CVD_C25730001_San_Joaquin_Sector_Water_Testing___Analysis.pdf

Service Contract

MILLERTON LAKE SRA

San Joaquin Sector Water Testing and Analysis

Fresno, California

No. C25730001

July 2025

STATE OF CALIFORNIA

NATURAL RESOURCES AGENCY

DEPARTMENT OF PARKS AND RECREATION

� State of California • Natural Resources Agency

� DEPARTMENT OF PARKS AND RECREATION

P .0. Box 942896 • Sacramento, CA 94296-0001

Request for Quote (RFQ) Small Business Option

RFQ#: C25730001

San Joaquin Sector Water Testing and Analysis

Quotes due on July 16, 2025

Gavin Newsom, Governor

Armando Quintero, Director

As a State of California certified Small Business (SB), you are invited to review and respond to this contracting opportunity for services offered by the Department of Parks and Recreation, Central Valley District, San Joaquin Millerton Lake SRA. Government Code Section 14838.5 allows state agencies to contract with California certified SBs·for goods, services, and information technology for up to $249,999.99 as long as the agency obtains price quotations from two or more certified SBs, including microbusiness(es) (MBs) or DVBEs with the condition that the contract award, if made, is to a California certified SB (MB) or DVBE.

To submit a quote for these services, you must comply with the instructions contained in this document as well as the requirements stated in the State's Scope of Work (SOW). By submitting a Quote, your firm agrees to the terms and conditions stated in this RFQ.

Any questions regarding this contracting opportunity must be submitted in writing to the Department Contact person below prior to June 09, 2025, by 2:00 p.m. Read the attached document carefully.

Responses to this RFQ and any required copies must be submitted via email to Theresa.Acosta@parks.ca.gov by 2:00 p.m. on July 16, 2025.

California Department of Parks and Recreation San Joaquin Sector, Millerton Lake SRA

Central Valley District Theresa Acosta

22708 Broadway St.

Columbia, CA 95310

209-536-5930 Theresa.Acosta@parks.ca.gov

KEY ACTION DATES

SJ Millerton Lake SRA Contract: C25730001

Listed below are the key action dates and times by which the actions must be taken or completed. All dates after the submission of Quotes are approximate and may be adjusted by DPR without addendum to this RFQ. All times are Pacific Standard Time (PST).

Key Action Date

Release of RFQ June 30, 2025

Q & A Due by July 09, 2025, by 2:00 pm PST

Submission of Quotes July 16, 2025, by 2:00 pm PST

Review of Quote Submissions July 16, 2025

Anticipated Award July 17, 2025

Anticipated Contract Start Date August 1st , 2025

INQUIRIES/QUESTIONS

Written questions must be submitted to Theresa.Acosta@parks.ca.gov and received by the date mentioned in the Q&A Submission due date referenced in the Key Action Dates above. If a bidder submits a question after the scheduled date(s), DPR will attempt to answer the question, but does not guarantee that the answer will be provided prior to the due date.

QUOTE SUBMISSION

If your firm is interested in submitting a Quote for this opportunity, please review and submit the following as part of the Quote:

1. Comp!eted Request for Quote Cover Sheet (Attachment 1)

2. Completed Request for Quote Checklist (Attachment 2)

3. Completed Quote Worksheet (Attachment 3)

4. Required Attachments (Attachment 4)

SMALL BUSINESS REGULATIONS

Contract:C25730001

This RFQ is allowed by Government Code section 14838.5 (a) and (b) and may only be awarded to a certified Small Business, including microbusinesses, without advertising in an amount not to exceed $249,999.99.

DVBE PARTICIPATION

This RFQ procurement vehicle is the Small Business Option. The DVBE participation requirement does not apply.

GENERAL TERMS AND CONDITIONS

The General Terms and Conditions for Non-IT services contracts will be incorporated in the agreement resulting from this RFQ by reference to the Internet site:

https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List Folder/Standard-Contract-Language

The State objects to and will not evaluate or consider any additional terms or conditions submitted by a bidder. This applies to any language appearing in documents attached as part of the bidder's Quote. In signing and submitting a Quote, the bidder agrees that any additional terms and conditions, whether submitted intentionally or inadvertently, shall have no force or effect. Quotes that reference a bidder's own terms or conditions may be subject to rejection.

METHOD OF AWARD

This solicitation shall be awarded to the lowest responsive and responsible bidder meeting all administrative and technical requirements, terms, and conditions of this solicitation. If a bidder is determined to be non-responsive or non-responsible, the Quote may be rejected.

A responsive bidder submits a Quote compliant with the solicitation requirements and indicates performance without material deviation from the terms and conditions of the proposed contract.

A responsible bidder submits a responsive Quote and possesses the experience, facilities, reputation, financial resources, and other factors existing at the time of contract award.

AMENDMENTS

Consistent with the terms and conditions of this solicitation and resulting contract, and upon mutual consent of both parties, DPR may execute written amendments to the contract resulting from this

RFQ.

DARFUR CONTRACTING ACT CERTIFICATION FORM

Contract:C25730001

All bidders must complete the Darfur Contracting Act Certification Form and include it with the bid response.

For the reasons described in PCC Section 104 75, the California Legislature and the Governor signed into law the Darfur Contracting Act of 2008, which precludes State agencies generally from contracting with "scrutinized" companies that do business in the African nation of Sudan. "Scrutinized" companies, as defined in PCC Section 10476, are ineligible to, and cannot, bid on or submit a proposal for a Contract with a State agency for goods or services. Pursuant to PCC Section 104 78, if a bidder currently or within the previous three years has had business activities in Sudan, it must certify that it is not a "scrutinized" company.

A "scrutinized" company may still, however, submit a bid if the company first obtains permission from the Department of General Services (DGS), as described in PCC Section 10477(b).

EXECUTIVE ORDER N-6-22 - RUSSIA SANCTIONS

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals. "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. By submitting a bid or proposal, Contractor represents that it is not a target of Economic Sanctions. 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.

PAYEE DATA RECORD FORM

All bidders must complete the Payee Data Record Form (STD. 204/STD. 205) listing their Taxpayer Identification Number and include it in the bid response.

A completed STD. 204 and DPR 88 is required for all bidders entering into a transaction that may lead to a payment from the State. Bidders who do not wish to complete the STD. 204 may elect not to do business with the State.

BIDDER DECLARATION FORM

All bidders must complete the GSPD 05-105 Bidder Declaration Form and include it with their Quote.

When completing the declaration, bidders must identify all subcontractors proposed for participation in the contract. A subcontractor is any person, firm, corporation, or organization contracting to perform any part of the prime's contract Bidders awarded a contract are contractually obligated to use the subcontractors for the corresponding work identified, unless the State agrees to a substitution, and it is incorporated by amendment to the contract.

COMMERCIALLY USEFUL FUNCTION

Contract:C25730001

A Certified Small Business (SB) or Microbusiness (MB) shall provide goods or services that contribute to the fulfillment of the contract requirements by performing a Commercially Useful Function (CUF).

CUF is defined as doing all of the following:

1. Is responsible for the execution of a distinct element of the work of the contract (including the supplying of service and goods);

2. Carries out its obligation by 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 quality, ordering, installing, if applicable, and making payment; and

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

A SB or MB contractor, subcontractor or supplier is not performing a CUF if its role is limited to that of an extra participant in the transaction, contract or project through which funds are passed to obtain the appearance of SB or MB participation.

All SB, MB or DVBEs must complete and submit the DPR 87 CUF Certification and submit with their Quote.

Exhibit A

SCOPE OF WORK

SJ Millerton Lake SRA Contract:C25730001

Furnish all labor, tools, and equipment as necessary to perform Analysis on Water and Wastewater Samples.

-Bacteriological water samples analyzed for Total Coliforms Presence or Absence of Total or Fecal Coliform, or E. coli.

- Raw surface water source for Total Coliform and E. coli bacteria. The coliform test shall be performed using a density analytical method and the results reported in units of M.P.N. using the MMO-MUG method.

- Raw surface water source for Nitrite (As N) monitoring triennially and Nitrate (As N) monitoring annually.

Wastewater samples analyzed for Biochemical Oxygen Demand, Total Nitrogen, Electrical Conductivity monitored every Quarterly year.

The laboratory will also include retests, if necessary.

Park staff will collect weekly samples for analysis. Park staff will label all samples with the date, time and location of collection. Samples to be analyzed must be picked up the same day and the tests performed tc California State Water Resource Control Board (S.W.R.C.B.) standards by the vendor within 24 hours from the time the samples were collected by park staff. The vendor will be required to pick up ( or otherwise provide for sample delivery to the laboratory) the samples from 5290 Millerton Road, Friant, CA 93626 (Maintenance Yard refrigerator), and transport the samples to the vendor's laboratory for analysis.

The laboratory will provide analytical results to Millerton Lake S.R.A. designated staff and electronic to C.S.W.R.C.B. Division of Drinking Water through the California Laboratory Intake Portal (C.L.I.P.)

process. All test results for the month must be provided to staff no later than the 10th day of the following month. The laboratory will also provide immediate notification of Presence in any Bacteriological water sample to designated park staff. The laboratory shall report Nitrate, Nitrite analytical results through C.L.I.P. process. by the 10th day of the month following the month in which the analyses were completed.

Attachment 1

COVERSHEET

SJ Millerton Lake SRA Contract:C25730001

Request for Quote Cover Sheet for Non-IT Services

QUOTE DUE DATE: July 16, 2025

Vendor name and address:

Contact Name:

Phone:

Fax:

Authorized Vendor Representative (Print):

Title:

Signature:

Quotes must be sent to DPR via email before 2:00 pm on the due date.

RFQ# C25730001

ARE YOU A CA CERTIFIED SMALL

BUSINESS (required)?

D YES

D NO

SB Certification #:

Date:

Federal Employer Identification Number: ______________ _

Bidder offers and agrees that if this response is accepted within 45 calendar days following the date the response is due, all items and services upon which prices are quoted shall be furnished at the prices set opposite each item, delivered at the designated point(s) by the method of deliver and within the times specified and subject to the attached General Terms and Conditions. By signing above, with inclusion of the date of signature, the above signed representative is authorized to bind their company contractually to the State of California for the duration of the contract period.

Attachment 2

CHECKLIST

The RFQ response must include all the following to be considered responsive:

D Request for Quote Cover Sheet (Attachment 1 )

D Request for Quote Checklist (Attachment 2)

D Quote Worksheet (Attachment 3)

D Required Attachments (Attachment 4) o Payee Data Record (STD 204/STD 205) o Payee Data Record Supplement (DPR 88) o Bidder Declarations (GSPD 05-105) o DVBE Declarations (DGS PD 843) o California Civil Rights Laws Certification (if over $100,000.00) o Contractor Certification Clauses (CCC 04/2017) o Darfur Contracting Act Certification (DPR 7 4) o CUF Certification (DPR 87)

Participant Resumes

SJ Millerton Lake SRA Contract:C25730001

Attachment 3

COST WORKSHEET

Millerton Lake State Recreation Area Water Testing & Analysis of Water Samples

SJ Millerton Lake SRA Contract:C25730001

The bidder hereby proposes to furnish all labor, materials, tools, and equipment as necessary to provide water testing and analysis of water samples collected from 2 water systems and 1 water treatment intake at Millerton Lake State Recreation Area according to the attached specification sheet, complete and ready for use in accordance with the contract documents, therefore, for the following stipulated sums which prices include all applicable taxes and other expenses:

Item

1.

2.

3.

4.

5.

6.

7.

Description

Drinking Water Presence/Absence, Total & Fecal Coliform-3 tanks once per week

Drinking Water-HPC Microbiological Test if Needed

Raw water intake at Treatment plant-3x5 total & Fecal Coliform- Enumeration (MPN)-

Raw Water Intake at Treatment Plant- Nitrate Monitoring

Raw Water intake at Treatment Plant - Nitrite Monitoring. + 0( every other year)

Retest of items 3 & 4 above if needed

Retest of Item 1 Above if needed

Quantity

Once a Week x 3 samples (156 samples a year)

Once a Month x 3 samples (36 samples a year)

Once a Month x 1 intake (12 intakes a year)

Once per year x 1 intake (12 intakes a year)

Biennial x 1 intake

3 per year x 1 intake (3 intakes a year)

12 per year x 3 samples (36 samples per year)

Unit Price

_ __ _.per sample

___ __,per sample

___ ___,per sample

___ ___,per sample

___ _,per sample

___ _.per sample

___ _,per sample

TOTAL BID for 36 MONTHS (12 MONTHS X 3 YEARS)

In case of discrepancy between the unit price and the total set forth for the item, the unit price shall prevail; however, if the amount set fourth as a unit price is ambiguous or uncertain for any cause, or is omitted, the amount set forth in the "item total" column shall be divided by the estimated quantity for the item and the price thus obtained shall be the unit price. In case of discrepancy between the stipulated totals and the actual sum of the totals, the actual sum of all item totals shall prevail. Any test quantities beyond the number specified in this contract (per week, month or year) above, will be considered outside of Contract and should be invoice separately as such.

The foregoing quantities are approximate only, being given solely as basis for the preparation and comparison of bids, and the state does not expressly or by implication, agree that the actual amount of work will correspond therewith. 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's Representative.

Such changes shall not affect the unit price of that or any other item.

All work shall be performed in a professional manner and conform to standards of high quality to the entire satisfaction of the State. All work shall be done on time basis outlined in the specifications during the period of NTP- 36 Calendar Months

Attachment 4

REQUIRED ATTACHMENTS

Payee Data Record (STD 204) and Supplement (DPR 88)

SJ Millerton Lake SRA Contract:C25730001

All Contractors must complete the STD 204 and DPR 88 and return with your Quote.

https://www.documents.dgs.ca.gov/dgs/FMC/PDF/Std204.pdf

Bidder Declaration

Bidders must complete this form and identify current California certifications and any subcontractors.

DVBE Declarations

All DVBE Contractors must complete the Bidder Declaration DGS PD 843 and include with your Quote.

https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd 843.pdf

California Civil Rights Laws Certification

Pursuant to PCC 2010, all bidders that submit a Quote in excess of $100,000 must complete the California Civil Rights Laws Certification and return with your Quote.

https:/ /www.documents.dgs.ca.gov/dgs/FMC/DGS/OLS004. pdf

Contractor Certification Clauses (CCC 04/2017)

All Contractors must complete the Contractor Certification Clauses and include with your Quote.

https://www.dgs.ca.gov/-/media/Divisions/0LS/Resources/CCC- 042017.pdf?la=en&hash=4DE3E4DC414511AE378794200BA43E8F91 C758EE

Darfur Contracting Act Certification (DPR 74)

Pursuant to PCC 104 78, all Contractors must complete the Darfur Contracting Act Certification and include with your Quote.

CUF Bidder Certification (DPR 87) All California SB, MB, and DVBE suppliers contracting and subcontracting must complete this certification form and include with your Quote.

Participant Resumes Consultant services contracts of $5,000 or more shall provide a completed resume for each contract participant who will exercise a major administrative role or major policy or consultant role, as identified by the contractor.

STATE OF CALIFORNIA- DEPARTMENT OF FINANCE

PAYEE DATA RECORD

I Print Form I I Reset Form I

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

Section 1 - Pa�ee 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

Check one 1 box onl that matches the enti

□ SOLE PROPRIETOR/ INDIVIDUAL

□ SINGLE MEMBER LLC Disregarded Entity owned by an individual

□ PARTNERSHIP

□ ESTATE OR TRUST

I E-MAIL ADDRESS

ee listed in Section 1 above. See instructions on CORPORATION (see instructions on page 2)

D MEDICAL (e.g., dentistry, chiropractic, etc.)

D LEGAL (e.g., attorney services)

D EXEMPT (e.g., nonprofit)

□ ALL OTHERS

Section.._ 3 - Tax Identification NumJ:>er

Enter your Tax Identification Number (TIN) in the appropriate box. The TIN must a e2 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 E mployer 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 m status chan enc below.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE E-MAIL ADDRESS

SIGNATURE DATE TELEPHONE (include area code)

Section 6 - Paymg State Agency Please return comoleted form to·

STATE AGENCY/DEPARTMENT OFFICE UNIT/SECTION

MAILING ADDRESS FAX I TELEPHONE (include area code)

CITY STATE ZIP CODE E-MAIL ADDRESS

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 p�yments.

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, ii 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 Callfomia Revenue and Taxation Code (R&TC).

• __ _ _ ___ ~ ___ __ _. _ ... ... _ _ _ S�!;\iQ11 1 - f aIyee lrifonnation _ . _ _ _

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 (LLCs) 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 OBA, 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 OBA, trade, or fictitious business names under Business Name.

Business Name - Enter the business name, OBA 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 subsequent changes to the remittance address

Sectien 2 - Entit.v TYoe -

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

Individual • Sole Proorielorshio • Grantor (Revocable LivinA) Trust dlsreoarded for federal tax lourposes Sole Proorietor/lndivldual Limited Liability Comoanv /LLCl owned bv an Individual and is disreoarded for federal tax ourooses Sinole Member LLC-owned bv an individual Partnerships • Limited Liability Partnerships (LLPl • and, LLC treated as a Partnership Partnershios Estate • Trust (other than disreoarded Grantor Trust) Estate or Trust Corporation that is medical in nature (e.g., medical and healthcare services, physician care, nursery Corporation-Medical care, dentlstrv etc. • LLC that is to be taxed like a Corooralion 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 matt.ers, etc.l • LLC that is to be taxed like a Corooralion and is leoal in nature Corporation that aualifles for an Exemot status, includlna 501{c) 3 and domestic non-orofrt coroorations. Corooration-Exemot Corporation that does not meet the qualifications of any of the other corporation types listed above • LLC Corporation-All Other that is to be taxed as a Corporation and does not meet anv of the other corporation tvpes listed above

Section 3 - Tax Identification Number The State of California requires that all parties entering into business transactions that may lead to payment(s) from the state provide their Taxpayer Identification Number (TIN). The TIN is required by R&TC sections 18646 and 18661 to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information reitur_ns as required b the IRC section 6109(a) and R&TC section 18662 arid its re ulations.

_________ S=e=c t=io""n ..... 4-.. -:- payee Residency_,S,.,, t at=u=s�----

Are you a California resident or nonresident?

• A corporation will be defined as a "resident" if ii has a permanent place of business in California or is qualified through the Secretary of State to do business in

California.

• A partnership is considered a resident partnership if it has a permanent place of business in California.

• An estate is a resident if the decedent was a California resident at time of death.

• A trust is a resident if at least one trustee is a California resident.

o For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:

Withholding Services and Compliance Section: 1-888-792-4900 E-mail address: wscs.gen@ftb.ca.gov For hearing impaired with TDD, call: 1-800-822-6268 ���- Website: www.ftb.ca.gov

Section 5 - eertification Provide the name, title, email address, signature, and telephone number of individual completing this form and date completed. In the event that a SSN or ITIN is provided, the individual identified as the tax liable party must certify the form. Note: the signee may differ from the tax liable party in this situation if the signee can vide a eower of attorneY. documented for the in State A enc is section must be com t

Section 7{b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency. which requests an Individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number Is solicited, and what uses will be made of ii. It is mandatory to furnish the Information requested. Federal law requires that payment for which the requested informa\ion is not provided is subject to federal backup withholding and state law Imposes noncompliance penalties of up to $20,000. You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

Ali questions should be referred to the requesting state agency listed on the bottom front of this form.

State of California - Natural Resources Agency

PAYEE DATA RECORD SUPPLEMENT

GOODS VS. SERVICES

FOR DEPARTMENT USE ONLY

SUPPLIER ID. (If Known )

UPLOAD TO SUPPLIER

RECORD IN Fl$Cal

All suppliers doing business with the Department of Parks and Recreation must complete this form.

Vendor Information PAYEE'S LEGAL BUSINESS NAME (Type or Print)

I

TAX ID NUMBER

Submission Checklist

Upon completion, submit to the requesting department listed in box/section 6 of the attached STD. 204:

D STD. 204, Payee Data Record D STD. 205, Payee Data Record Supplement (If applicable) (Remit-to Address: different than Mailing, or multiple) D DPR 88, Payee Data Record Supplement - Goods vs. Services

Will tangible goods be provided?

□ Yes □ No

Attach: No additional attachments needed.

D Seller's Permit (No. )

D Certificate of Registration (No.

□ NO ATTACHMENT NEEDED

- No inventory or sales staff in CA.

Certificate of Acceptance

When doing business with the Department of Parks and Recreation I accept and will abide by the State's IT General Provisions or General Provisions Non-IT Commodities, as applicable, located on the internet at www.pd.dgs.ca.gov/modellang/GeneralProvisions.htm.

Authorized Representative - complete and sign (REQUIRED)

AUTHORIZED REPRESENTATIVE'S SIGNATURE PRINTED NAME

2S

EXECUTED IN THE COUNTY AND STATE OF DATE

DPR 88 (Rev. 4/2021)(Excel 4/26/2021)

DPR 88, PAYEE DATA RECORD SUPPLEMENT (GOODS VS. SERVICES)

INSTRUCTIONS

All current and potential vendors/suppliers must have completed both the STD. 204 and DPR 88 in its entirety prior to commencing business with the Department of Parks and Recreation (DPR). STD. 205 is optional dependent upon remittance information (see form for details).

DEPARTMENT INSTRUCTIONS

Send DPR 88, STD. 204 (with section 6 pre-filled on the STD. 204), and STD. 205 to vendor/supplier for completion.

Fill in Supplier JD if known in appropriate box in the top, right corner of the DPR 88. Once forms are returned, check for completeness. Resend to vendor/suppler if necessary until all information, signatures and attachments are included.

Once complete, upload into the Fl$Cal Systems Supplier Record for Fl$Cal review and approval.

Original forms must be retained in the procurement file at the DistricUSection level.

DPR 88 COMPLETION INSTRUCTIONS FOR VENDOR/SUPPLIER

Complete all required information and return form to the requesting department listed in Box/Section 6 of the STD.

204.

Upon completion, submtt to the requesting department[JSif�L.b.wrlsedio.D.B...Df.ltie....allac.bed.sIICL2� 0 STD. 204, Payee Data Record r._ check when finished with each form D STD. 205, Payee Data Record Supplemen Rem�-to Address: multiple or d" rent than Mailing Address) 0 DPR 88, Payee Oala Record Supplement

WIii tangible ;oods be rovld.cl?

□Yes If.yes, complete the Attach: appropriaffJ checkbox below 0 Sel/ers Permit (NO. _______ _,

□ Certificate of RegistratJon (No. ____ _

0 NO ATTACHMENT NEEDED

• No inventory or sates starr fn CA.

----1 If you have inventory or sales staff in CA, choose appropriate checkbox, enter permit or certificate no.

in space previded, & attach copy of permit/cert .

If you do N0T have inventory or sales staff in CA, check here and no add;t;onal attachments are needed.

Authorized Representative - complete and sign (REQUIRED)

AUTHORIZED REPRESENTATIVE.'S SIGNATURE

� I This section must be signed with ExEcuTeo IN THE couNTY AND STATE 4 all boxes/fields completed.

DPR 88 (lnstructions)(Rev. 4/2021)

PRINTED NAME

I

I DATE

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 Ll (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 �r co�any O}lll!J,at least 51 % of the equipment provided in this contract (quantity and value)? Yes LJ No LJ N/ALJ

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?

CERTIFICATION: 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-Department of General Services, Procurement Division

GSPD-05-l0S (REV 08/09) Instructions

BIDDER DECLARATION Instructions

All prime bidders (the firm submitting the bid) must complete the Bidder Declaration.

1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled"None" and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the line:

Microbusiness (MB)

• Small Business (SB)

• Nonprofit Veteran Service Agency (NVSA)

Disabled Veteran Business Enterprise (DVBE)

1.b. Mark either"Yes" or"No" to identify whether subcontractors will be used for the contract. If the response is

"No';proceed to Item #1.c. lf"Yes';enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors.

Bidders certified as MB,SB, NVSA, and/or DVBE must provide a commercially useful function as defined in Military and Veterans Code Section 999 for DVBEs and Government Code Section 14837(d)(4)(A) for small/ microbusinesses.

Bids must propose that certified bidders provide a commercially useful function for the resulting contract or the bid will be deemed non-responsive and rejected by the State. For questions regarding the solicitation, contact the procurement official identified in the solicitation.

Note: A subcontractor is any person, firm, corporation, or organization contracting to perform part of the prime's contract.

1.c. This item is only to be completed by businesses certified by California as a DVBE.

(1) Declare whether the prime bidder is a broker or agent by marking either"Yes" or"No''. The Military and Veterans Code Section 999.2 (b) defines"broker" or"agent" as a certified OVBE contractor or subcon tractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value ofthe materials, supplies, services, and of each piece of equipment provided under the contract.

(2) If bidding rental equipment, mark either"Yes" or"No" to identify ifthe prime bidder owns at least 51 % of the equipment provided (quantity and value). lfnot bidding rental equipment, mark"N/A"for"not applicable."

2. If no subcontractors are proposed, do not complete the table. Read the certification at the bottom of the form and complete"Page _ of_" on the form.

If subcontractors will be used, complete the table listing all subcontractors. If necessary, attach additional pages and complete the"Page_ of_" accordingly.

2. (continued) Column Labels

Subcontrador Name, Contact Person, Phone Number & Fax Number-List each element for all subcontractors.

Subcontrador Address & Email Address-Enter the address and if available, an Email address.

CA Certification (MB, SB, NVSA, OVBE or None)-lf the subcontractor possesses a current State of

California certification(s), verify on this website (www.eprocure.pd.dgs.ca.goy).

Work performed or goods provided for this contract-Identify the distinct element of work contained in the contract to be performed or the goods to be provided by each subcontractor. Certified subcontractors must provide a commercially useful function for the contract. (See paragraph 1.b above for code citations regarding the definition of commercially useful function.) If a certified subcontractor is further subcontract ing a greater portion of the work or goods provided for the resulting contract than would be expected by normal industry practices, attach a separate sheet of paper explaining the situation.

Corresponding% of bid price-Enter the corresponding percentage of the total bid price for the goods and/or services to be provided by each subcontractor. Do not enter a dollar amount.

Good Standing?-Provide a response for each subcontractor listed. Enter either"Yes" or"No"to indicate that the prime bidder has verified that the subcontractor(s) is in good standing for all of the following:

Possesses valid license(s) for any license(s) or permits required by the solicitation or by law

If a corporation, the company is qualified to do business in California and designated by the State of California Secretary of State to be in good standing Possesses valid State of California certification(s) if claiming MB, SB, NVSA, and/or DVBE status

51% Rental?-This pertains to the applicability of rental equipment. Based on the following parameters, enter either"N/A" (not applicable),"Yes" or"No"for each subcontractor listed.

Enter"N/A"if the:

Subcontractor is NOT a DVBE (regardless of whether or not rental equipment is provided by the subcontractor) or Subcontractor is NOT providing rental equipment (regardless of whether or not subcontractor is a

DVBE)

Enter''Yes"ifthe subcontractor is a California certified DVBE providing rental equipment and the subcontractor owns at least 51 % of the rental equipment (quantity and value) it will be providing for the contract.

Enter"No"if the subcontractor is a California certified DVBE providing rental equipment but the sub contractor does NOT own at least 51% of the rental equipment (quantity and value) it will be providing.

Read the certification at the bottom of the page and complete the "Page_ of_" accordingly.

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: ___________ _

SECTION2

SCPRS Ref. Number. __________ _

(FOR STATE USE ONLY)

APPLIES TO ALL DVBEs. Check only .Q.!1! 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 retum(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) (Signature of DV Manager) (Date Signed)

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STATE OF CALIFORNIA

CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT

DGS OLS 04 (Rev. 01/17)

DEPARTMENT OF GENERAL SERVICES

OFFICE OF LEGAL SERVICES

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 to any 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 the Civil 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 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).

CERTlflCATION

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

Executed in the County of Executed in the State of

Date Executed

Contractor Certification Clauses

CCC 04/2017

GERTI Fl CATION

I, the official named below, CERTIFY UNDER PENAL TY 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 I

Executed in the County 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…