IFB.pdf

The following is a list of documents which should be included in your Internet Package.

Form Name Attachment No # Pages Invitation for Bid- Cover Letter 1 Invitation for Bid 9 Bid Proposal, ADM 1412 1 1 Contractor Certification Clauses 2 4 Bid/Bidder Certification Sheet 3 2 Darfur Contracting Act 4 1 Required Attachment Checklist 5 1 Proposed Form of Agreement, STD 213 6 13

If this Bid Package is downloaded via the Internet, you will need to submit your signed bid documents in a sealed envelope with the following information on the envelope as provided in the sample below:

YOUR RETURN

ADDRESS

Agreement No. 04A4938

Bid Due Date: May 10, 2016 Postage

Department of Transportation Division of Procurement and Contracts ATTN: Bid Unit 1727 30th Street, 4th Floor, MS-65 Sacramento, CA 95816-7006

BID SUBMITTAL DO NOT OPEN

STATE OF CALIFORNIA------- CALIFORNIA STATE TRANSPORTATION AGENCY EDMUND G BROWN Jr., Governor

DEPARTMENT OF TRANSPORTATION

ADMINISTRATION

DIVISION OF PROCUREMENT AND CONTRACTS

1727 30th STREET, MS-65

SACRAMENTO, CA 95816-7006

PHONE (916) 227-6098

FAX (916) 227-6138

TTY 711

http://caltrans-opac.ca.gov

Serious drought.

Help save water!

April 26, 2016

INVITATION FOR BID (IFB)

IFB # 04A4938

Notice to Prospective Contractors

You are invited to review and respond to this IFB #04A4938, entitled, Physical Exam/Medical Testing Services. In submitting your bid, you shall comply with the instructions found herein. In addition to those programs and preferences that are specified in this solicitation, Prospective Contractors are encouraged to consider programs and preferences that are available, such as those for the use of small businesses, disadvantaged businesses, disabled veteran businesses, and other businesses covered by State and Federal programs and preferences.

As required by Executive Order S-02-06, Department of Transportation (Caltrans) is committed to meeting the State’s 25 percent (25%) Small Business (SB) participation goal. Certified SBs and Microbusinesses (MB are encouraged to submit bids. See Section D, Special Programs, Item 1, in this IFB for requirements.

A Disabled Veteran Business Enterprise (DVBE) goal is not required, but DVBE participation is encouraged, and a DVBE incentive may apply to this IFB. See Section D, Special Programs, Item 2, in this IFB for requirements.

Note that all contracts entered into with Caltrans will include, by reference, General Terms and Conditions (GTC) and Contractor Certification Clauses (CCC) that may be viewed and downloaded at Internet site http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx.

The designated contact person for this IFB is:

Rolesa Indalecio Department of Transportation Rolesa.indalecio@dot.ca.gov

(916) 227-6098

(916) 227-6138

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

*Technical questions regarding this solicitation will be addressed, in writing, and in accordance with the Questions and Answers portion of this IFB. See Section C, Item 1, Time Schedule for more details.

Sincerely, ROLESA INDALECIO

Contract Analyst http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx

Invitation For Bid IFB Number 04A4938

Table of Contents

SECTION PAGE

A) Purpose and Description of Service 1

B) Bidder Minimum Qualifications 1

C) Bid Requirements and Information 1

1. Time Schedule 1

2. Questions and Answers 1

3. Costs Included in Bid Rates 2

4. Small Business Preference 2

5. Contractor License 2

6. Insurance 2

7. Darfur Contracting Act 3

8. Bid Submittal 3

9. Evaluation and Selection 5

10. Award and Protest 6

11. Standard Conditions of Service 7

D) Special Programs 8

1. Small Business Preference 8

2. Disabled Veteran Business Enterprise (DVBE) Programs 8

Attachments

1. Bid Proposal, ADM 1412

2. Contractor Certification Clauses, CCC 307

3. Bid/Bidder Certification Sheet

4. Darfur Contracting Act

5. Required Attachment Check List

6. Proposed Form of Agreement, STD 213:

Exhibit A, Scope of Work Exhibit B, Budget Detail and Payment Provisions Exhibit C, General Terms and Conditions Exhibit D, Special Terms and Conditions Exhibit E, Additional Provisions

A) Purpose and Description of Services

The Contractor shall be a California licensed physician and shall provide facility, personnel, equipment, instruments, materials, and supplies to perform medical examinations as required by the Department of Motor Vehicles (DMV) for Class A or B Driver License; DMV Annual Physical Examination as required by the California Code of Regulations and Spirometry (Pulmonary Function Test), Semi-Annual Airborne Lead Blood Base Line Testing, as required.

Refer to the Proposed Form of Agreement, Exhibit A, which is attached to this IFB as Attachment 6, for a more complete description of services.

B) Bidder’s Minimum Qualifications

1. The bidder’s firm, where all examinations shall be performed, must be no more than 50 miles from the Caltrans District 2 Region Office, located in at 1490 George Drive, Redding, CA 96003.

Only those bids submitted that meet this requirement shall be considered a valid bid.

2. The bidder shall be properly licensed in accordance with the laws of the State of California and shall possess a Medical Board of California Certified Physician’s license. A copy of the Physician’s license shall be submitted with the bid package.

C) Bid Requirements and Information

1. Time Schedule

It is recognized that time is of the essence. All bidders are hereby advised of the following schedule and will be expected to adhere to the required dates and times.

EVENT DATE TIME

(Pacific Time)

IFB available to prospective bidders April 26, 2016 Written Question Submittal May 3, 2016 4:00 PM Final Date and Time for Bid Submission May 10, 2016 2:15 PM Bid Opening May 10, 2016 3:00 PM

2. Questions and Answers A. Questions regarding this IFB must be submitted in writing by May 3, 2016. Bidders are encouraged to submit their written questions via e-mail to rolesa.indalecio@dot.ca.gov.

B. Written questions must include: the individual's name, firm name, complete address and must reference IFB No. 04A4938. Questions must be sent to one of the following:

EMAIL, MAIL OR FAX TO:

Email: rolesa.indalecio@dot.ca.gov Department of Transportation

Division of Procurement and Contracts Attention: Rolesa Indalecio

1727 30th Street, MS-65 Sacramento, CA 95816

Fax No.: (916) 227-6138

C. Written responses to all questions will be collectively compiled and posted, as an Addendum, to the Cal eProcure/FI$Cal website (https://caleprocure.com/pages/index.aspx). It is the responsibility of the Bidder to access the website for any changes or addenda that may be posted.

Refer to this IFB, Section C 1, Time Schedule, for the schedule of events and dates/times. It is the responsibility of the bidder to check Cal eProcure for all addenda. Bidder can contact the Contract Analyst named above:

3. Costs Included in Bid Rates Bid prices/rates shall include the cost of employer payments to or on behalf of employees, subsistence, travel, compensation insurance premiums, unemployment contributions, social security taxes, contract bond premiums, and any other taxes or assessments, including but not limited to, sales and use taxes required by law or otherwise and no additional allowance will be paid unless separate payment provisions in the Agreement should specifically provide otherwise.

4. Small Business Preference: http://www.pd.dgs.ca.gov/smbus SB Preference will be granted on this IFB. Only firms certified as a "Small Business” or “Microbusiness" with the Department of General Services (DGS), Office of Small Business and DVBE Service (OSDS) will be granted this preference.

5. Contractor License Bidder must have, at time of bid submittal and for the duration of the contract, a valid, current Certified Physician’s license issued by the Medical Board of California, for the type of work to be performed. Bidder shall obtain, pay for and maintain, in good standing, all necessary licenses and permits to accomplish the work. Bidders will be considered non-responsive unless proper licensing requirements are met. An invalid license will result in rejection of the bid. Positive verification of a valid license issued by the Medical Board of California will be performed by Caltrans (reference Business & Professions Code section 7028.15).

6. Insurance A. The bidder, who receives the Agreement award, must provide a Certificate of Insurance providing proof of insurance to the Division of Procurement and Contracts within ten (10) working days from the date of notification of award. The State’s Office of Risk and Insurance Management will review insurance certificates and/or proof of self-insurance documentation before execution of the Agreement. Refer to the Proposed Form of Agreement Exhibit E, Attachment 6, for the applicable and specific Insurance requirements and coverage limits.

B. The insurance carrier shall provide an endorsement for the additional insured statement as follows:

https://caleprocure.com/pages/index.aspx http://www.pd.dgs.ca.gov/smbus

Caltrans, State of California, its officers, agents, and employees shall be included as additional insured, but only with respect to work performed for the State of California under this Agreement.

C. The additional insured endorsement must accompany the certificate of insurance.

7. Darfur Contracting Act A. The Darfur Contracting Act, PCC section 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. The Act was passed by the California Legislature and signed into law by the Governor to preclude State agencies generally from contracting with “scrutinized” companies that do business in the African nation of Sudan (of which the Darfur region is a part), for the reasons described in PCC section, 10475. All bidders shall complete the Darfur Contracting Act Certification form, Attachment 4, and submit with bid.

B. If your company has not, within the previous three years, had any business activities or other operations outside of the United States, complete Option 1 on the Darfur Contracting Act Certification form, Attachment 4.

C. A scrutinized company is a company doing business in Sudan as defined in PCC section 10476. Scrutinized companies are ineligible to, and cannot bid on, or submit a proposal for an Agreement with a State agency for goods or services. (PCC section 10477(a)).

D. Therefore, PCC section 10478 (a) requires a company that currently has (or within the previous three (3) years has had business activities or other operations outside of the United States to certify that it is not a “scrutinized” company when it submits a bid or proposal to a State agency.

E. A scrutinized company may still; however, submit a bid or proposal for an Agreement with a State agency for goods or services if the company first obtains permission from the Department of General Services (DGS) according to the criteria set forth in PCC section 10477(b).

8. Bid Submittal A. All bids must be submitted and received by Caltrans Division of Procurement and Contracts, Bid Unit by dates and times shown in the IFB, Section C) Bid Requirements and Information, Item 1) Time Schedule.

B. The mailing package/envelope should be labeled as follows:

Note: All packages not clearly or properly labeled as indicated below, including overnight mail and hand delivered packages may be rejected.

C. Late bids will not be considered.

D. All bids shall include the documents identified on the IFB’s Required Attachment

Checklist, Attachment 5. Bids not including the required attachment(s) shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements.

E. Only an individual who is legally authorized to bind the proposing firm contractually shall sign all documents requiring a signature, and each document must bear an original ink signature.

F. If your bid is hand delivered, you must date and time stamp the sealed envelope/package immediately upon arrival. The date/time stamp machine is located in the lobby on the first floor to the right of the security guard station at the address noted above. After date/time stamping, the bid should be placed in the locked bid cabinet located below the time stamp. If the bid package is too large to be electronically stamped, date/time stamp one of the labels provided and attach it to the proposal package. When the bid package is too large for the locked bid cabinet, ask the security guard to call the Division of Procurement and Contracts reception desk at 227-6000 to have your bid package picked up.

G. Bid opening will be held at the above address at 3:00 PM on the date specified in Section C - Bid Requirements and Information, Item1 - Time Schedule. Bidders may participate in person or via teleconference by calling 1-866-700-7952 and entering the pass code 7089821#.

Calls will be accepted beginning at 2:50 PM until the conclusion of the bid opening. Bids will be read in Agreement numeric order; questions will not be allowed; and information will not be repeated. Bid opening results will be posted online on the Division of Procurement and Contracts web site at http://caltrans-opac.ca.gov/contracts/bidresults.htm by 12:00 P.M. on the day following the bid opening. The Agreement will be awarded to the lowest responsible bidder meeting the requirements outlined in the IFB.

H. Bids must include the performance of all the services described herein. Any attempt to modify the bid document to deviate from the work specifications will not be considered and will cause a bid to be rejected.

postage YOUR RETURN

Agreement No. 04A4938 Bid Due Date: May 10, 2016 Bid Due Time: 2:15 P.M.

Bid Opening: 3:00 P.M.

Attention: Rolesa Indalecio

Department of Transportation

Division of Procurement and Contracts

ATTN: BID UNIT

1727 30th Street, 4TH Floor, MS-65 Sacramento, CA 95816-7006

BID SUBMITTAL DO NOT OPEN

http://caltrans-opac.ca.gov/contracts/bidresults.htm

I. A bid may be rejected if it is conditional, incomplete, or if it contains any alterations of form or other irregularities of any kind. Caltrans may reject any bid on the basis that it is not responsive or from a non-responsible bidder, and may waive any immaterial deviation in a bid. Caltrans waiver of an immaterial defect shall in no way modify the IFB document or excuse the bidder from full compliance with all requirements if awarded the agreement.

J. Costs for developing bids and in anticipation of award of an Agreement is entirely the responsibility of the bidder and shall not be charged to the State.

K. Only an individual who is authorized to bind the bidding firm contractually shall sign the Bid/Bidder Certification Sheet, Attachment 3. The signature must also indicate the title or position that the individual holds in the firm. An unsigned bid may be rejected.

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

M. A bidder may withdraw a bid by, prior to bid opening, submitting a written withdrawal request to Caltrans, signed by the bidder or an agent authorized in accordance with Section K, above.

A bidder may thereafter submit a new bid prior to the bid submittal deadline. Bids may not be withdrawn without cause subsequent to bid submittal deadline.

N. Caltrans may modify the IFB prior to the date fixed for submission of bids by the issuance of an addendum sent to all parties who received a bid package.

O. Caltrans reserves the right to reject all bids for reasonable cause.

P. Bidders are cautioned not to rely on Caltrans during its evaluation process to discover and report to the bidder any defects and/or errors in the submitted documents. Before submitting their documents, bidders should carefully proof them for errors and full adherence to the IFB requirements.

Q. Where applicable, the 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 the Agreement amount will be made due to a lack of careful examination of work sites and specifications.

R. Caltrans does not accept alternate Agreement language from a bidder. A bid with such language will be considered a counter proposal and will be rejected. The State’s GTCs are not negotiable. The GTC 610 may be viewed at http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx

9. Evaluation and Selection A. At the time of bid opening, each bid proposal’s total and any small business and/or micro business information (if applicable) will be read aloud. Bids are considered preliminary pending review and verification of applicable bid requirements such as: small business preference, DVBE, DBE, licensing, bonding, qualifications, or other requirements as stated in the IFB. Agreements will be awarded to the lowest responsive responsible bidder.

B. Each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this IFB. Caltrans will check the bid submittal package to verify it received all required documents. Positive verification of required documents will be performed to determine its responsiveness to the State's needs.

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

D. The Agreement, if awarded, shall be awarded to the lowest responsible bidder meeting the specifications. A bid meets the specifications if it complies with all of the requirements in this solicitation. In the event of a tie bid, Caltrans will draw lots to determine the successful bidder. Only one proposal or bid may be submitted by an entity: individual, firm, partnership, corporation, joint venture or combination thereof. Receipt of more than one bid from an entity will result in all bids from that entity being rejected and returned to the bidder.

10. Award and Protest A. Bid results may be viewed on the internet at 12:00 P.M. (Noon) on the first business day following the bid due date at http://caltrans-opac.ca.gov.

B. Whenever an Agreement is awarded under a procedure that provides for competitive bidding, but the Agreement is not to be awarded to the low bidder, the low bidder shall be given notice five (5) working days prior to the award of the Agreement by telegram, electronic facsimile transmission, overnight courier, Internet transmission, or personal delivery.

C. Upon written request by any bidder, notice of the proposed award shall be posted in a public place in the office of the awarding agency at least five (5) working days prior to awarding the Agreement.

D. Grounds for Filing a Protest: After the issuance of the applicable Agreement award notices as specified in this IFB, the right to protest the proposed award of an Agreement is afforded any bidder who claims it should have been awarded the Agreement because it was the lowest responsible bidder meeting the specifications.

E. Filing a Protest: The initial protest must be submitted to the Caltrans, Protest Unit prior to the award of the Agreement. When a protest has been submitted, the Agreement shall not be awarded until either the protest has been withdrawn or DGS has decided the matter.

F. Within five (5) days after filing the initial protest, the protesting bidder shall file with DGS and Caltrans, Protest Unit with a full and complete written statement specifying the grounds for the protest. The written protest must be sent to the addresses below:

Department of Transportation Division of Procurement & Contracts Attention: Bid, Protest, & Dispute Branch Chief 1727 30th Street, MS-65 Sacramento, CA 95816 Phone Number: (916) 227-6096 Fax Number: (916) 227-1950

Department of General Services Office of Legal Services Attention: Protest Coordinator 707 Third Street, 7th Floor West Sacramento, CA 95605 Phone Number: (916) 376-5080 Fax Number: (916) 376-5088

Note: It is suggested that you submit any protest by certified or registered mail.

G. Upon award of the Agreement Contractor shall complete and submit to Caltrans, the Payee Data Record form (STD 204), to determine if the Contractor is subject to State income tax http://caltrans-opac.ca.gov/ withholding pursuant to California Revenue and Taxation Code section 18662 et seq. This form can be found on the Internet at www.osp.dgs.ca.gov under the heading STANDARD FORMS. No payment shall be made unless a completed STD 204 has been returned to Caltrans.

H. Bidder(s) must complete, sign and submit to Caltrans, all pages of the Contractor Certification Clauses (CCC), Attachment 2, with bid package.

11. Standard Conditions of Service A. Service shall not begin prior to the express date set by the Caltrans Contract Manager 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 Caltrans Contract Manager, upon five (5) days written notice to the Contractor, reserves the right to terminate the Agreement. In addition, the Contractor shall be liable to Caltrans for the difference between Contractor's bid price and the actual cost of performing work by the second lowest bidder or by another Contractor.

B. All performance under the Agreement shall be completed on or before the termination date of the Agreement.

C. Antitrust Provisions

1) In submitting a bid to a public purchasing body, the bidder offers and agrees that if the bid is accepted, it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15 or under the Cartwright Act Chapter 2, commencing with Section 16700, of Part 2 of Division 7 of the Business and Professions Code {BPC}), arising from purchases of goods, materials, or services by the bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing body tenders final payment to the bidder. (See GC section 4552)

2) If the awarding body or public purchasing body receives, either through judgment or settlement, a monetary recovery for a cause of action assigned under this chapter, the assignor shall be entitled to receive reimbursement for actual legal costs incurred and may, upon demand, recover from the public body any portion of the recovery, including treble damages, attributable to overcharges that were paid

3) Upon demand in writing by the assignor, the assignee shall, within one year from such demand, reassign the cause of action assigned under this part if the assignor has been or may have been injured by the violation of law for which the cause of action arose and (a) the assignee has not been injured thereby, or (b) the assignee declines to file a court action for the cause of action. (See GC section 4554)

D. If the bidder is awarded the Agreement and refuses to sign the Agreement presented for signature within the time and manner required, the bidder will be liable to Caltrans for actual damages resulting to Caltrans therefrom or ten percent (10%) of the amount bid, whichever is less.

E. Loss Leader usage is prohibited in this solicitation: It is unlawful for any person engaged in business within this State to sell or use any article or product as a "loss leader" as defined in Section 17030 of the California Business and Professions Code. "Loss Leader" means any http://www.dgs.ca.gov/dgs/ProgramsServices/Forms/FMC/search/resultsNumber.aspx?number=204 article or product sold at less than cost: a) where the purpose is to induce, promote or encourage the purchase of other merchandise; or b) where the effect is a tendency or capacity to mislead or deceive purchasers of prospective purchasers; or c) where the effect is to divert trade from or otherwise injure competitors.

F. No oral understanding or agreement shall be binding on either party.

D) Special Programs The following Special Programs are applicable to this IFB.

1. Small Business (SB) or Microbusiness (MB) Preference A. GC section 14835 et seq. requires that a five percent (5%) preference be given to contractors who qualify as a certified SB or MB. References to a SB shall also include MB. The rules and regulations of this law, including the definition of a SB for the delivery of services, are contained in Title 2, California Code of Regulations (2 CCR) 1896 et seq.

B. To claim the SB preference, your firm must have its principal place of business located in California and be certified by the California Department of General Services (DGS), Office of Small Business and DVBE Services (OSDS). The preference amount may not exceed fifty thousand dollars ($50,000) for any bid. If prospective Contractor is claiming the five percent (5%) SB preference, complete Section 16 of the Bid/Bidder Certification Sheet, Attachment 3.

C. Certified SB bidder(s) shall have precedence over NSB bidders in the application of SB preference(s).

D. SB preferences may not be applied to any bid deemed non-responsive with the solicitation instructions or from a non-responsible bidder.

E. Questions regarding the certification approval process or SB program should be directed to OSDS at (800) 559-5529 or (916) 375-4940. For the 24-Hour Recording & Mail Request call

(916) 322-5060, or E-mail: osdshelp@dgs.ca.gov.

F. Additional references are at http://www.dgs.ca.gov/pd/Programs/OSDS.aspx.

2. Disabled Veteran Business Enterprise (DVBE) Programs A. DVBE Participation Program with NO Goals

A DVBE goal is not required, but DVBE participation is encouraged, and a DVBE incentive will apply to this IFB as described below.

B. DVBE Incentive Program

1) The DVBE Incentive Program applies to this solicitation. It is separate from the DVBE Participation Program and was established in MVC §999 et seq., and 2 CCR §1896.99 et seq. A dollar cap of $100,000 is set for all combined incentives and preferences. The incentive is used only for evaluation purposes to arrive at the successful bidder and does not alter the amounts of the actual bid. Any responsive and responsible bidder with the confirmed DVBE participation per the Table in paragraph 3) below is eligible to receive the incentive. Bidders who are not responsive and responsible are not eligible to receive the incentive.

http://www.dgs.ca.gov/pd/Programs/OSDS.aspx

2) Caltrans will apply an incentive to bids from DGS Certified DVBE firms. The bidders who claim to be DGS Certified DVBE firms will be verified by Caltrans prior to award of the Agreement. The incentive amount is equal to the percentage of the lowest responsive and responsible bid being evaluated per the Table below.

3) Table for IFB (Low Price Method):

Verified DVBE Participation

DVBE Incentive Amount

100% 5%

4) When applying the DVBE Incentive, a NSB shall not displace or otherwise supersede an award to a DGS Certified Small Business.

5) Additional information: http://www.dgs.ca.gov/pd/Programs/OSDS.aspx.

http://www.dgs.ca.gov/pd/Programs/OSDS.aspx

STATE OF CALIFORNIA ∙ DEPARTMENT OF TRANSPORTATION

BID PROPOSAL ATTACHMENT 1

ADM-1412 (REV. 11/2015)

CONTRACTOR’S NAME (Please Print): CONTRACT NO.

ITEM

NO.

ESTIMATED

QUANTITY

UNIT OF

MEASURE ITEM UNIT PRICE

( Price Per Unit of Measure)

TOTAL

(Estimated Quantity X Unit

Price)

DMV Annual Physical Examinations in accordance with Exhibit A, Scope of Work, Item 7 (1)

1 200 Each Class A and B Driver License Examination $

Spirometry (Pulmonary Function Testing) in accordance with Exhibit A, Scope of Work, Item 7 (2)

2 100 Each Respiratory Compliance – basic Physical Examination $

3 100 Each Respiratory Compliance – Pulmonary Function $

(1) THE ABOVE QUANTITIES ARE ESTIMATES ONLY AND ARE GIVEN AS A BASIS FOR COMPARISON OF BIDS. NO

GUARANTEE IS MADE OR IMPLIED AS TO THE EXACT QUANTITY THAT WILL BE NEEDED.

TOTAL THIS

PROPOSAL

(2) IN CASE OF DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL SET FORTH FOR A UNIT BASIS ITEM, THE

UNIT PRICE SHALL PREVAIL.

(3) PLEASE DO NOT ALTAR, MODIFY, OR CHANGE THIS BID PROPOSAL SHEET. ANY ALTERATIONS, MODIFICATIONS, OR CHANGES TO THIS BID PROPOSAL SHEET MAY BE GROUNDS TO REJECT THE BID.

(4) EACH LINE ITEM MUST BE BID. PLEASE DO NOT LEAVE ANY UNIT PRICE COLUMN BLANK OR THIS BID WILL BE

DISQUALIFIED FROM THE COMPETITION FOR CONTRACT AWARD.

ATTACHMENT 2

CONTRACTOR CERTIFICATION CLAUSES

CCC-307

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

1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 8103) (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.)

1.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 https://www.dir.ca.gov/sweatfreecode.htm, 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 over $100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code Section 10295.3.

https://www.dir.ca.gov/sweatfreecode.htm

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.

ATTACHMENT 3

BID/BIDDER CERTIFICATION SHEET

Only an individual who is authorized to bind the bidding firm contractually shall sign the Bid/Bidder Certification Sheet. The signature must indicate the title or position that the individual holds in the firm. This Bid/Bidder Certification Sheet must be signed and returned along with all "required attachments" as an entire package with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.

A. Our all-inclusive bid is submitted in a sealed envelope marked “Bid Submittal - Do Not Open”.

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

C. I have read and understand the DVBE participation requirements and have included documentation demonstrating that I have met the participation goals.

D. 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.

E. The signature and date affixed hereon certifies that this bid is a firm offer for a 90-day period.

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

1. Company Name 2. Telephone Number 2a. Fax Number 2b. Email Address

3. Address

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.

Indicate the Department of Industrial Relations information:

9. Contractor Registration Number

Indicate applicable license and/or certification information:

10. Contractor’s State Licensing 11. PUC License Number Board Number CAL-T-

12. Bidder’ Name (Print) 13. Title

14. Signature 15. Date

16. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as:

a. Small Business Enterprise 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 OSDS, if an application is pending: _________________

17. Are you a Non-Small Business committing to the use of 25% Certified Small Business Subcontractor Participation?

Yes No

If Yes, complete and return the Bidder Declaration form, GSPD-05-105 with your bid.

ATTACHMENT 3

BID/BIDDER CERTIFICATION SHEET

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

Item Numbers Instructions

1, 2, 2a, 3

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 your firm holds a California contractor’s license. This information will used to verify possession of a contractor’s license for public works agreements.

Complete if your firm holds a PUC license. This information will be used to verify possession of a PUC license for public works agreements.

11, 12, 13, 14, Must be completed. These items are self-explanatory.

If certified as a Small Business Enterprise, place a check in the "yes" box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the "Yes" box and enter your service code on the line. If you are not certified to one or both, place a check in the "No" box. If your certification is pending, enter the date your application was submitted to the Department of General Services, Office Small Business and DVBE Services. To get certified, go to http://www.pd.dgs.ca.gov/smbus/default.htm

ATTACHMENT 4

Darfur Contracting Act

Instructions: Complete, as applicable, and submit with bid.

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.

OPTION #1 - CERTIFICATION

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, complete and sign this section and submit with bid package.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below has not, within the previous three years, had any business activities or other operations outside of the United States. 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)

OPTION #2 - 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)

Date Executed Executed in the County and State of

OPTION #3 – 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) Federal ID Number

By (Authorized Signature)

Date Executed Executed in the County and State of

ATTACHMENT 5

REQUIRED ATTACHMENT CHECKLIST

A complete bid or bid package will consist of the items identified below.

Complete this checklist to confirm the items in your bid package. Place a check mark or “X” next to each item that you are submitting to Caltrans. All attachments identified below (unless noted otherwise) are required and must be returned as instructed or your bid may be considered non-responsive. Return the Attachment Checklist with your bid package.

Do NOT submit the Proposed Form of Agreement, Attachment 6, company advertisements, brochures, informational pamphlets or any other document unless specifically noted in the IFB Requirements and/or as listed below.

Attachments Attachment Name/Description

Attachment 1 Bid Proposal, ADM 1412

Attachment 2 Contractor Certification Clauses (CCC 307). The CCC 307 can also be found on the Internet at http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx. Page one (1) must be signed and submitted prior to the award of the contract.

Attachment 3 Bid/Bidder Certification Sheet

Attachment 4 Darfur Contracting Act

Attachment 5 Required Attachment Checklist Copy Medical Board of California Certified Physicians License

STATE OF CALIFORNIA Department of Transportation STANDARD AGREEMENT IFB Number 04A4938 STD 213 (Rev 09/01)

ATTACHMENT #6

Proposed Form of Agreement

AGREEMENT NUMBER

REGISTRATION NUMBER

1. This Agreement is entered into between the State Agency and the Contractor named below:

STATE AGENCY'S NAME

California Department of Transportation (Caltrans)

CONTRACTOR’S NAME

TBD

2. The term of this June 1, 2016 (estimate) or upon

Caltrans approval, whichever is later through May 31, 2018 (estimate)

Agreement is:

3. The maximum amount $TBD of this Agreement is:

4. The parties agree to comply with the terms and conditions of the following exhibits/attachments, which are by this reference made a part of the Agreement.

Exhibit A – Scope of Work 3 Pages Exhibit B – Budget Detail and Payment Provisions 2 Pages Exhibit C* – General Terms and Conditions (Electronic File: GTC 610) Exhibit D - Special Terms and Conditions 3 Pages Exhibit E – Additional Provisions 3 Pages Attachment 1 - Bid Proposal (To be attached upon award) 1 Page Attachment 2 – Toll Bridge Maintenance Region Medical Examination Authorization Form 1 Page

Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this Agreement as if attached hereto. These documents can be viewed at http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx.

IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.

CONTRACTOR California Department of General Services Use Only CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.)

TBD

BY (Authorized Signature)

DATE SIGNED (Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING

STATE OF CALIFORNIA

AGENCY NAME

California Department of Transportation (Caltrans) BY (Authorized Signature)

DATE SIGNED (Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per:

Rajit Sharma, Contract Officer Exemption Letter 12.0

ADDRESS

Division of Procurement and Contracts 1727 30th Street, MS 65 Sacramento, CA 95816

Note to Bidders:

The following pages represent a sample of the Agreement that will be awarded, if any, from this IFB.

Please review it carefully and present any…