ATTACHMENT 1

BID/BIDDER CERTIFICATION SHEET

By completing and signing this Bid Cover Page, the Bidder organization certifies that it has complied with all the requirements of the IFB and that it unconditionally commits to the total dollar amount of its cost proposal (Item 13), which is binding for the term of the contract.

Refer to the following instructions for assistance with completing this form.

Item Instructions 1, 2, 3, 4 Provide the Bidder organization’s basic information.

5 Indicate the Bidder organization’s ownership structure.

6 Provide the Bidder organization’s federal Employee Identification Number and, if applicable, its California corporation number.

7 If applicable, provide the Bidder’s license and/or certification numbers that are required to satisfy the minimum or desirable qualifications of the IFB.

8, 9, 10, 11 Provide the name and title of the Bidder representative who is authorized to contractually bind the Bidder organization; provide the Bidder representative’s signature and date of certification.

12 Indicate whether the Bidder organization is certified as a California Small Business and/or a Disabled Veteran Business Enterprise; if so, provide the certification number(s).

13 Indicate the total dollar amount of the Bidder’s cost proposal.

Bidder Information and Certification

1. Bidder Organization Name

2. Bidder Telephone Number

3. Bidder Fax Number

4. Bidder Address

5. Bidder Organization Type ☐ Sole Proprietorship ☐ Partnership ☐ Corporation ☐ Limited Liability Company

6. Applicable Employer and/or Corporation Numbers Federal Employer ID No. (EIN): California Corporation No.:

7. Applicable License and/or Certification Information

8. Bidder Representative Name (Print)

9. Bidder Representative Title

10. Bidder Representative Signature 11. Date

12. Bidder Certifications with the California Department of General Services

a. California Small Business ☐ Yes (Certification number: ) ☐ No ☐ Pending (Submitted on: )

b. Disabled Veteran Business Enterprise ☐ Yes (Certification number: ) ☐ No ☐ Pending (Submitted on: )

NOTE: If the Bidder is certified, a copy of the certification or the approval letter must be provided.

13. Cost Proposal $________ Per Physical

ATTACHMENT 2

BID SUBMISSION ATTACHMENT CHECKLIST

A complete bid submission 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 required attachments must be returned. This checklist should be returned with your bid submission.

Attachment Required Attachment Name/Description

_____ Attachment 1 YES Bid Cover Page

_____ Attachment 2 YES Bid Submission Checklist

_____ Attachment 3 YES Payee Data Record

_____ Attachment 4 YES Contractors Certification Clause

_____ Attachment 5 YES Bidder Declaration

_____ Attachment 6 YES Proof of Insurance

_____ Attachment 7 YES Cost Worksheet

_____ Attachment 8 IF APP Darfur Contracting Act

_____ Attachment 9 IF APP DVBE Declarations

ATTACHMENT 3

PAYEE DATA RECORD

A Bidder must complete the Payee Data Record form STD 204, located at the following internet site:

http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf .

If you do not have Internet access, a hard copy can be provided to you.

The completed Payee Data Record STD 204 must be included in the bid submission, noted as Attachment 3.

Additional Remittance Address Information

PAYEE DATA RECORD SUPPLEMENT

If contractor obtains multiple active remittance address locations, a payee data record supplement STD 205 is required.

http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

ATTACHMENT 4

CONTRACTORS CERTIFICIATION CLAUSE

A Bidder must complete the Contractor’s Certification Clause, located at the following internet site: https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/CCC-042017.pdf

If you do not have Internet access, a hard copy can be provided to you.

If applicable, the completed Contractor’s Certification Clause must be included in the bid submission, noted as Attachment 4.

https://www.dgs.ca.gov/-/media/Divisions/OLS/Resources/CCC-042017.pdf

ATTACHMENT 5

BIDDER DECLARATION

A Bidder must complete the Bidder Declaration form GSPD-05-105, located at the following internet site: http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf

If you do not have Internet access, a hard copy can be provided to you.

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.

The completed Bidder Declaration GSPD-05-105 must be included in the bid submission, noted as Attachment 5.

http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf

ATTACHMENT 6

PROOF OF INSURANCE

A Bidder must submit current proof of insurance as Attachment 6 for the following:

• Commercial General Liability

• Commercial Automobile Insurance

• Worker’s Compensation

A certificate of insurance (COI) may be provided as proof of insurance. The COI and/or proof of insurance documents will be named Attachment 7 and be submitted with the bid submission. Endorsements to insurance policies are not required for bid submission.

Certificates of Insurance with Endorsements are required post award as follows:

Commercial General Liability Certificate with limits of not less than $1,000,000 with:

o An additional insured endorsement.

o A Primary and Non-contributory endorsement.

Commercial Auto Liability Certificate with limits of not less than $1,000,000 for Owned, Non- Owned, and Scheduled autos with:

o An additional insured endorsement.

Worker’s Compensation Certificate with Employer’s Liability coverage of $1,000,000 per accident with:

o A waiver of subrogation in favor of the State for all work performed by the contractor, its employees, agents and subcontractors.

Endorsements must include "State Of California, It's Officers, Agents, And Employees" or ““… where required by written contract… ” language

Contact your insurance representative to ensure your insurance program satisfies the requirements of the sample contract, prior to bidding.

ATTACHMENT 7

BID-COST SHEET

*Cost per physical: $_____________________ Includes cost of insurance, sales tax, and every other item of expense, direct or indirect, incidental to the Bid Price.

*Award based on lowest cost per physical.

ATTACHMENT 8 (IF APPLICABLE)

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.

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.

If your company has within the previous three years, had any business activities or other operations outside of the United States, you must complete this form located at the following internet site: https://www.dgs.ca.gov/-/media/CBAFDC111B6C43B09496B8391E11F394.ashx

If you do not have Internet access, a hard copy can be provided to you.

If applicable, the completed Darfur Contracting Act Certification must be included in the bid submission, noted as Attachment 8.

https://www.dgs.ca.gov/-/media/CBAFDC111B6C43B09496B8391E11F394.ashx

ATTACHMENT 9 (IF APPLICABLE)

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS

If the Bidder wishes to claim the Disabled Veteran Business Enterprise (DVBE) incentive. A Bidder must complete the Disabled Veteran Business Enterprise Declarations, located at the following internet site: https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd_843.pdf

If you do not have Internet access, a hard copy can be provided by contacting the Analyst listed on the IFB.

If completed, Disabled Veteran Business Enterprise Declarations must be included in the bid submission, noted as Attachment 9.

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