CS269001_Exhibit_B-Attachment_1-DS_1166.pdf

This is a Benefits Summary Attachment form (DS 1166) for the State of California Health and Human Services Agency, Department of Developmental Services, related to contract CS269001 for laundry services at Canyon Springs Community facility in Cathedral City, California. The form serves as a required submission document to accompany monthly invoices and is used to document hourly wages and benefits for employees providing laundry services. The form requires contractors to list employee names, hourly wages, hours worked, hourly benefits rates, and calculate total costs by multiplying hours worked by hourly benefits amounts. The form must be completed monthly for each service period and submitted with corresponding invoices to facilitate proper billing and compensation tracking.

The document emphasizes contractor compliance with Government Code Section 19134, noting that failure to adhere to its provisions constitutes material breach of contract subject to immediate termination at the state's discretion. All contract documents related to Section 19134 implementation are subject to audit by the Department of General Services, Bureau of State Audits, and other state designees. This form represents a standard administrative requirement for laundry service contractors working with the Department of Developmental Services and establishes accountability measures for wage and benefits documentation throughout the contract term.