IFB_-_Attachment_A_Bid_Forms__C26802376_.pdf

Attachment A – Bid Forms

State of California Invitation for Bid No.: C26802376 Department of Parks and Recreation STATEWIDE PROGRAM SUPPORT CENTER District Facilities Management Program Comprehensive Janitorial Services (Bay F-J)

ATTACHMENT A - BID FORMS

Bidder’s Checklist (1 page) Exhibit B, Attachment I, Service Contracts Bid Form (DPR 940B – 1 Page) Cost Sheet (5 – Pages) Payee Data Record (STD 204 – 2 Pages) Payee Data Record Supplement (STD 205 – 2 Pages) Payee Data Record Supplement (DPR 88 – 1 Page) Bidder’s Declaration (GSPD 05-105 – 2 Pages) Disabled Veteran Business Enterprise Declarations (DGS PD 843 – 1 Page) Commercially Useful Function – Bidder Certification (DPR 87 – 1 page) Darfur Contracting Act (DPR 74 – 1 Page) California Civil Rights Laws Attachment (DGS OLS 04 – 1 Page) Contractor Certification Clauses (CCC-1005 – 4 Pages) Artificial Intelligence (AI) Disclosure (DPR 97B – 3 Pages) If incorporated, the California Secretary of State standing for your firm Certification of Small Business, DVBE, etc. for your firm from Cal-eProcure Copy of valid California city or county business license or permit for your firm

If not a California business, an affidavit that business is in good standing with the state, province, or country in which business is headquartered

Please note: Any Subcontractors performing work and/or providing goods must complete the documents listed below and be included in the bid to be considered responsive.

Payee Data Record Supplement (DPR 88 – 1 Page) Commercially Useful Function – Bidder Certification (DPR 87 – 1 page) Artificial Intelligence (AI) Disclosure (DPR 97B – 3 Pages) If incorporated, the California Secretary of State standing for subcontractor(s) Certification of Small Business, DVBE, etc. for subcontractor(s) from Cal-eProcure Copy of valid California city or county business license or permit for subcontractor(s)

If not a California business, an affidavit that business is in good standing with the state, province, or country in which business is headquartered

Attachment A – Bid Forms

State of California Invitation for Bids No.: C26802376 Department of Parks and Recreation District STATEWIDE PROGRAM SUPPORT CENTER District Facilities Management Program Comprehensive Janitorial Services (Bay F-J)

BIDDER’S CHECKLIST

A complete bid package shall consist of the items identified below. Return this checklist along with all required documentation to ensure responsiveness to this Invitation for Bid.

Required Bid Forms Bidder’s Checklist (1 page) Exhibit B, Attachment I, Service Contracts Bid Form (DPR 940B – 2 Pages) Cost Sheet (5 Pages) Payee Data Record (STD 204 – 2 Pages) Payee Data Record Supplement (STD 205 – 2 Pages) Payee Data Record Supplement (DPR 88 – 1 Page) Bidder’s Declaration (GSPD 05-105 – 2 Pages) Disabled Veteran Business Enterprise Declarations (DGS PD 843 – 1 Page) Commercially Useful Function – Bidder Certification (DPR 87 – 1 page) Darfur Contracting Act, if applicable (DPR 74 – 1 Page)

N/A – Form is not applicable California Civil Rights Laws Attachment (DGS OLS 04 – 1 Page) Contractor Certification Clause (CCC-1005 – 4 Pages) Artificial Intelligence (AI) Disclosure Form (DPR 97B – 3 Pages) If incorporated, the California Secretary of State Business standing for your firm.

Certification of Small Business, DVBE, etc. for your firm from Cal-eProcure’s website Copy of valid California city or county business license or permit for your firm

If not a California business, an affidavit that business is in good standing with the state, province, or country in which business is headquartered

Please note: Any Subcontractors performing work and/or providing goods must complete the documents listed below and be included in the bid to be considered responsive.

Payee Data Record Supplement (DPR 88 – 1 Page) Artificial Intelligence (AI) Disclosure Form (DPR 97B – 3 Pages) Commercially Useful Function – Bidder Certification (DPR 87 – 1 page) If incorporated, the California Secretary of State Business standing for subcontractor(s) Certification of Small Business, DVBE, etc. for subcontractor(s) from Cal-eProcure’s website Copy of valid California city or county business license or permit for the subcontractor(s)

If not a California business, an affidavit that business is in good standing with the state, province, or country in which business is headquartered

NOTE TO BIDDER: In addition to the above, the Contractor shall be ready to furnish the following to DPR upon award.

• Copy of General Liability Insurance

• Copy of Workers Compensation Insurance

• Copy of Automobile Insurance

DPR 940B (Rev. 5/2011)(Excel 5/5/2011)

District Facilities Management Program

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

SERVICE CONTRACTS BID FORM

DATE

UNIT

PROJECT

Comprehensive Janitorial Services (Bay F-J)

BID OPENING

Friday, August 28, 2026 at 2:00 p.m.

FIRM NAME FAX NO.

ADDRESS CITY/STATE/ZIP CODE

STATUS OF BUSINESS (check appropriate box.)

Individual.

Corporation. State in which incorporated:

Partnership. Full names of partners:

DEPARTMENT OF PARKS AND RECREATION

TITLE

DATE

BIDDER'S PRINTED NAME

LICENSE CLASSIFICATION ARE YOU CLAIMING PREFERENCE AS A SMALL BUSINESS?

NoYes. Small Business Certification No.

THE STATE RESERVES THE RIGHT TO WAIVE ANY IRREGULARITY IN ANY BID OR TO REJECT ANY OR ALL BIDS.

The undersigned hereby proposes to furnish services, materials, or equipment, or to perform all work required in accordance with the bid documents for the foregoing titled project, and such addenda thereto as may be issued prior to bid opening date.

Nondiscrimination Compliance Statement The prospective contractor's signature affixed hereon and dated shall constitute a certification under penalty of perjury under the laws of the State of California that the bidder has, unless exempted, complied with the nondiscrimination program requirements of Government Code Section 12990 and Title 2, California Code of Regulations Section 8103.

Disabled Veteran Business Enterprise Participation In accordance with Public Contract Code Section 10115, the Department of Parks and Recreation has established criteria to implement the disabled veteran business enterprise (DVBE) program goal which bidder must meet; provided, however, the DVBE participation requirement is included herein and made part of the bid documents. (See DVBE Notice included in solicitation for details.)

Small Business Preference A five percent preference will be granted to any bidder currently certified by the Department of General Services as a California Small Business. (See Small Business Notice included in solicitation for details.)

Exhibit B, Attachment 1

PHONE NO.

BIDDER'S SIGNATURE (Signature)

FEDERAL EMPLOYER ID NO.

CONTRACT NUMBER

C26802376

The undersigned is duly authorized to submit this bid on behalf of the company.

EXHIBIT B, ATTACHMENT II

COST SHEET

The Contractor shall provide all labor, materials, equipment, and every other item of expense, direct or indirect (including any applicable taxes), necessary to complete the services in accordance with the specifications described in the Statement of Work, Exhibit A, at the rates specified below. The California Department of Parks and Recreation makes no guarantee, expressed or implied, on the actual amount of services or number of hours that shall be required for this Agreement, and reserves the right to omit portions or quantities of work, as may be deemed necessary. Payment for service performed under this Agreement shall be for actual expenditures incurred. The rates referenced below shall be binding for the term of the Agreement.

Please Note: Your hourly rate must comply with all sections of Government Code 19134. A Schedule of Employee Benefits Rates and Wages can be found on the Cal HR website here: https://www.calhr.ca.gov/about-calhr/divisions-programs/labor-relations/personal-services-contracts/

Please note: In accordance with SOW 3(f), due to facility size and current anticipated service trends, the minimum number of staff required for facility janitorial services are 2 Full-Time and 1 Part-Time employees.

**If hourly rate for any of your employees differs, please designate their "classification" or job title within the price boxes as well as their hourly rate.**

SERVICE LOCATION: 4940 Lang Ave, McClellan Park, CA 95652 Bays F-J

PLEASE LIST EMPLOYEE OR SUBCONTRACTOR CLASSIFICATION/TITLE AND

HOURLY RATE IF APPLICABLE

Classification Hourly Rate

Classification Hourly Rate

Classification Hourly Rate

Classification Hourly Rate https://www.calhr.ca.gov/about-calhr/divisions-programs/labor-https://www.calhr.ca.gov/about-calhr/divisions-programs/labor-

INSTRUCTIONS FOR DAILY, WEEKLY, BIWEEKLY, MONTHLY, AND BI-MONTHLY

SERVICES:

Please review the duties listed in the SOW for Daily, Weekly, Biweekly, Monthly and Bi- Monthly services. Using your knowledge of janitorial services, please provide an estimate of the time staff would typically take to complete these services.

Calculate total employee benefit per month using the chart below.

1. HOURLY QUOTE FOR DAILY, WEEKLY, BIWEEKLY, MONTHLY AND BI-

MONTHLY JANITORIAL SERVICES (Monday through Friday, 8:00AM - 5:00PM) Use 173.2/hr for Full Time Employees and 86.6hr/per month for Part Time Employees

Classification of Custodian:

$ (per hour) x /hr per month average x employee(s) = $_______ /month

A. (multiply by 12) = $

Classification of Custodian:

$ (per hour) x /hr per month average x employee(s) = $_______ /month

B. (multiply by 12) = $

Classification of Custodian:

$ (per hour) x /hr per month average x employee(s) = $_______ /month

C. (multiply by 12) = $ TOTAL (A + B + C): $ per year

INSTRUCTIONS FOR QUARTERLY AND ANNUAL SERVICES:

Please review the duties listed in the SOW for Quarterly and Annual services. Using your knowledge of janitorial services, please provide an estimate of the time staff would typically take to complete these services, and combine all service times into one "shift" time.

For example, if you estimate quarterly service floor care would take your staff around 2 hours to complete and dusting 2 hours, please calculate as follows (hourly rate) x (4-hour shift) x (4 employees) x (4 times a year) = rate per year.

** this is just an example, please create your own shift calculations.

2. HOURLY QUOTE FOR QUARTERLY JANITORIAL SERVICES

Classification of Custodian:

$ (per hour) x -hour shift x employee(s) x 4 times per year

A. = $ per year

Classification of Custodian:

$ (per hour) x -hour shift x employee(s) x 4 times per year

B. = $ per year

Classification of Custodian:

$ (per hour) x -hour shift x employee(s) x 4 times per year

C. = $ per year

TOTAL (A + B + C): $ per year

3. HOURLY QUOTE FOR ANNUAL JANITORIAL SERVICES

$ (per hour) x /hr per month average x employee(s)

A. = $ per year

Classification of Custodian:

$ (per hour) x /hr per month average x employee(s)

B. = $ per year

$ (per hour) x /hr per month average x employee(s)

C. = $ per year

**If rate for annual services is per service, list below** =$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for

=$ per service for D. = $ per year

TOTAL (A + B + C + D): $ per year

4. TOTAL MISCELLANEOUS MONTHLY EXPENSES **

$ per month A. (multiply by 12) = $_______________

TOTAL (A): $ per year

Calculate the yearly cost of services by totaling the amount of daily, weekly, bi-weekly, monthly, bi-monthly, quarterly, and yearly services alongside any miscellaneous costs.

5. TOTAL YEARLY COST (total of items 1, 2, 3, 4) $ per year

Calculate the total cost of contract by multiplying the total yearly cost by the duration of contract (3 years).

6. TOTAL CONTRACT COST (item 5 x 3 years) $ per year x 3 = $_______________ total contract cost

The bidder further certifies that the requirements of GC Section 19134 relative to employee benefits will be met by providing:

Please Check One:

Employee Benefits to Covered Employees

Cash Payments to Covered Employees

Combination of Employee Benefits and Cash Payments to Covered Employees

General Liability Insurance Company Name:

* These rates are subject to change during the term of the agreement. Should these state rates change during the term of the Agreement, the Agreement will be amended accordingly retroactive to the date of the rate change.

** Includes the cost of all equipment (including brooms, buffers, mops, etc.), transportation, materials, supplies (including cleaning/chemical agents, paper products including 2-ply toilet paper, trash can liners, consumables, etc.), operating expenses, annual inflation cost/rate adjustments, profit margin, and other items required to perform all work for janitorial services as per Exhibit A.

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)

Section 1 – Payee 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 E-MAIL ADDRESS

Section 2 – Entity Type Check one (1) box only that matches the entity type of the Payee listed in Section 1 above. (See instructions on page 2)

CORPORATION (see instructions on page 2)SOLE PROPRIETOR / INDIVIDUAL MEDICAL (e.g., dentistry, chiropractic, etc.)SINGLE MEMBER LLC Disregarded Entity owned by an individual

PARTNERSHIP

ESTATE OR TRUST

LEGAL (e.g., attorney services)

EXEMPT (e.g., nonprofit)

ALL OTHERS

Section 3 – Tax Identification Number Enter your Tax Identification Number (TIN) in the appropriate box. The TIN must match the name given in Section 1 of this form. Do not provide more than one (1) TIN.

The TIN is a 9-digit number. Note: Payment will not be processed without a TIN.

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.

Grantor Trusts (such as a Revocable Living Trust while the grantors 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.

Social Security Number (SSN) or Individual Tax Identification Number (ITIN)

OR

Federal Employer 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 my residency status change, I will promptly notify the state agency below.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE E-MAIL ADDRESS

SIGNATURE DATE TELEPHONE (include area code)

Section 6 – Paying State Agency Please return completed form to:

STATE AGENCY/DEPARTMENT OFFICE UNIT/SECTION

MAILING ADDRESS FAX TELEPHONE (include area code)

CITY STATE ZIP CODE E-MAIL ADDRESS

Print Form Reset Form

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 payments.

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, it 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 California Revenue and Taxation Code (R&TC).

Section 1 – Payee Information 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 DBA, 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 DBA, trade, or fictitious business names under Business Name.

Business Name – Enter the business name, DBA 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.

Section 2 – Entity Type If the Payee in Section 1 is a(n)… THEN Select the Box for…

Grantor (Revocable Living) Trust disregarded for federal tax purposes Sole Proprietor/Individual Limited Liability Company (LLC) owned by an individual and is disregarded for federal tax purposes Single Member LLC-owned by an individual Partnerships Limited Liability Partnerships (LLP) and, LLC treated as a Partnership Partnerships Estate Trust (other than disregarded Grantor Trust) Estate or Trust Corporation that is medical in nature (e.g., medical and healthcare services, physician care, nursery care, dentistry, etc. LLC that is to be taxed like a Corporation and is medical in nature

Corporation-Medical

Corporation that is legal in nature (e.g., services of attorneys, arbitrators, notary publics involving legal or law related matters, etc.) LLC that is to be taxed like a Corporation and is legal in nature

Corporation-Legal

Corporation that qualifies for an Exempt status, including 501(c) 3 and domestic non-profit corporations. Corporation-Exempt Corporation that does not meet the qualifications of any of the other corporation types listed above LLC that is to be taxed as a Corporation and does not meet any of the other corporation types listed above

Corporation-All Other

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 returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

Section 4 – Payee Residency Status Are you a California resident or nonresident?

A corporation will be defined as a "resident" if it 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 – Certification 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 signe e can provide a power of attorney documented for the individual.

Section 6 – Paying State Agency This section must be completed by the state agency/department requesting the STD 204.

Privacy Statement 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 it. It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information 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.

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

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

(This form is optional. Form is used to provide remittance address information if different than the mailing address on the STD 204 – Payee Data Record.

Use this form to provide additional remittance addresses and additional Authorized Representatives of the Payee not identified on the STD 204.)

Payee Information (must match the STD 204) NAME (Required. Do not leave blank.)

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above)

TAX ID NUMBER (Required)

SSN, ITIN, or FEIN that matches Tax ID number provided on STD 204

Additional Remittance Address Information Use the fields below to provide remittance addresses for payee if different from the mailing address on the STD 204.

The addresses provided below are for remittance purposes only. 1099 information returns will be sent to the mailing address specified on the STD 204.

REMITTANCE ADDRESS (number, street, apt or suite no.)

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

Additional Contact Information Use the fields below to provide additional Authorized Representatives for the Payee if applicable.

CONTACT NAME

TELEPHONE (Include area code) EMAIL

CONTACT NAME

TELEPHONE EMAIL

CONTACT NAME

TELEPHONE EMAIL

Certification I hereby certify under penalty of perjury that the information provided on this supplemental document is true and correct.

By signing this document, I authorize the State of California to remit payment to the addresses specified on this supplemental form (STD 205) and certify that all persons identified on this form are authorized representatives of this payee. Payments remitted to any of the listed addresses may be reported on 1099 information returns to the tax liable entity identified on the accompanying Payee Data Record - STD 204.

NAME OF AUTHORIZED PAYEE REPRESENTATIVE

(Print or Type name)

TITLE E-MAIL ADDRESS

SIGNATURE

X___________________________________________

DATE TELEPHONE (Include area code)

Print Form Reset Form

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

(This form is optional. Form is used to provide remittance address information if different than the mailing address on the STD 204 – Payee Data Record.

Use this form to provide additional remittance addresses and additional Authorized Representatives of the Payee not identified on the STD 204.)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record Supplement, STD 205. Sign, date, and return to the state agency/department with a completed STD 204. Prompt return of the fully completed forms will prevent delays when processing payments.

Purpose – Completion of this form (STD 205) is optional. Payees may use this form to provide remittance addresses or contact information in addition to the 1099 information return mailing address provided on the STD 204. This form shall only be used in conjunction with the STD 204, and will not be accepted without a STD 204.

Please note: The State of California Government will issue 1099 information returns to the mailing address provided on the most recently dated form STD 204 validated by the Payee. Addresses provided on this form (STD 205) will be used for remittance purposes only. If the payee would like to update the address for receiving 1099 information returns, please complete the STD 204.

Payee Information: The Payee’s Tax ID number (TIN) and Name (including any Business, DBA, or Disregarded LLC names) are required. This information is subject to TIN matching via the IRS database for validation. Payee Information provided in this section must clearly match the STD 204. Any discrepancies may result in delays of payment, up to and including denial of the request.

Name – Enter the name of the Payee. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

Business Name – Enter the business name, DBA name, trade or fictitious name, or disregarded LLC name.

Tax ID 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 returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

Additional Remittance Address Information - Enter the Payee’s additional remittance address(s) that are not listed on STD 204. Up to five (5) addresses may be provided on this form. The Payee may provide additional remittance addresses on a second STD 205 form if needed.

Additional Contact Information - Enter the Payee’s additional or updated contact information. Up to three contacts may be identified on this form. Payee may provide additional contacts on a second STD 205 if needed.

PRIVACY STATEMENT

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 it.

It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information 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.

All questions should be referred to the requesting state agency listed on the bottom front of the STD 204 form.

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

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

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

DPR 88 (Rev. 4/20210)(Excel 4/26/2021)

Vendor Information

Authorized Representative - complete and sign (REQUIRED)

FOR DEPARTMENT USE ONLY

Certificate of Acceptance

Submission Checklist

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

PAYEE DATA RECORD SUPPLEMENT

GOODS VS. SERVICES

PAYEE'S LEGAL BUSINESS NAME (Type or Print)

DATE

PRINTED NAME

Seller's Permit (No.

Certificate of Registration (No.

TAX ID NUMBER

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.

UPLOAD TO SUPPLIER

RECORD IN FI$Cal

SUPPLIER ID. (If Known )

EXECUTED IN THE COUNTY AND STATE OF

No

NO ATTACHMENT NEEDED

- No inventory or sales staff in CA.

Will tangible goods be provided?

Attach:

Yes

No additional attachments needed.

AUTHORIZED REPRESENTATIVE'S SIGNATURE

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

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

STD. 204.

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).

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 ID 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 FI$Cal Systems Supplier Record for FI$Cal review and approval.

Original forms must be retained in the procurement file at the District/Section level.

DPR 88 COMPLETION INSTRUCTIONS FOR VENDOR/SUPPLIER

DEPARTMENT INSTRUCTIONS

check when finished with each form

If no tangible goods provided, skip to Authorized Representative Section.If yes, complete the appropriate checkbox below

If you do NOT have inventory or sales staff in CA, check here and no additional attachments are needed.

This section must be signed with all boxes/fields completed.

If you have inventory or sales staff in CA, choose appropriate checkbox, enter permit or certificate

no. in space provided, & attach copy of permit/cert.

Signature:________________________ Date:_____________

State of California-Department of General Services, Procurement Division

GSPD-05-105 (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 DVBE 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 of the 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 if the 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, Contad Person, Phone Number & Fax Number-List each element for all subcontractors.

Subcontractor 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.gov).

Work performed or goods provided for this contrad-ldentify 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"if the 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 uPage _ of_" accordingly.

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)

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)

DPR REFERENCE/AGREEMENT NUMBER

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 ONLY

C26802376

State 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.

AGREEMENT/PAPO NO.

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:

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

Contractor/Bidder Firm Name (Printed) Federal ID Number

Date Executed Executed in the County of

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.

By (Authorized Signature)

Printed Name and Title of Person Signing

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.

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