STATE OF CALIFORNIA DEPARTMENT OF REHABILITATION

REQUEST FOR QUOTE

DR 815 (Rev. 08/15) Page 1 of 2

RFQ NUMBER: QUOTE DUE DATE: TIME DUE:

DOR CONTACT: PHONE: FAX:

E-MAIL:

Line Qty Description

Unique Circumstances:

It is unlawful for any person engaged in business within this state to sell or use any article or product as a "loss leader" as defined in Section 17030 of the Business and Professions Code.

FEDERAL DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

By accepting and fulfilling this agreement for goods and/or services the contractor/vendor certifies that neither it nor its principles is presently debarred, suspended, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal Department or Agency.

(Reference website: http://www.sam.gov)

VOID CONTRACT FOR TAX DELINQUENCY (AB1424)

Any agreement that a state agency enters into after July 1, 2012, is void if the contract is between a state agency and a contractor whose name appears on either list of the 500 largest tax delinquencies pursuant to Section 7063 or 19195 of the Revenue and Taxation Code. (Public Contract Code sec.

10295.4). In accordance with Public Contract Code Section 10295.4, State Agencies are required to cancel agreements with entities that appear on either list, the Franchise Tax Board list, located at: https://www.ftb.ca.gov/aboutFTB/Delinquent_Taxpayers.shtml, Board of Equalization located at:

http://www.boe.ca.gov/cgi-bin/deliq.cgi

Award will be made based on lowest cost unless unique circumstances dictate otherwise. Bid quotes will be accepted by U.S. Mail, E-mail, or FAX.

Your bid quote must include the RFQ number and all information requested. FAX bid quotes will be considered only if they are sent to fax number listed above. Bid quotes sent to any other fax number or DOR Contact will not be considered. To be considered, all pages of the faxed bid quote must be received prior to the bid opening time. The information received will be considered “the complete bid”. Please be advised, there is a heavy demand placed on fax machines receiving bids and the State assumes no responsibility if a supplier cannot transmit the bid via fax or if the entire bid is not received prior to the bid opening time.

Current State of California Bidder Instructions (GSPD-451) apply to this solicitation. The GSPD-451 is available at the DGS Procurement Division website under Model Bidder Instructions tab at: http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx.

Current State of California General Provisions (GSPD-401 non-IT or IT) also apply to this solicitation. The GSPD-401 is available at the DGS Procurement Division website located under General Provisions (IT & Non-IT) tab at: http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx .

For Consumer purchases – DOR will make every effort to solicit quotes from small businesses whenever possible.

By submitting a bid quote, you are acknowledging your acceptance of the Terms and Conditions of the Bidder Instructions and General Provisions.

For Administrative Purchases – The Small Business preference and DVBE advertising requirements apply to this solicitation. The DVBE Incentive has been waived for this solicitation. The Small Business preference regulations are located at the DGS Procurement Division website at:

http://www.pd.dgs.ca.gov/smbus/default.htm. The DVBE program requirements are located at the DGS Procurement Division website at:

http://www.documents.dgs.ca.gov/pd/delegations/STD840.doc. The current DVBE incentive and exemption requirements are located at the DGS Procurement Division website at: http://www.pd.dgs.ca.gov/dvbe/dvbeincentive.htm.

For IT goods and/or services, special provisions apply to this solicitation. The IT Special Provisions Modules are available at the DGS Procurement Division website under IT Modules (Special Provisions) tab at: http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx.

The State is required to purchase recycled content products whenever possible. The Recycled Content Certification must be included with your bid quote. The verification form is available at: http://www.calrecycle.ca.gov/BuyRecycled/StateAgency/Forms/CalRecycle074.pdf.

By submitting a bid quote, you are acknowledging your acceptance of the terms and conditions of the Small Business preference, DVBE advertising requirements, DVBE incentive and Bidder Instructions and General Provisions.

https://www.ftb.ca.gov/aboutFTB/Delinquent_Taxpayers.shtml http://www.boe.ca.gov/cgi-bin/deliq.cgi http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx http://www.pd.dgs.ca.gov/smbus/default.htm http://www.documents.dgs.ca.gov/pd/delegations/STD840.doc http://www.pd.dgs.ca.gov/dvbe/dvbeincentive.htm http://www.dgs.ca.gov/pd/Resources/ModelLanguage.aspx http://www.calrecycle.ca.gov/BuyRecycled/StateAgency/Forms/CalRecycle074.pdf

STATE OF CALIFORNIA DEPARTMENT OF REHABILITATION

REQUEST FOR QUOTE

DR 815 (Rev. 08/15) Page 2 of 2

RFQ NUMBER: DOR CONTACT:

Supplier Name Supplier Address, City/State, Zip Person Contacted Phone Number Fax Number Certified Small/Micro Business Yes # No SM MB DVBE Date Quote Received Date Quote Expires Seller’s Permit Warranty Period Delivery Date Line Qty Description Unit $ Extension 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

FOB Destination, Freight Prepaid Price of freight included in cost of commodity – no additional freight charges added by vendor. State does not own goods during shipment.

FOB Destination, Freight Prepay and Add Seller prepays freight and adds cost to the invoice. State accepts responsibility for freight upon delivery. Cost of freight must be noted and added in price extension. If freight costs are $50.00 or more, the vendor must attach a copy of the actual freight bill with the invoice to process payment. Freight costs of $500 or more must be approved by Transportation Management call (916) 376-1888 for best rates.

FOB Origin, Freight Collect State accepts ownership responsibility for merchandise at the Seller’s dock and pays freight charges. This is not a suggested method, if used Transportation Management must be called at (916) 376-1888. Cost of freight is an evaluation item and must be noted and added in price extension.

Total Quote (Tax is not an evaluation item, add tax to the purchase order)

PREPARED BY:

PRINT NAME:

DATE: