equipment, or to perform all work required in accordance with the bid documents for the foregoing titled project, and such addenda thereto as may be issued prior to bid opening date.

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.

Disabled Veteran Business Enterprise Participation In accordance with Public Contract Code Section 10115, the Department of Parks and Recreation has established criteria to implement the disabled veteran business enterprise (DVBE) program goal which bidder must meet; provided, however, the DVBE participation requirement is included herein and made part of the bid documents. (See DVBE Notice included in solicitation for details.)

Small Business Preference A five percent preference will be granted to any bidder currently certified by the Department of General Services as a California Small Business. (See Small Business Notice included in solicitation for details.)

Exhibit B, Attachment 1

PHONE NO.

BIDDER'S SIGNATURE (Signature)

FEDERAL EMPLOYER ID NO.

CONTRACT NUMBER

C25925038

The undersigned is duly authorized to submit this bid on behalf of the company.

Shari.Paige Highlight

Agreement Number: C25925038

Exhibit B, Attachment I

Exhibit B, Attachment I

Bid Form Worksheet

Contractor hereby agrees to furnish all materials, tools, equipment and labor necessary to provide the monthly bottom scrubbing, cleaning, maintenance and inspection services for three (3) Surf Watch Lifeguard Rescue vessels at a time. Shaft collars to be changed four (4) times a year as needed. There are two shaft collars per boat.

Contractor to use “Sea Shield Metal Guard” brand shaft collars. Contractor shall replace transom zinc place on an as-needed basis up to eight (8) times a year. All in accordance with attached specifications marked Exhibit A, Attachment I. Indicate your rates in the blanks provided. A figure must be entered in each blank. These figures include all applicable taxes and other expenses. Contract will be awarded based on lowest responsive bid.

Special Note

Current Surf Watch boats IV, VIII, and X may be replaced one by one by new Surf

Watch boats. Once a boat has been replaced, former boats will no longer need servicing and instead the new one will require servicing. Incoming boats will be of the same length and require the same scope of work and material. Contractor will only bill Parks for active boats and shall not bill for more than three (3) boats at one time.

ITEM 1

The cost for bottom cleaning, maintenance and inspection each month:

SW IV / 29’ Boat $ per month x 12 months = $

SW VIII / 33’ Boat $ per month x 12 months = $

SW X / 33’ Boat $ per month x 12 months = $

Total cost for monthly bottom cleaning services for three (3) boats, IV, VIII, X, for one

(1) year = $

YEAR ONE (May 1, 2026 – April 30, 2027)

ITEM 2

The cost for “Sea Shield Metal Guard” brand shaft collars, two per boat, to be changed four times a year as needed:

SW IV / 29’ Boat - $ for two (2) 1 3/8 in. shaft collar replacement x four (4)

SW VIII / 33’ Boat - $ for two (2) 1½ in. shaft collar replacement x four (4) =

SW X / 33’ Boat - $ for two (2) 1½ in. shaft collar replacement x four (4) =

Total cost for “Sea Shield Metal Guard” brand shaft collars, two per boat, to be changed four times a year as needed – for three (3) boats, IV, VIII, X, for one

ITEM 3

The cost for “transom zinc plates” to be changed as needed up to four times a year.

SW IV / 29’ Boat transom zinc-$ up to eight (8) per year zinc plates =

SW VIII / 33’ Boat transom zinc-$ up to eight (8) per year zinc plates =

SW X / 33’ Boat transom zinc-$ up to eight (8) per year zinc plates =

Total cost for “transom zinc plates” to be changed as needed up to four times a year

– for three (3) boats, IV, VIII, X, for one

YEAR 1 SUB-TOTAL (To include Year 1 Scheduled Service Cost):

ITEM 1

The cost for bottom cleaning, maintenance and inspection each month:

SW IV / 29’ Boat $ per month x 12 months = $

SW VIII / 33’ Boat $ per month x 12 months = $

SW X / 33’ Boat $ per month x 12 months = $

Total cost for monthly bottom cleaning services for three (3) boats, IV, VIII, X, for one four times a year as needed:

SW IV / 29’ Boat - $ for two (2) 1 3/8 in. shaft collar replacement x four (4)

SW VIII / 33’ Boat - $ for two (2) 1½ in. shaft collar replacement x four (4) =

SW IV / 29’ Boat transom zinc-$ up to eight (8) per year zinc plates =

SW VIII / 33’ Boat transom zinc-$ up to eight (8) per year zinc plates =

YEAR TWO (May 1, 2027 – April 30, 2028)

– for three (3) boats, IV, VII, VIII, X, for one

ITEM 1

The cost for bottom cleaning, maintenance and inspection each month:

SW IV / 29’ Boat $ per month x 12 months = $

SW VIII / 33’ Boat $ per month x 12 months = $

SW X / 33’ Boat $ per month x 12 months = $

Total cost for monthly bottom cleaning services for three (3) boats, IV, VIII, X, for one four times a year as needed:

SW IV / 29’ Boat - $ for two (2) 1 3/8 in. shaft collar replacement x four (4)

SW VIII / 33’ Boat - $ for two (2) 1½ in. shaft collar replacement x four (4) =

YEAR 2 SUB-TOTAL (To include Year 2 Scheduled Service Cost):

YEAR THREE (May 1, 2028 – April 30, 2029)

SW IV / 29’ Boat transom zinc-$ up to eight (8) per year zinc plates =

SW VIII / 33’ Boat transom zinc-$ up to eight (8) per year zinc plates =

– for three (3) boats, IV, VIII, X, for one

YEAR 3 SUB-TOTAL (To include Year 3 Scheduled Service Cost):

STATE OF CALIFORNIA · DEPARTMENT OF PARKS AND RECREATION

Orange Coast District

EXHIBIT B - ATTACHMENT 2

BID SUMMARY FORM

Agreement Number: C25925038 Exhibit B, Attachment 2

CONTRACTOR’S NAME (Please Print): CONTRACT NO.

C25925038

ITEM

NO.

TERM

TOTAL

(In Figures)

Year 1- May 1, 2026 to April 30, 2027-:

Total Cost for year one (1) of monthly boat maintenance, changing shaft collars four (4) times per year), and changing transom zinc plates as needed up to eight (8) times per year for year one (1) at:

1907 Bayside Drive, Corona Del Mar, CA 92625

Year 2- May 1, 2027 to April 30, 2028:

Total Cost for year two (2) of monthly boat maintenance, changing shaft collars four (4) times per year), and changing transom zinc plates as needed up to eight (8) times per year for year two (2) at:

1907 Bayside Drive, Corona Del Mar, CA 92625

Year 3- May 1, 2028 to April 30, 2029:

Total Cost for year three (3) of monthly boat maintenance, changing shaft collars four (4) times per year), and changing transom zinc plates as needed up to eight (8) times per year for year three (3) at:

1907 Bayside Drive, Corona Del Mar, CA 92625

IN CASE OF DISCREPANCY BETWEEN THE STIPULATED TOTALS AND THE ACTUAL SUM OF

THE TOTALS, THE ACTUAL SUM OF ALL ITEMS SHALL PREVAIL. THIS PAGE IS FOR INITIAL

EVALUATION PURPOSES ONLY.

GRAND TOTAL

Contractor Name and Contact Information

Company Name:

Representative Name:

Phone:

Email:

Signature: Date:

Agreement Number: C25925021

Vendor Contact Information Vendor Name Phone

Business Address City/State/Zip Code

Remittance Address City/State/Zip Code

Primary Contract Representative Name & Title:

Address:

City/State/Zip Code:

Phone:

Fax:

E-mail address:

Billing/Accounting Contact Name & Title:

Address:

City/State/Zip Code:

Phone:

E-mail address:

Agreement Number: C25925021

Authorized Signature Name & Title:

Address:

City/State/Zip Code:

Phone:

Fax:

E-mail address:

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:

C25925038

b. DGS PD 843, DVBE Declaration

DPR 479IW (Rev. 10/2025)(Page 5 of 5)

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 bylaw, state agencies have a goal to award at least 3% of their annual contract dollars to certifiedDVBE’s.

2. When a firm bids on a state DPR contract that contains DVBE participation, the firm may benefit from the DVBE Incentive program. We encourage all suppliers to obtain as much DVBE participation as possible.

3. INCOMPLETE DOCUMENTATION (GSPD 05-105 AND DGS PD 843) WILL 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 corresponding percentage of the total bid price for the services/goods to be provided by each subcontractor.

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 486 (New 1/2010)(Excel 1/26/2010)

COMPANY INFORMATION

COMPANY INFORMATION: List the information (Company Name, Contact information) of subcontractor(s) and supplier(s) proposed for DVBE. If prime contractor is a DVBE, the name must be listed for participation.

COMPLETION INSTRUCTIONS

PART 1 — SUMMARY OF DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) PARTICIPATION

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

COMPANY NAME

CONTACT

COMPANY NAME

CONTACT

I hereby certifiy that I have made a diligent effort to ascertain the facts with regard to the representations made herein. In making this certification, I am aware of Section 12650 et seq. of the Government Code providing for the imposition of treble damages for making false claims against the State and Section 10115.10 of the Public Contract Code making it a crime for intentionally making an untrue statement in this certificate.

PART 2 — BIDDER'S CERTIFICATION

BIDDING COMPANY'S NAME

SIGNATURE

DATE

TITLE (e.g. BUSINESS OWNER/CHIEF EXECUTIVE OFFICER, ETC.)

CONTRACTING WITH: Show the name of the department or company with which the company listed is contracting.

PRINT OUT: In order to claim DVBE participation credit, a printout from the eProcurement system showing their supplier ID and the status of their certification must be furnished with the bidder's bid or upon the signing of contract documents. Check mark if a copy of the printout is included.

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

TIER: Bidder may count toward its participation goal the dollar value of work and supplies to be obtained by its primary subcontractors and suppliers from DVBE firms as second and third level tier subcontractors/suppliers. Contracting tier should be indicated with the following designations:

DVBE 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: The dollar amount of the bid to be performed by the listed company’s own forces.

PERCENTAGE OF BID: The percentage of the total bid amount the dollar value represents.

CONTRACTING WITH

PERCENT OF BID

PRINT-

OUT

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

COMPANY NAME

CONTACT

CONTRACTING WITH

PERCENT OF BID

PRINT-

OUT

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

COMPANY NAME

CONTACT

CONTRACTING WITH

PERCENT OF BID

PRINT-

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

COMPANY NAME

CONTACT

COMPANY NAME

CONTACT

CONTRACTING WITH

PERCENT OF BID

PRINT-

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

BIDDER'S DVBE PARTICIPATION

PRINTED NAME

OUT

OUT

SOLICITATION NUMBER

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.: Provide the DVBE Certification Number assigned to company.

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: ___________ _

SECTION 2

SCPRS Ref. Number: __________ _

(FOR ST ATE USE ONLY)

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

D 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.

D 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)

(Printed Name of DV Owner/Manager)

Firm/Principal for whom the DVBE is acting as a broker or agent:

(If more than one firm, list on extra sheets.)

Firm/Principal Phone: Address:

SECTION 3

(Signature of DV Owner/ Manager) (Date Signed)

(Signature of DV Owner/Manager) (Date Signed)

(Print or Type Name)

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

D 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.

D 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)

(Address of Owner)

(Signature) (Date Signed)

(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)

PRINT CLEAR

(Signature of DV Manager) (Date Signed)

Page __ of __

COMPANY NAME CONTRACTING WITH NATURE OF WORK TIER DOLLAR

VALUE

% OF

BID

Total Small Business Subcontractor Dollar Value

Total Amount of Bid

TOTAL % OF BID FOR ALL SMALL BUSINESS SUBCONTRACTORS

DPR 85 (Rev. 6/2011)(Excel 6/6/2011)

COMPLETION INSTRUCTIONS

SMALL BUSINESS PREFERENCE

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

Certified Small Businesses (SBs) may receive a 5% preference. Non Certified Small Business (SB) contractors may receive a 5% preference by subcontracting a minimum of 25% of the total monetary amount of their bid to Certified Small Businesses.

See the DPR 478, Small Business Notice for more information about the SB Preference.

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 is 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.

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

PRINTOUT: In order to claim the 25% Small Business participation credit, a printout from the Office of Small Business and DVBE Services eProcurement website for each SB listed.

PRINT-

OUT

DATECONTRACTOR NAME

PART I

IS CONTRACTOR A CALIFORNIA CERTIFIED SMALL BUSINESS?

YES NO

If Yes, attach Contractor's certification printout from the eProcurement website to this form and stop here.

If No, you still may qualify for the Small Business Preference, complete Part II below.

PART II

SB CERT NO.

SB CERT NUMBER:

SB CERT NUMBER:

SB CERT NUMBER:

SB CERT NUMBER:

State of California � Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

ARTIFICIAL INTELLIGENCE (AI) FORM

Instructions for this form are on Page 3.

I. BIDDER CONTACT INFORMATION

BUSINESS NAME SOLICITATION NUMBER

REPRESENTATIVE NAME BUSINESS TELEPHONE NUMBER

BUSINESS ADDRESS CITY STATE ZIP CODE

Description of Services:

Describe in detail the services being provided. Include names of products and large language model.

II. DISCLOSURE

Will you and/or your subcontractor(s) be using or offering AI technology, model, service, or system (collectively, �product�) for this product in question?

Yes. (Answer 1-5 below) No. (Skip to Section III)

1. What type of AI is included?

Traditional AI Generative AI

2. Is the AI required for this product?

No Yes Other:

DPR 97B ( /2025)(Word to PDF /2025)(Page 1 of 3)

ARTIFICIAL INTELLIGENCE (AI) FORM (Continued)

3. What is the model and version of this product?

4. What is the license tier of the AI product, if applicable (free, enterprise, platinum, etc.)?

5. How is the AI solution delivered: IaaS, PaaS, SaaS, or will it be deployed on-premises? (Indicate if this is a thin client, thick client, web extension, plugin, etc.)

Provide the best contact for information related to questions related to the AI included in the product (if different than the representative listed in Section I.)

NAME E-MAIL PHONE NUMBER

III. SIGNATURE

By signing this document, I have identified and reported any AI use in the performance of this product in question.

Signature Date

DPR 97B ( /2025)(Page 2 of 3)

ARTIFICIAL INTELLIGENCE (AI) FORM (Instructions)

Instructions:

The Department of Parks and Recreation (DPR) is required to track and complete risk assessments for any Generative Artificial Intelligence (GenAI) purchases. This document is intended to help DPR identify GenAI and assess the risk related to any GenAI purchases.

Section I:

Bidders shall fill in their contact information.

The DPR staff shall fill out the Description of Services in detail and/or reference the applicable Statement of Work or attachment(s). Include the services to be provided related to AI and include the names of products and large language model. It is important to include as much detail as possible related to any AI aspect of the potential purchase.

Section II:

Bidders shall disclose any aspect of AI related to the purchase.

If �no� is selected, no further information is required in this section.

If �yes� is selected, the Bidder shall fill out answers to questions 1-5. Bidders should provide as much detail as possible related to the AI technology, model, service or system as it relates to what the DPR is soliciting for.

If GenAI is selected and the DPR staff intends to pursue the product, the DPR staff must complete the SIMM 5305-F GenAI Intelligence Risk Assessment, Data Classification section and the Risk Assessment Questionnaire questions a-j; and submit it to ISPO@parks.ca.gov

Contact ISPO@parks.ca.gov for assistance with completing this assessment.

Upon review, ISPO will contact the DPR staff for more information, if needed, prior to submitting the finalized document to the California Department of Technology.

Procurement efforts will be placed on temporary hold pending CDT approval.

Definitions:

IaaS � Infrastructure as a Service is a cloud computing model that provides on-demand access to virtualized computing resources like servers, storage, and networking.

PaaS � Platform as a Service is a cloud computing model that provides a complete platform for developing, running, and managing applications.

SaaS � Software as a Service a cloud-based software delivery model where users access and use applications over the internet via a subscription rather than purchasing and installing software locally.

Section III:

Bidder signatures are required to certify all provided information on this document is true and accurate to the best of their knowledge.

DPR 97B ( /2025)(Page 3 of 3)

State of California-Department of General Services, Procurement Division

GSPD-05-105 (REV 08/09)

Solicitation Number ______ _

BIDDER DECLARATION

1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form}:

a. Identify current California certification(s) (MB, SB, NVSA, DVBE}: _____ or None 0_ (If "None'; go to Item #2)

b. Will subcontractors be used for this contract? Yes D No D (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary.

c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes D No D

(2) If the contract includes equipment rental,does[f co any own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/AO

2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name, Contact Person, Subcontractor Address CA Certification (MB, SB, Work performed or goods provided Corresponding Good 51% Phone Number & Fax Number & Email Address NVSA, DVBE or None) for this contract % of bid price Standing? Rental?

CER TIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.

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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.

LEGAL BUSINESS NAME (including �Doing Business As� DBA name) DPR REFERENCE/AGREEMENT NUMBER

CERTIFICATIONS (mark all that apply)

Small Business Micro Business DVBE

DGS CERTIFICATION NUMBER

(OSDS)

EXPIRATION DATE

For this agreement, this business is the: Prime Contractor Subcontractor

All Certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code Section 14837(d)(4)(A) for Small and Micro Businesses, and Military and Veterans Code Section 999(b)(5)(B)(i) for DVBEs.

A. Is the GSPD-05-105, Bidder Declaration attached? Yes No

B. Is the DGS PD 843, Disabled Veteran Business Enterprise Declarations form attached if applicable?

Yes No N/A

Please answer the following 5 questions as they apply to your company for the goods and/or services being acquired in this solicitation:

Will your business be responsible for the execution of a distinct element of the resulting work?

Yes No

Will your business carry out the obligation of the contract by actually performing, managing or supervising the work involved?

Yes No

3 Will you perform work that is normal for your business, service and functions? Yes No

Will your business be responsible for products, inventories, materials, suppliers required for the contract, negotiating price, determining quality and quantity, ordering, installing (if applicable) and making payment?

(Note: This only applies to GOODS. If this is a service, mark N/A and skip to #5.)

Goods Services

Yes No N/A

If subcontracting a portion of the work, is it a normal portion as expected by current industry practices? (Also answer Yes if not subcontracting any portion.)

Yes No

A response of �No� may result in your quote being deemed non-responsive and disqualified.

BIDDER�S CERTIFICATION

The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

PRINTED NAME AND TITLE OF AUTHORIZED SIGNER SIGNATURE DATE

DEPARTMENT OF PARKS AND RECREATION USE

APPROVED DENIED

DPR BUYER/EVALUATOR PRINTED NAME SIGNATURE DATE

DPR 87 (Rev. 5/2025)(Word to PDF 5/28/2025)

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