C26063000_Please_DocuSign_DVBE_Exemption_Req.pdf

STATE OF CALIFORNIA

DVBE EXEMPTION REQUEST

STD 8 16 (Rev. 09/20)

INSTRUCTIONS

Department of General Services

DEPARTMENT INFORMATION

DEPARTMENT (includes Boards, Commissions, and Associations)

PROCUREMENT IDENTIFIER(S) (include requisition number a nd estimated amount of purchase if applicable)

CONTACT NAME

BUSINESS STREET ADDRESS

BUSINESS MAILING ADDRESS (if different from Street Address)

BUSINESS PHONE BUSINESS EMAIL

THE DEPARTMENT REQUESTS TO:

EXEMPT the DVBE Program Requirements and INCLUDE the DVBE Incentive. Please ensure that:

• The reason for exempting the DVBE Program Requirements is provided in the Exemption Justification section below.

• The purchase indicates the DVBE Program Requirements have been exempted, but the DVBE incentive applies.

EXEMPT the DVBE Incentive and INCLUDE the DVBE Program Requirements. Please ensure that:

• The reason for e xempting the DVBE Incentive is provided in the Exemption Justification section below.

• The purchase indicates the DVBE Incentive has been exempted, but the DVBE Program Requirements apply.

EXEMPT the DVBE Program Requirements and the DVBE Incentive. Please ensure that:

• The reason for exempting the DVBE Program Requirements and the DVBE Incentive is provided in the Exemption Justification section below.

EXEMPTION JUSTIFICATION

Reason(s) f or excluding the DVBE Program Requirements and/or D VBE Incentive for this purchase:

SIGNATURE APPROVAL (Department designee completing the Std. 816)

PRINTED

NAME

TITLE

SIGNATURE

(Please click here to sign with a Digital ID) DATE

Use this form to request approval to exempt the Disabled Veteran Business Enterprise (DVBE) Program Requirements and/or DVBE Incentive. Submit one form per solicitation. Do not bundle multiple solicitations together. For additional information, see the State Contracting Manual.

SIGNATURE APPROVAL (Highest ranking executive or designee only)

PRINTED NAME TITLE

SIGNATURE (Please click here to sign with a Digital ID) DATE

Docusign Envelope ID: 5AACE226-283E-88A1-837D-5955EC5DC1C6

715 P Street, Sacramento, CA 95814

This is a justification to waive the DVBE portion of this contract. There are no DVBE vendors in caleprocure to find and consider DVBE businesses. By waving this, it allows more bidders to place bids on this carbonless receipts and reproduction. This will be a statewide opportunity for a potential increase of bidders. Using UNSPSC classification codes

82121500, services area and zip codes were in Sacramento area. Locations are all over CA where the work will be done.

The search results are inconclusive. DGS OSP doesn't have the capabilities to produce this order.

715 P Street, Sacramento, CA 95814 samantha.le@parks.ca.gov

Samantha Le

X

Department of Parks and Recreation

916-902-8288

C26063000 $55,000.00

SB DVBE AdvocateMichele Sakamoto

10/1/2026

Sammy Wong Supervisor II

10/5/2026

Docusign Envelope ID: 5AACE226-283E-88A1-837D-5955EC5DC1C6

All businesses are encouraged to provide voluntary diversity data information in their CaleProcure profiles. The data will help us shape policies and develop strategies to improve opportunities for all businesses to contract with the state.

Click HERE (https://fiscal.cdn.prismic.io/fiscal/394445b2-9d0e-40a3-b940- 9315c3783793_Diversity+Data+Procedures+%28Registered%29+%281%29.pdf) for instructions. More information is available on the Statewide Supplier Diversity Program (https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/Statewide-Supplier- Diversity-Program/Statewide-Supplier-Diversity-Program) page.

x

Business Name

9/30/26, 9:06 AM The State of California Certifications https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx 1/4

Contract #C26063000 Date: 9/30/2026

Docusign Envelope ID: 5AACE226-283E-88A1-837D-5955EC5DC1C6 https://fiscal.cdn.prismic.io/fiscal/394445b2-9d0e-40a3-b940-9315c3783793_Diversity+Data+Procedures+%28Registered%29+%281%29.pdf https://fiscal.cdn.prismic.io/fiscal/394445b2-9d0e-40a3-b940-9315c3783793_Diversity+Data+Procedures+%28Registered%29+%281%29.pdf https://fiscal.cdn.prismic.io/fiscal/394445b2-9d0e-40a3-b940-9315c3783793_Diversity+Data+Procedures+%28Registered%29+%281%29.pdf https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/Statewide-Supplier-Diversity-Program/Statewide-Supplier-Diversity-Program https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/Statewide-Supplier-Diversity-Program/Statewide-Supplier-Diversity-Program https://www.dgs.ca.gov/PD/About/Page-Content/PD-Branch-Intro-Accordion-List/Statewide-Supplier-Diversity-Program/Statewide-Supplier-Diversity-Program

Certification ID

Certification Type Micro Business (MB)

Small Business (SB)

Small Business for the Purpose of Public Works (SB-PW)

Disabled Veteran Business Enterprise (DVBE)

Non-Profit Veteran Service Agency (NVSA)

Non-Profit Recognition (NP)

Business Type Construction

Manufacturer

Non-Manufacturer

Service

UNSPSC Classifications

UNSPSC Codes

82121500

ADD

9/30/26, 9:06 AM The State of California Certifications https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx 2/4

NAICS Classifications (only used by manufacturers)

Contractor's License Classifications

Service Area (County)

Service Area IDs

Keywords

Keyword

Printing receipt binding

ADD

ADD

9/30/26, 9:06 AM The State of California Certifications https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx 3/4

Zip Code

Zip Code

95812

Clear Criteria Search

9/30/26, 9:06 AM The State of California Certifications https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx 4/4

Certificate Of Completion Envelope Id: 5AACE226-283E-88A1-837D-5955EC5DC1C6 Status: Completed

Subject: C26063000 Please DocuSign: DVBE Exemption Request std816 Acct .pdf

Source Envelope:

Document Pages: 9 Signatures: 2 Envelope Originator:

Certificate Pages: 5 Initials: 0 Michele Sakamoto

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-08:00) Pacific Time (US & Canada)

715 P Street

Sacramento, CA 95814

Michele.Sakamoto@parks.ca.gov

IP Address: 134.186.96.199

Record Tracking Status: Original

9/30/2026 11:50:31 AM

Holder: Michele Sakamoto

Michele.Sakamoto@parks.ca.gov

Location: DocuSign

Security Appliance Status: Connected Pool: StateLocal

Signer Events Signature Timestamp Samantha Le samantha.le@parks.ca.gov

Security Level:

DocuSign.email

ID: 1

9/30/2026 11:50:33 AM

Completed

Using IP Address: 134.186.96.199

Sent: 9/30/2026 11:50:32 AM

Viewed: 9/30/2026 11:50:46 AM

Signed: 9/30/2026 11:52:24 AM

Electronic Record and Signature Disclosure:

Accepted: 9/30/2026 9:10:32 AM ID: 29e55468-0bb8-4717-8099-64d65010efeb

Michele Sakamoto

Michele.Sakamoto@parks.ca.gov

SB DVBE Advocate

CA Dept of Parks and Recreation

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 134.186.96.100

Sent: 9/30/2026 11:52:25 AM

Viewed: 10/1/2026 7:41:48 AM

Signed: 10/1/2026 7:50:21 AM

Electronic Record and Signature Disclosure:

Not Offered via Docusign

Sammy Wong

Sammy.Wong@parks.ca.gov

Supervisor II

Signing Group: DVBE Waiver Management

Signature

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 76.149.77.65

Sent: 10/1/2026 7:50:23 AM

Viewed: 10/5/2026 8:42:52 AM

Signed: 10/5/2026 8:43:23 AM

Electronic Record and Signature Disclosure:

Not Offered via Docusign

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp

Carbon Copy Events Status Timestamp Lisa Hafoka

Lisa.Hafoka@parks.ca.gov

Security Level: Email, Account Authentication (None)

Sent: 10/5/2026 8:43:25 AM

Electronic Record and Signature Disclosure:

Not Offered via Docusign

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 9/30/2026 11:50:32 AM

Envelope Updated Security Checked 9/30/2026 11:52:24 AM

Envelope Updated Security Checked 10/1/2026 7:41:21 AM

Envelope Updated Security Checked 10/1/2026 7:50:21 AM

Certified Delivered Security Checked 10/5/2026 8:42:52 AM

Signing Complete Security Checked 10/5/2026 8:43:23 AM

Completed Security Checked 10/5/2026 8:43:25 AM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure

ELECTRONIC RECORD AND SIGNATURE DISCLOSURE

From time to time, California State Department of Parks and Recreation (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic

Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking

‘CONTINUE’ within the DocuSign system.

Getting paper copies

At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time

(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a

$0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below.

Withdrawing your consent

If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below.

Consequences of changing your mind

If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us.

All notices and disclosures will be sent to you electronically

Electronic Record and Signature Disclosure created on: 4/19/2023 2:49:58 PM Parties agreed to: Samantha Le

Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given

us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us.

How to contact California State Department of Parks and Recreation:

You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows:

To contact us by email send messages to: esign@parks.ca.gov

To advise California State Department of Parks and Recreation of your new email address

To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at and in the body of such request you must state: your previous email address, your new email address.

If you created a DocuSign account, you may update it with your new email address through your account preferences.

To request paper copies from California State Department of Parks and Recreation

To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to and in the body of such request you must state your email address, full name, mailing address, and telephone number.

To withdraw your consent with California State Department of Parks and Recreation

To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

i. decline to sign a document from within your signing session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;

ii. send us an email to esign@parks.ca.gov and in the body of such request you must state your email, full name, mailing address, and telephone number. . .

Required hardware and software

The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: https://support.docusign.com/guides/signer-guide-signing-system-requirements.

Acknowledging your access and consent to receive and sign documents electronically

To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format as described herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.

By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm that:

You can access and read this Electronic Record and Signature Disclosure; and

You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and

Until or unless you notify California State Department of Parks and Recreation as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by California State Department of Parks and

Recreation during the course of your relationship with California State Department of

Parks and Recreation.

https://support.docusign.com/guides/signer-guide-signing-system-requirements https://support.docusign.com/guides/signer-guide-signing-system-requirements

Accessibility Report

Filename:

STD 816 Draft 5.pdf

Report created by:

Kevin Vang, IT Person, Kevin.Vang@dgs.ca.gov

Organization:

DGS, DGS

[Personal and organization information from the Preferences > Identity dialog.]

Summary

The checker found no problems in this document.

Needs manual check: 2

Passed manually: 0

Failed manually: 0

Skipped: 0

Passed: 30

Failed: 0

Detailed Report

Document

Rule Name Status Description

Accessibility permission flag Passed Accessibility permission flag must be set

Image-only PDF Passed Document is not image-only PDF

Tagged PDF Passed Document is tagged PDF

Logical Reading Order Needs manual check Document structure provides a logical reading order

Primary language Passed Text language is specified

Title Passed Document title is showing in title bar

Bookmarks Passed Bookmarks are present in large documents

Color contrast Needs manual check Document has appropriate color contrast

Page Content

Rule Name Status Description

Tagged content Passed All page content is tagged

Tagged annotations Passed All annotations are tagged

Tab order Passed Tab order is consistent with structure order

Character encoding Passed Reliable character encoding is provided

Tagged multimedia Passed All multimedia objects are tagged

Screen flicker Passed Page will not cause screen flicker

Scripts Passed No inaccessible scripts

Timed responses Passed Page does not require timed responses

Navigation links Passed Navigation links are not repetitive

Forms

Rule Name Status Description

Tagged form fields Passed All form fields are tagged

Field descriptions Passed All form fields have description

Alternate Text

Rule Name Status Description

Figures alternate text Passed Figures require alternate text

Nested alternate text Passed Alternate text that will never be read

Associated with content Passed Alternate text must be associated with some content

Hides annotation Passed Alternate text should not hide annotation

Other elements alternate text Passed Other elements that require alternate text

Tables

Rule Name Status Description

Rows Passed TR must be a child of Table, THead, TBody, or TFoot

TH and TD Passed TH and TD must be children of TR

Headers Passed Tables should have headers

Regularity Passed Tables must contain the same number of columns in each row and rows in each column

Summary Passed Tables must have a summary

Lists

Rule Name Status Description

List items Passed LI must be a child of L

Lbl and LBody Passed Lbl and LBody must be children of LI

Headings

Rule Name Status Description

Appropriate nesting Passed Appropriate nesting

Back to Top