IFB_C23-32672.1.pdf

April 2024

INVITATION FOR BID (IFB)

Notice to Prospective Bidders You are invited to review and respond to this IFB

BID NUMBER #C23-32672.1

VENDING MACHINE CONTRACT

Nine (9) Locations in Sacramento, Yolo, and El Dorado County, California

In submitting your bid, you must comply with the instructions found herein.

You are invited to review and respond to this Invitation for Bid (IFB) # C23-32672.1, for Nine (9) Locations in Sacramento, Yolo, and El Dorado County, California for the Department of Rehabilitation. In submitting your bid, you must comply with these instructions.

THIS SOLICITATION INCLUDES THE SMALL BUSINESS (SB) AND DISABLED VETERANS

BUSINESS ENTERPRISE (DVBE) INCENTIVES

Note that all agreements entered into with the State of California will include by reference General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at Internet site https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services- Resources-List-Folder/Standard-Contract-Language. If you do not have Internet access, a hard copy can be provided by contacting the person listed below.

In the opinion of the Department of Rehabilitation, this IFB is complete and without need of explanation. However, if you have questions regarding this IFB, they must be submitted in writing, via email to the Contract Analyst listed below by the date listed in the Key Action Dates on page 3. All questions and answers will be posted on the Cal eProcure website at https://caleprocure.ca.gov/pages/index.aspx by the date listed in the Key Action Dates.

All questions must be asked in writing via email and will be answered in Cal eProcure.

The contract analyst for this IFB is: Nathaniel Hayes Nathaniel.Hayes@dor.ca.gov

Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum.

State of California

Health and Human Services Agency Department of Rehabilitation

Contracts & Procurement Section 721 Capitol Mall 6th Floor, Sacramento, CA 95814 https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://caleprocure.ca.gov/pages/index.aspx mailto:Nathaniel.Hayes@dor.ca.gov

A) PURPOSE AND DESCRIPTION OF SERVICES

Contractor agrees to supply all labor, materials, tools, vending machine equipment, products and transportation necessary to perform all services required for the vending machines on behalf of the Department of Rehabilitation’s Business Enterprises Program.

The anticipated contract term dates are Upon Approval – April 30, 2027. The projected gross receipts for a three-year period are $34,209.00. This amount is an estimate only. The awarded contractor must submit commissions based on the actual gross income which reflects monthly meter readings. (23) Vending Machines.

Bids must address all services described in Exhibit A - Scope of Work and Exhibit A.1, Locations and Equipment

This IFB shall give the option to amend for more time and money in the event that additional services must be performed which were wholly unanticipated and not specified in the original written Scope of Work, but which in the opinion of both parties is necessary to the successful accomplishment of the general scope of work outlined, however, an amendment for these additional services to the agreement must be executed prior to any work being authorized by DOR.

B) BIDDER MINIMUM QUALIFICATIONS: PROOF REQUIRED AT BID OPENING

PLEASE NOTE: Bidders shall resubmit proof of qualifications when submitting each new bid proposal. Documents on file with previously awarded contracts shall not be referenced and/or considered.

1) License(s) And Permit(s):

The Contractor shall be an individual or firm licensed to do business in California and shall obtain at his/her expense all license(s) and permit(s) required by law for accomplishing any work required in connection with this Contract.

The Contractor shall provide proof of current Business License(s) and/or Business Tax Certificate from the state, city, or county in which you are headquartered at bid opening.

The Contractor shall provide a Sellers permit from the city, or county in which you are headquartered at bid opening.

If you are a corporation, a copy of your Certificate of Status from the Secretary of State’s Office must be submitted at bid opening.

In addition, for corporations and limited liability companies, state agencies are required to verify with the California Secretary of State (SOS) office to confirm the Contractor/vendor is authorized to carry out business in California. You may view the lists and status at https://www.sos.ca.gov/business-programs/business-entities/

In the event any license(s) and/or permit(s) expire at any time during the term of this Contract; Contractor agrees to provide agency a copy of the renewed license(s) and/or permit(s) within 30 days following the expiration date. In the event the Contractor fails to keep in effect at all times all required license(s) and permit(s), the State may, in addition to any other remedies it may have, terminate this Contract upon occurrence of such event.

2) Proof of Current Insurance Certificates: Mandatory limits of $1,000,000.00 each on Commercial General Liability, Commercial Automobile Liability and Workers’ Compensation Insurance if applicable or Exemption/Waiver Statement. Unless otherwise stated, the bidder shall meet all qualifications and insurance requirements at the time of the bid opening by submitting evidence of current insurance(s) certificates.

(See Exhibit D for complete details regarding insurance requirements).

3) Servicing Location Sites Contract is conditioned on the contractor maintaining a principal point of business, or a physical branch office, within one hundred (100) miles of the Vending location sites. The Department of Rehabilitation shall have the option to cancel this Agreement with no liability occurring to the State if this contract term is not upheld by the contractor. Note: A “Post Office Box” address will not be accepted.

4) Prohibition on Tax Delinquency 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 Section 10295.4). In accordance with Public Contract Code Section 10295.4, agencies are required to cancel Agreements with entities that appear on either list.

(Franchise Tax Board) https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/index.html

(California Department of Tax and Fee Administration) https://www.cdtfa.ca.gov/taxes-and-fees/top500.htm

5) Federal Debarment, Suspension, Ineligibility and Voluntary Exclusion:

Expenditures from this Contract may involve Federal funds. The Federal Department of Labor requires all State agencies which are expending Federal funds to have in the Contract file a certification by the Contractor that they have not been debarred nor suspended from doing business with the Federal government.

Failure to submit the required documents (i.e., licenses, permits, insurances and/or signed workers’ compensation waiver statement) as listed above in Section B, 1) and

2) will be considered non-responsive.

C) BID REQUIREMENTS AND INFORMATION

https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/index.html https://www.cdtfa.ca.gov/taxes-and-fees/top500.htm

1) Key Action Dates:

EVENT DATE/TIME

IFB available to prospective Bidders April 12, 2024 Deadline to ask Questions April 18, 2024, by 2:00pm Deadline to post Q&A to Cal eProcure April 23, 2024, by 2:00pm Final Date for Bid Submission April 29, 2024, by 2:00pm Public Bid Opening April 30, 2024, at 2:00pm Anticipated Intent to Award May 1, 2024 Five (5) day protest period May 2, 2024 to May 8, 2024 Anticipated Award Date May 9, 2024 Contract Period* Upon Approval through April 30, 2027

2) Questions Regarding the IFB:

Any questions regarding this IFB must be submitted in writing, via email to the contract analyst listed on page 1. Emails should include the individual's name, firm name, address, and must reference the IFB #. All answers will be posted on the Cal eProcure website. It is the responsibility of the Bidder to check the California State Contract Register at https://caleprocure.ca.gov/pages/index.aspx when inquiring about an addendum, questions, answers, and any other posts related to this IFB.

3) Submission of Bid:

1. (PREFERED) Bids may submitted via email to Nathaniel.Hayes@dor.ca.gov.The subject line of the email must read as follows: Bid #C23-32672.1 Sacramento, Yolo, and El Dorado County- Vending Machine Revenue Contract Bid Opening Date April 30, 2024 at 2:00pm or

2. Bids may be submitted under sealed cover and sent to the DOR by US Postal

Service Deliveries or Hand Delivered (i.e. UPS, Express Mail, Federal Express) by the dates and times shown in Section C, Bid Requirements and Information, Item 1) Key Action Dates, (page X). Email is preferred, however, if you chose this option, you must notify the analyst via email at Nathaniel.Hayes@dor.ca.gov PRIOR to sending your bid via mail.

The sealed cover must be plainly marked with the IFB number and title, must show your firm name and address, and must be marked with "DO NOT OPEN", as shown in the following example:

*************DO NOT OPEN***************

Department of Rehabilitation Contract Section - Attn: Nathaniel Hayes

721 Capitol Mall, 6th Floor Sacramento, California 95814

IFB# C23-32672.1

Please note:

https://caleprocure.ca.gov/pages/index.aspx

If a contractor is delinquent in commission payments, that account must be cleared before the bid opening or the bid may be rejected. If a contractor has had an agreement terminated by the Department of Rehabilitation for cause other than commission payments within the last twelve months, the bid may be rejected. If the contractor has had an agreement terminated by the Department of Rehabilitation for non-payment of commissions, regardless of the time frame, then those payments must be paid prior to the bid opening or that bid will be rejected. If the contractor has any outstanding commissions that are over 12 months old as of the date of the bid, payment must be received prior to bid submission or the bid may be rejected.

a) Bids not submitted under sealed cover will be rejected.

b) All bids shall include the documents identified in Attachment 1, Required Attachment Checklist. Bids not including the proper "required attachments" shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements and will be rejected.

c) Bids must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and will cause a bid to be rejected.

d) A bid will be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all bids and may waive an immaterial deviation in a bid. The State's waiver of an immaterial deviation shall in no way modify the IFB document or excuse the Bidder from full compliance with all requirements if awarded this Agreement.

e) Costs incurred for developing bids and in anticipation of award of this Agreement are entirely the responsibility of the Bidder and shall not be charged to the State of California.

f) All documents requiring a signature must bear an original signature or electronic signature of a person authorized to bind the Bidder Contractually. The signature should indicate the title or position that the individual holds in the firm. That person shall sign the Bid/Bidder Certification Sheet. An unsigned Bid/Bidder Certification Sheet will be rejected.

g) A Bidder may modify a bid after its submission by withdrawing its original bid and resubmitting a new bid prior to the bid submission deadline. Bidder modifications offered in any other manner, oral or written, will not be considered.

h) A Bidder may withdraw its bid by submitting a written withdrawal request to the State, via hand delivery, US Mail, FedEx, or UPS, signed by the Bidder or an authorized agent. A Bidder may thereafter submit a new bid prior to the bid submission deadline. Bids may not be withdrawn without cause subsequent to bid submission deadline.

i) The State may modify the IFB prior to the date fixed for submission of bids by the issuance of an addendum to all parties who received a bid package.

j) The State reserves the right to reject all bids. The agency is not required to award an

Agreement.

k) Before submitting a response to this solicitation, Bidders should review, correct all errors and confirm compliance with the IFB requirements.

l) Where applicable, Bidder should carefully examine work sites and specifications. Bidder shall investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered. No additions or increases to this Agreement amount will be made due to a lack of careful examination of work sites and specifications.

m) The State does not accept alternate Contract language from a prospective Contractor. A bid with such language will be considered a counter proposal and will be rejected. The State’s General Terms and Conditions (GTC 04/2017) are not negotiable.

n) No oral understanding or Agreement shall be binding on either party.

4) Public Bid Opening

Bid opening will be held via zoom link at the time and date specified in the Key Action Dates. Bidders may attend via zoom link: IFB Bid Opening.

Bids will be read in random order. Questions will not be allowed and information will not be repeated.

5) Evaluation and Selection:

a) At the time of bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this

IFB.

b) The State will evaluate each bid to determine its responsiveness to the published requirements.

c) Bids that contain false or misleading statements, or which provide references, which do not support an attribute or condition claimed by the bidder, may be rejected.

d) Any award, if any, will be awarded to the highest responsive bidder upon receipt of signed contract.

e) Any bid may be rejected whenever the determination is made by the State that the bid received is not in accordance with current NAMA Operating Ratio Report (www.vending.org).

f) Any bid that promises a commission rate above 24% must provide an explanation on how commission rate is achievable using the attached form (Exhibit B Attachment B.2).

6) Award and Protest:

a) Whenever an agreement is awarded under a procedure which provides for competitive bidding, but the agreement is not to be awarded to the highest bidder, the highest bidder shall be notified by telegram, electronic facsimile transmission (fax), overnight courier, or personal delivery within five (5) working days prior to the award of the agreement.

b) Award if made, will be to the most reasonable, responsive and responsible bidder.

c) Failure of the highest responsive bidder to submit all required documents within 10 business days after notice of award (i.e., bid documents, licenses, permits, insurances and/or signed workers’ compensation waiver statement, as listed in 1) and 2) above) and bid documents, will be https://dor-ca-gov.zoom.us/j/81899933436?pwd=RlNSTFM3V21mZ3duQlNTclJXT2pkUT09 http://www.vending.org/ considered non-responsive and the DOR will have the option to withdraw the award.

d) Contractor must sign and submit to the awarding agency, page one (1) of the Contractor Certification Clauses (CCC), which can be found on the Internet at https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services- Resources-List-Folder/Standard-Contract-Language

e) Tie Breakers: In case of a tie, a coin toss will be administered by the Contracts and Procurement Section with two witnesses present to determine the winning bid.

f) If any Bidder, prior to the award of an Agreement, files a written protest during the five (5) day protest period with the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, California 95605 and the DOR on the grounds that the (protesting) Bidder is the highest responsive responsible Bidder, this Agreement shall not be awarded until either the protest has been withdrawn or the Department of General Services has decided the matter.

g) Within five (5) days after filing the initial protest, the protesting Bidder shall file with the Department of General Services and the DOR a detailed written statement specifying the grounds for the protest. The written protest must be sent to the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, California 95605. A copy of the detailed written statement should be mailed to the DOR. It is suggested that you submit any protest by certified or registered mail.

h) Upon resolution of the protest and award of this Agreement, Contractor must have sign and submitted to the DOR, page one (1) of the Contractor Certification Clauses (CCC-4/2017), which can be found on the Internet at www.dgs.ca.gov/contracts. This document is only required if the Contractor has not submitted this form to the DOR within the last three (3) years.

7) Disposition of Bids:

a) Upon bid opening, all documents submitted in response to this IFB will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.).

However, the contents of all proposals, draft bids, correspondence, agenda, memoranda, working papers, or any other medium, which discloses any aspect of a bidder's proposal, shall be held in the strictest confidence until the award is made. The content of all working papers and discussions relating to a bid shall be held confidential indefinitely unless the public's interest is best served by disclosure because of its direct pertinence to a decision, agreement, or evaluation of a bid. Any disclosure of this subject by the bidder prior to the award is a basis for rejecting a bid and ruling the bidder ineligible to further participate in the bidding process.

b) Bid packages may be returned only at the bidder's expense, unless such expense is waived by the awarding agency.

8) Agreement Execution and Performance:

a) Performance shall start not later than 15 days, or on the express date set by the awarding agency and the Contractor, after all approvals have been obtained and the agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, the awarding agency, upon five (5) days written notice to the Contractor, reserves the right to terminate the agreement. In addition, the https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language http://www.dgs.ca.gov/contracts

Contractor shall be liable to the State for the difference between the Contractor’s bid price and the actual cost of performing work by the second highest bidder or by another Contractor.

b) Resolution of differences between IFB and contract language:

If an inconsistency or conflict arises between the terms and conditions appearing in the final agreement and the proposed terms and conditions appearing in this IFB, any inconsistency or conflict will be resolved by giving precedence to the agreement.

c) Subcontracting: No subcontracting will be allowed with this contract opportunity.

9) Anti-Trust GC 4550 et seq., BP 16720-27, SCM 5.30:

The antitrust laws are a system of California and federal laws that prohibit unwarranted restraints on free and open competition. If an agency suspects antitrust activity (such as bid-rigging or price fixing), the agency shall contact the Attorney General’s office.

10) Confidentiality:

a) Contractor agrees that any report or material created during the performance of this agreement will not be released to any source except as required by this agreement or otherwise authorized by DOR.

b) Contractor agrees that any information obtained in the performance of this agreement is confidential and shall not be published or open to public inspection in any manner, except as authorized by DOR.

c) Contractor agrees to maintain the confidentiality of any information concerning any consumers that the contractor may obtain in the performance of this agreement and specifically agrees to comply with the provisions applicable to such information as set forth in 34 Code of Federal Regulations, Section 361.38, title 9, California code of Regulations, Section 7140 et seq., and the Information Practices Act of 1977 (California Civil Code Section 1798 et seq.)

d) Contractor agrees to report any security breach or information security incident involving DOR consumers’ personal information to the DOR’s Contract Administrator and the DOR’s Information Security Officer. The DOR’s Information Security Officer can be contacted via e-mail at isoinfo@dor.ca.gov.

e) Security breaches or information security incidents that shall be reported include, but are not limited to:

1. Inappropriate use or unauthorized disclosure of DOR consumers’ personal information by the Contractor or the Contractor’s assignees.

Disclosure methods include, but are not limited to, electronic, paper, and verbal. Unauthorized access to DOR consumers’ personal information. Information can be held in medium that includes, but is not limited to, electronic and paper.

2. Loss or theft of information technology (IT) equipment, electronic devices/media, paper media, or data containing DOR consumers’ personal information. IT equipment and electronic devices/media include, but are not limited to, computers (e.g., laptop and desktop, netbooks, tablets), smartphones, cell phones, CDs, DVDs, USB flash drives, servers, printers, peripherals, assistive technology devices (e.g., note-takers, videophones), and copiers. Data can be held in medium that includes, but is not limited to, electronic and paper.

mailto:isoinfo@dor.ca.gov

f) Contractor agrees to provide annual security and privacy training for all individuals who have access to personal, confidential, or sensitive information relating to the performance of this agreement.

g) Contractor agrees to obtain and maintain acknowledgements from all individuals to evidence their understanding of the consequences of violating California privacy laws and the contractor’s information privacy and security policies.

h) For contractors that do not have a security program that includes annual security and privacy training, a self-training manual is available on the DOR website under the “Providers” tab in the “Becoming a Service Provider" section under “Annual Security and Privacy Training for VR Service Providers.” The self-training manual is named “Protecting Privacy in State Government” and can be downloaded at the following link:

https://www.dor.ca.gov/Home/SecurityandPrivacy

i) Additional training and awareness tools are available at the California Office of Information Security (OIS) website and the California Office of Privacy Protection (COPP) website. The COPP created the self-training manual, “Protecting Privacy in State Government” that DOR revised to meet its business needs.

11) Preference/Social Economic Programs

Pursuant to Executive Order S-02-06 and Military & Veterans Code Section 999.2, each department shall have an annual statewide participation goal in state Contracting of not less than 25 percent for certified Small Business (SB) and not less than 3 percent for certified Disabled Veteran Business Enterprise (DVBE).

These goals were established to enhance and encourage competition by creating an optimum environment that affords all businesses equal access to State Contracting opportunities. The DOR will make every effort to seek out certified SB and DVBE for this solicitation.

Questions regarding Small/Micro Business or the Disabled Veteran Business Enterprise Program may be directed to:

SB/DVBE Program Advocate

Contracts and Procurement Section 721 Capitol Mall, 6th Floor Sacramento, California 95814

(916) 558-5680

SEE SEPARATE ATTACHMENT 9 - SMALL BUSINESS CERTIFICATION

SEE SEPARATE ATTACHMENT 10 - DISABLED VETERAN BUSINESS

ENTERPRISE (DVBE)

12) Declaration Forms

All bidders must complete the Bidder Declaration GSPD-05-105 and include it with the bid response. When completing the declaration, bidders must identify all subcontractors proposed for participation in the 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.

https://www.dor.ca.gov/Home/SecurityandPrivacy

Bidders who have been certified by California as a DVBE (or who are bidding rental equipment and have obtained the participation of subcontractors certified by California as a DVBE) must also submit a completed form(s) STD. 843 (Disabled Veteran Business Enterprise Declaration). All disabled veteran owners and disabled veteran managers of the DVBE(s) must sign the form(s). Should the form not be included with the solicitation, contact the State contracting official or obtain a copy at the following website: https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd_843.pdf The completed form should be included with the bid response.

At the State’s option prior to award, bidders may be required to submit additional written clarifying information. Failure to submit the requested written information as specified may be grounds for bid rejection.

13) Required Attachments

Refer to the following pages for additional Required Attachments that are a part of this Agreement.

https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd_843.pdf

ATTACHMENT #1

IFB ATTACHMENTS and REQUIREMENT CHECK LIST

BID NUMBER # C23-32672.1

Nine (9) Locations in Sacramento, Yolo, and El Dorado County, California

NOTE: READ CAREFULLY, FAILURE TOSUBMIT ALL REQUIRED DOCUMENTS AT

BID OPENING WILL BE CAUSE FOR REJECTION

A complete bid or bid package will consist of the items identified below. Complete this checklist to confirm the items in your bid. Place a check mark or “X” next to each item that you are submitting to the State. For your bid to be responsive, all applicable required attachments must be returned. This checklist must also be returned with your bid package.

Attachment Attachment Name/Description

Attachment 1 IFB Attachment and Requirement Check List required

Attachment 2 Bid/Bidder Certification Sheet (with original signature) required

Attachment 3 Darfur Contracting Act Certification Form required

Attachment 4 Payee Data Record (Std.204) required

Attachment 5 Contractor Certification Clauses (CCC). The CCC 4/2017 must be signed and submitted to Department of Rehabilitation.

Attachment 6 DR 486B - Vending Machine Commission Statement (VMCS) required (return acknowledges Contractor will utilize VMCS form when submitting commission statements to the BEP)

Attachment 7 Technical Capabilities Information required

Attachment 8 Section C BIDDER DECLERATION – GSPD-05-105 (Must be signed at the bottom of document)

Attachment 9 Small Business Participation Requirements (If applicable) (Separate Attachment) DGS approved Small Business Certification

Attachment 10 California Disabled Veteran Business Enterprise Program Incentive (Separate Attachment) Section A - DVBE COMMITMENT OPTION

Section B - BIDDER CERTIFICATION OF DVBE PARTICIPATION DGS approved Disabled Veteran Business Enterprise Certificate

STD. 843 Disabled Veteran Business Enterprise Declaration

IFB Requirement Proof of Current Insurance Certificates (See Exhibit D for limits):

Commercial General Liability Automobile Liability Workers’ Compensation

**Expired certificates will not be accepted and your bid will be disqualified**

IFB Requirement Proof of current Business License(s) and/or Business Tax Certificate from the state, city, or county in which you are headquartered Required

IFB Requirement Secretary of State’s incorporation documentation (If applicable)

IFB Requirement Sellers permit from the city, or county in which you are Headquartered Required

ATTACHMENT #2

BID/BIDDER CERTIFICATION SHEET

BID NUMBER # C23-32672.1

This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as an entire package with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.

Do not return Section C, Bid Requirements and Information. Do not return “Sample Agreement” at the end of this IFB.

Our all-inclusive bid is submitted as follows:

Percentage Rate of: _____________

(Contractor will submit one flat bid rate for all machines: example: 15%, 18%, etc.)

A. All required attachments are included with this certification sheet.

B. The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification.

C. An Unsigned Bid/Bidder Certification Sheet May Be Cause for Rejection.

1. Company Name 2. Telephone Number 2a. Fax Number

3. Address 3a. Email

Indicate your organization type:

4. Sole Proprietorship 5. Partnership 6. Corporation Indicate the applicable employee and/or corporation number:

7. Federal Employee ID No. (FEIN) 8. California Corporation No.

9. Indicate applicable license and/or certification information:

10. Bidder’s Name (Print) 11. Title

12. Signature 13. Date

14. Are you certified with the Department of General Services, Office of Small Business and DVBE

Certification (OSDC) .

a. California Small Business

Yes No If yes, enter certification number:

b. Disabled Veteran Business Enterprise Yes No

If yes, enter your service code below:

NOTE: A copy of your Certification is required to be included if either of the above items is checked “Yes”. Date application was submitted to OSBCR, if an application is pending:

Completion Instructions for Bid/Bidder Certification Sheet Complete the numbered items on the Bid/Bidder Certification Sheet by following the instructions below.

Item # Instructions

1, 2, 3, 3a

Must be completed. These items are self-explanatory.

Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business.

Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit.

Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.

Enter your federal employee tax identification number.

Enter your corporation number assigned by the California Secretary of State’s Office.

This information is used for checking if a corporation is in good standing and qualified to conduct business in California.

Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required of the type of services being procured.

10, 11 12, 13, Must be completed. These items are self-explanatory.

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.

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.

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) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

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.

ATTACHMENT #3

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) Federal ID Number

Printed Name and Title of Person

ATTACHMENT #5

CCC-04/2017 CERTIFICATION

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California.

Contractor/Bidder Firm Name (Printed)

Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County of

CONTRACTOR CERTIFICATION CLAUSES

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.

http://www.dir.ca.gov/

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 any state agency to provide goods or services.

Former State Employees (Pub. Contract Code §10411):

1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency.

2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service.

If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub.

Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))

2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700)

3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)

4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.

5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:

a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled.

b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax.

c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State.

6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement.

7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution.

8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity.

CCC April 2017 FINAL

DEPARTMENT OF REHABILITATION

Commission Rate (%)

Agency Name

Address City Floor/ Room

VM

Serial #

VM

Type

Meter Start

Meter End

Total Sales

Gross Sales

Commission Paid

Page Totals $

ATTACHMENT #6

P. O. Box 944222 Sacramento, CA 94244-2220

VENDING MACHINE COMMISSION STATEMENT

DR 486B (Rev. 03/15) Department of Rehabilitation Accounting Services Section

Submit Completed Report with Payment to:

BUSINESS ENTERPRISES PROGRAM

STATE OF CALIFORNIA

VENDING MACHINE COMMISSION STATEMENT

Sales Activity Report

List all machines serviced at each agency.

Contract Number:

Contractor Name: Period Covered:

ATTACHMENT # 7

TECHNICAL CAPABILITIES INFORMATION

Technical Capabilities information must accompany this Invitation for Bid in order for the Bid to be considered.

TECHNICAL CAPABILITIES

1. Provide an explanation of the refund system that will be in place:

2. Provide information on your company's service schedule for inspection and restocking each service site listed on Exhibit A Attachment A.1- Locations and Equipment.

3. Provide a plan for your company's anticipated phase in strategy.

4. Provide information on the procedures you plan to utilize for tracking sales.

5. Provide information on how your company handles customer complaints, suggestions and request.

6. Is your company currently for sale or involved in any transaction to expand or to become acquired by another business entity? If yes, explain the impact both in organizational and directional terms.

7. Provide any details of all past or pending litigation or claims filed against your company that would affect your company's performance under a contract with the DOR-BEP-VMU.

8. Is your company currently in default on any loan agreement or financing agreement with any bank, financial institution, or other entity? If yes, specify date(s), details, circumstances and prospects for resolution.

Section C BIDDER DECLARATION - GSPD–05–105

1. Prime Bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):

a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): ____________ or None ____ (If “None”, go to Item #2)

b. Will subcontractors be used for this Contract? Yes ___ No ___ (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 ___ No ___

(2) If the Contract includes equipment rental, does your company own at least 51% of the equipment provided in this Contract (quantity and value)? Yes ___ No ___ N/A ___

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 Phone

Number & Fax Number

Subcontractor Address&

Email Address

CA

Certification

(MB, SB,

DVBE or

None)

Work performed or goods provided for this

Contract

Corresponding % of bid price

Good Standing?

51% Rental?

3. CERTIFICATION: By signing this form, I certify under penalty of perjury that the information provided is true and correct.

Printed Name: ____________________________ Signature:

_____________________________ Date Signed: __________________

State of California—Department of General Services, Procurement Division GSPD–05–105 (EST 8/05) Written Version Page ___of

ATTACHMENT # 8

SECTION C.1 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)

• Small Business Nonprofit Veteran Service Agency (SB/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. If “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, SB/NVSA, and/or DVBE must provide a commercially useful function as defined in Military and Veterans Code Section 999(e)(2)(A) for DVBEs and Government Code Section 14837(d)(4)(A) for small/microbusinesses. For questions regarding commercially useful function determinations made in conjunction with certification approval, contact the Department of General Services, Procurement Division, Office of Small Business and DVBE Certification (OSDC), OSDC Certification and Compliance Unit via email at:

osdchelp@dgs.ca.gov.

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.