C26925010_Bid_Forms_and_Documents.pdf

Bid Document Checklist

Contract Number: C26925010

Attach this checklist to bid and other required documentation listed below. When submitting bid forms, do not include form instruction pages.

IMPORTANT : If the form is not applicable mark “N/A” on the form and return with bid.

Forms and Description

☐ Bid Document Checklist

☐ Exhibit B, Attachment 1 – Bid Forms

☐ DARFUR Contracting Act Certification - DPR 74

☐ Contractor Certification Clauses – CCC 04/2017

☐ Generative Artificial Intelligence (GenAI) Disclosure Form – DPR 97B

☐ California Civil Rights Law Attachment - DGS OLS 04

---------------- CA DVBE Program Requirements DocumentaƟon ----------------

☐ DVBE Checklist – DPR 479

☐ Bidder Declaration - GSPD 05-105

☐ Disabled Veteran Business Enterprise Declarations - DGS PD 843

☐ Commercially Useful Function – DPR 87

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

Note: Certificates of Insurance & Payee Data Record will be required after the award of contract. Reference Exhibit D, item 1 and STD 204, 205 / DPR 88

Waived but incentive still applies

Mark "n/a" and sign if not applicable

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

Department of Parks and Recreation

Orange Coast District

3030 Avenida del Presidente

BID OPENING

FOR DEPARTMENT USE ONLY

San Clemente, CA 92672

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

Exhibit B, Attachment 1

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

CHEMICAL TOILET RENTAL AND/OR 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

C26925010 1 4

9/1/2026 2:00 PM PST

1 5/22/2027 10/15/2027 X Contractor X 147 5 735

2 5/22/2028 10/15/2028 X Contractor X 147 5 735

3 5/22/2029 10/15/2029 X Contractor X 147 5 735

TOTAL COST FOR REGULAR SERVICES

ADDITIONAL CHEMICAL TOILETS - If requested, the contractor shall furnish the following additional chemical toilets:

TOTAL COST FOR ADDITIONAL TOILETS [(F)x(G)] ADDITIONAL SERVICES - If requested, the contractor shall provide the following additional services:

TOTAL COST FOR ADDITIONAL SERVICES [(H)x(I)x(J)]

TOTAL BID PRICE

DPR 325B Page 2

FOR DEPARTMENT USE ONLY

Orange Coast District Huntington State Beach Restroom 3 Location (REG UNITS)

DISTRICT

CHEMICAL TOILET RENTAL AND/OR SERVICE BID FORM - Exhibit B, Attachment 1 Bidder completes (D), (E), (G), (J), TOTAL COSTS, and TOTAL BID PRICE.

ESTIMATED REQUIREMENTS FOR CHEMICAL TOILET SERVICE ARE AS FOLLOWS:

PERIOD OF SERVICEI

T E M

From To

TYPE OF

PROVIDED

BY SERVICE DAYS

SERVICE

FREQUENCY

Weekly Every Other Week

(A)

NO. OF

SERVICE

DAYS FOR

PERIOD

(B)

NO. OF

TOILETS

EACH

SERVICE

(D)

COST PER

TOILET

PER

SERVICE

(E)

COST FOR

SERVICE

PERIOD

[(C)X(D)]

TYPE OF TOILETS (F) NO. OF EXTRA CHEMICAL TOILETS (G) COST PER TOILET

TYPE OF TOILETS (H) NO. OF TOILETS PER SERVICE

(J) COST PER TOILET

— Bidder understands that the quantities below are estimates only, for purposes of comparing bids, and that the State reserves the right to increase or decrease the amount of any item or eliminate any item or items as may be deemed necessary or advisable by the State. Such changes shall not affect the unit price of that item or any other items.

— In case of discrepancy between the unit price and the total set forth for the item, the unit price shall prevail. In case of discrepancy between the stipulated totals and the actual sum of the totals, the actual sum of all items shall prevail.

u n S o n M u e T e d W h u T r i F a t S

(C)

NO. OF TOILETS

SERVICED IN

CONTRACT

PERIOD [(A)X(B)]

(I) NO. OF ADDITIONAL SERVICES

CONTRACTOR NAME

AGREEMENT NO. PAGE

of u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S

PARK UNIT

Hdcp Reg

Handicapped Accessible

Handicapped Accessible

Regular

Regular

CHEMICAL TOILET UNITS TO BE MADE OF

Fiberglass Wood Metal

LOCATION WITHIN PARK UNIT

C26925010 2 4

Ryan.Thorne Highlight

Ryan.Thorne Highlight

Ryan.Thorne Highlight

1 5/22/2027 10/15/2027 X Contractor X 147 1 147

2 5/22/2028 10/15/2028 X Contractor X 147 1 147

3 5/22/2029 10/15/2029 X Contractor X 147 1 147

TOTAL COST FOR REGULAR SERVICES

ADDITIONAL CHEMICAL TOILETS - If requested, the contractor shall furnish the following additional chemical toilets:

TOTAL COST FOR ADDITIONAL TOILETS [(F)x(G)] ADDITIONAL SERVICES - If requested, the contractor shall provide the following additional services:

TOTAL COST FOR ADDITIONAL SERVICES [(H)x(I)x(J)]

TOTAL BID PRICE

DPR 325B Page 3

1 6

FOR DEPARTMENT USE ONLY

Orange Coast District Huntington State Beach Restroom 3 Location (ADA UNITS)

DISTRICT

CHEMICAL TOILET RENTAL AND/OR SERVICE BID FORM - Exhibit B, Attachment 1 Bidder completes (D), (E), (G), (J), TOTAL COSTS, and TOTAL BID PRICE.

ESTIMATED REQUIREMENTS FOR CHEMICAL TOILET SERVICE ARE AS FOLLOWS:

PERIOD OF SERVICEI

T E M

From To

TYPE OF

PROVIDED

BY SERVICE DAYS

SERVICE

FREQUENCY

Weekly Every Other Week

(A)

NO. OF

SERVICE

DAYS FOR

PERIOD

(B)

NO. OF

TOILETS

EACH

SERVICE

(D)

COST PER

TOILET

PER

SERVICE

(E)

COST FOR

SERVICE

PERIOD

[(C)X(D)]

TYPE OF TOILETS (F) NO. OF EXTRA CHEMICAL TOILETS (G) COST PER TOILET

TYPE OF TOILETS (H) NO. OF TOILETS PER SERVICE

(J) COST PER TOILET

— Bidder understands that the quantities below are estimates only, for purposes of comparing bids, and that the State reserves the right to increase or decrease the amount of any item or eliminate any item or items as may be deemed necessary or advisable by the State. Such changes shall not affect the unit price of that item or any other items.

— In case of discrepancy between the unit price and the total set forth for the item, the unit price shall prevail. In case of discrepancy between the stipulated totals and the actual sum of the totals, the actual sum of all items shall prevail.

u n S o n M u e T e d W h u T r i F a t S

(C)

NO. OF TOILETS

SERVICED IN

CONTRACT

PERIOD [(A)X(B)]

(I) NO. OF ADDITIONAL SERVICES

CONTRACTOR NAME

AGREEMENT NO. PAGE

of u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S

PARK UNIT

Hdcp Reg

Handicapped Accessible

Handicapped Accessible

Regular

Regular

CHEMICAL TOILET UNITS TO BE MADE OF

Fiberglass Wood Metal

LOCATION WITHIN PARK UNIT

C26925010 3 4

Ryan.Thorne Highlight

1 5/22/2027 10/15/2027 X Contractor X 147 1 147

2 5/22/2028 10/15/2028 X Contractor X 147 1 147

3 5/22/2029 10/15/2029 X Contractor X 147 1 147

TOTAL COST FOR REGULAR SERVICES

ADDITIONAL CHEMICAL TOILETS - If requested, the contractor shall furnish the following additional chemical toilets:

TOTAL COST FOR ADDITIONAL TOILETS [(F)x(G)] ADDITIONAL SERVICES - If requested, the contractor shall provide the following additional services:

TOTAL COST FOR ADDITIONAL SERVICES [(H)x(I)x(J)]

TOTAL BID PRICE

DPR 325B Page 4

1 6

FOR DEPARTMENT USE ONLY

Orange Coast District Huntington State Beach Restroom 3 Location (WASH STATIONS)

DISTRICT

CHEMICAL TOILET RENTAL AND/OR SERVICE BID FORM - Exhibit B, Attachment 1 Bidder completes (D), (E), (G), (J), TOTAL COSTS, and TOTAL BID PRICE.

ESTIMATED REQUIREMENTS FOR CHEMICAL TOILET SERVICE ARE AS FOLLOWS:

PERIOD OF SERVICEI

T E M

From To

PROVIDED

BY SERVICE DAYS

SERVICE

FREQUENCY

Weekly Every Other Week

(A)

NO. OF

SERVICE

DAYS FOR

PERIOD

(B)

NO. OF WASH

STATION EACH

SERVICE

(D) (E)

TYPE OF TOILETS (F) NO. OF EXTRA CHEMICAL TOILETS (G) COST PER TOILET

TYPE OF TOILETS (H) NO. OF WASH STATIONS PER SERVICE

(J) COST PER WASH STATION

— Bidder understands that the quantities below are estimates only, for purposes of comparing bids, and that the State reserves the right to increase or decrease the amount of any item or eliminate any item or items as may be deemed necessary or advisable by the State. Such changes shall not affect the unit price of that item or any other items.

— In case of discrepancy between the unit price and the total set forth for the item, the unit price shall prevail. In case of discrepancy between the stipulated totals and the actual sum of the totals, the actual sum of all items shall prevail.

u n S o n M u e T e d W h u T r i F a t S

(C)

NO. OF WASH

STATIONS

SERVICED IN

CONTRACT PERIOD

[(A) X (B)]

(I) NO. OF ADDITIONAL SERVICES

CONTRACTOR NAME

AGREEMENT NO. PAGE

of u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S u n S o n M u e T e d W h u T r i F a t S

PARK UNIT

Handicapped Accessible

Handicapped Accessible

Regular

Regular

CHEMICAL TOILET UNITS TO BE MADE OF

Fiberglass Wood Metal

LOCATION WITHIN PARK UNIT

Wash Station

COST PER

WASH STATION

PER SERVICE

COST FOR

SERVICE

PERIOD

[(C) X (D)]

C26925010 4 4

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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.

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:

AGREEMENT/PAPO NO.

C26925010

Contractor Certification Clause

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 of

CONTRACTOR CERTIFICATION CLAUSES

STATEMENT OF COMPLIANCE:

Contractor has, unless exempted, complied with the nondiscrimination program requirements. (GC 12990 (a-f) and CCR, Title 2, Section 8103) (Not applicable to public entities.)

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) Provide that every employee who works on the proposed Agreement will:

1. receive a copy of the company's drug-free 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: (1) the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (GC 8350 et seq.)

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. (PCC 10296) (Not applicable to public entities.)

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.

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.

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 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).

DOMESTIC PARTNERS:

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

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.

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.

a) Current State Employees (PCC 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.

b) Former State Employees (PCC 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. (PCC 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. (PCC 10430 (e))

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)

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.)

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.

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.

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.

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.

PAYEE DATA RECORD FORM STD. 204:

This form must be completed by all contractors that are not another state agency or other government entity.

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?

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

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

CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT OFFICE OF LEGAL SERVICES

DGS OLS 04 (Rev. 01/17)

Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or otherwise proposes to enter into or renew a contract with, a state agency with respect toany contract in the amount of $100,000 or above shall certify, under penalty of perjury, at the time the bid or proposal is submitted or the contract is renewed, all of the following:

1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of theCivil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and

2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies arenot 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.

By (Authorized Signature)

Printed Name and Title of Person Signing

Executed in the County of Executed in the State of

Date Executed

Proposer/Bidder Firm Name (Printed) Federal ID Number

b. DGS PD 843, DVBE Declaration

DPR 479IW (Rev. 4/2026)(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.

Signature____________________

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)

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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.

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)