IFB.RW2401016_Packaged_Milk_Products.pdf

State of California Department of Corrections and Rehabilitation

February 4, 2025

INVITATION FOR BID (IFB)

IFB # RW2401016

Notice to Prospective Contractors

The California Prison Industry Authority (CALPIA) invites you to review and respond to this Invitation for Bid (IFB), entitled RW2401016 for PACKAGED PROCESSED MILK PRODUCTS.

In submitting your bid, you must comply with the instructions found herein. CALPIA does not accept alternate contract language from a prospective vendor. A bid with such language will be considered a counter proposal and will be rejected. CALPIA’s General Provisions (GP’s) are not negotiable.

Mail or deliver your bid package for the IFB to the address below. Faxed or electronically forwarded bids will not be accepted. Bids not submitted under sealed cover will be rejected. 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:

IFB Number: RW2401016 IFB Name: PACKAGED PROCESSED MILK PRODUCTS Attention: LISA HORRELL Bid Submittal: Do Not Open

In the opinion of CALPIA, this IFB is complete and without need of explanation. However, should you have questions, or need clarifying information, please contact the Contract Analyst indicated below.

Due Date/Time: February 20, 2025 by 3 p.m.

CALPIA Contact Return Sealed Bid To:

Lisa Horrell Desk Phone: (916) 358-2150

Email: Lisa.Horrell@calpia.ca.gov

California Prison Industry Authority Attention: Lisa Horrell

560 East Natoma Street Folsom, CA 95630

This IFB covers the estimated annual requirement of PACKAGED PROCESSED MILK PRODUCTS for the California Prison Industry Authority (CALPIA) DAIRY ENTERPRISE at California State Prison-Corcoran in Corcoran, California. The CALPIA Dairy may periodically need to supplement its own production of milk in the event of lockdowns, equipment breakdowns, raw milk shortage, or other unforeseen emergencies. When production cannot keep up with demand, an outside source will be used.

Term: Any contract resulting from this solicitation will be for two (2) years regardless of the amount purchased, unless extended or terminated. The contract resulting from this solicitation may be extended for one (1) year by mutual agreement of CALPIA and the contractor.

mailto:Lisa.Horrell@calpia.ca.gov

IFB #RW2401016 Page 2 of 7 Packaged Milk Products

Method of Award:

Bidders are not required to bid on every delivery location listed on Exhibit 1 Cost Sheet.

However, bidders must bid on every line item for the desired location in order to be considered responsive.

Multiple contracts may be awarded as a result of this bidding effort. The contract award(s) will be made based on BEST VALUE as determined by CALPIA alone, under statutory authority, considering the following criteria and depending on the specific needs of CALPIA.

1. Cost: Fair, reasonable, and competitive price, expressed warranties, life cycle of product, and customer service commitments for goods and or services.

2. Performance: Past performance, including but not limited to the quality and/or reliability for the product or service as well as efficient billing practices; certification by the International Organization for Standardization (ISO).

3. Experience: Length of time and/or number of instances the bidder has offered or produced the requested type of product and/or service.

CALPIA may consider other factors deemed necessary to ensure that the best value is achieved.

In the interest of achieving best value, CALPIA does not grant Small Business, Disabled Veteran Business Enterprise (DVBE), Target Area Contract Preference Act (TACPA), Local Agency Military Base Recovery Act (LAMBRA), or Enterprise Zone Act (EZA) preferences in evaluating bids. Employment of ex-offenders by the bidder is encouraged by CALPIA as part of our ongoing mission to change lives through opportunities.

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

Lisa Horrell

LISA HORRELL

Contract Analyst

IFB #RW2401016 Page 3 of 7

Specifications:

All milk products must meet the California Department of Food and Agriculture (CDFA) guidelines for milk. All products sold to CALPIA under the ensuing agreement must be Grade A, rBST free, and certified Kosher. The temperature of the milk must be at or below 45⸰F at the time of delivery. Milk must have a minimum of 14 days remaining prior to expiration at the time of delivery.

Contract Dollar Value:

Any contract resulting from this bid will expire two (2) years from its effective date unless extended. However, in the event the ordering agency’s requirements are curtailed because of reducing requirements, cancellation of State programs, lack of fiscal appropriations, etc., the State shall be excused from purchasing any outstanding balances.

Quantities shown on the Cost Sheet (Exhibit 1) are estimated and are based on the anticipated contract purchase need. The State will not be obligated to purchase the contractor’s excess inventory of any line item if actual purchases vary from the anticipated purchase pattern. The State reserves the right to order more or less of any line item provided the total monetary amount of the contract is not exceeded.

Please Note:

Only bids quoted on the State’s own Cost Sheet will be considered. Bids submitted referencing supplier attachments, which include legal terms and conditions that conflict with the State’s general bid provisions shall be considered non-responsive and such bids shall be rejected. On the Cost Sheet if there is a discrepancy between the unit price and the extension price, the unit price shall prevail.

Contract Modifications:

Any contract resulting from this solicitation may be amended in writing at any time by mutual agreement of contracting parties. Change orders amending, modifying, or terminating the contract, including any modification of the compensation payable, may be issued only by the CALPIA Procurement Officer.

Emergency Extension Option:

In the event of an emergency, upon mutual agreement with the contractor(s), CALPIA may extend the contract for up to one (1) additional year beyond the stated term and any noted extensions. Extensions during this period may occur in various increments until the establishment of a new contract. The total of the Emergency Extension Option terms shall not exceed one (1) additional year. All original Terms and Conditions shall remain the same during the extensions. Emergency Extension Option may be exercised in the event that a replacement contract cannot be established due to the protest of Intent to Award, loss of key CALPIA procurement staff, or other circumstances that would otherwise cause an unanticipated disruption to CALPIA’s Dairy Enterprise.

Minimum delivery of product on this contract will be one (1) 53-foot truck load consisting of 60,480 half-pint cartons (approximately 24 pallets), or a combination of half-pint cartons and half-gallon containers. Orders for less than this quantity shall be considered non-contract and may be purchased from other sources.

IFB #RW2401016 Page 4 of 7

Maximum Order:

Maximum order quantity will be two (2) 53-foot trucks per delivery site in a 72-hour period.

Prices (Differential and Base) and Invoice Procedure:

Commodity unit price will consist of the sum of the Base Price standard (USDA) and the Differential Price offered in the bid. The Differential Price quoted by the Bidder will be “firm” for the duration of any contract resulting from this solicitation; however, the Base Price may fluctuate as the market dictates. The Base Price shall be taken from the United States Department of Agriculture (USDA) California Marketing Area Federal Milk Order 51 monthly standard price for Class I milk.

Invoicing Requirements:

The contractor is to render invoices as instructed on individual orders. Invoices shall include the purchase order number, the contract number, the item number, the unit price, and the extension price. With each invoice, the contractor will submit a copy of the applicable portion of the most recent USDA California Marketing Area Federal Milk Order pricing to substantiate the invoiced prices. Invoices submitted without the attached report will not be honored.

Ordering Procedure:

On an emergency basis, CALPIA will issue a purchase order for packaged processed milk (half-pint cartons, half-gallon containers, or combination of both) to be delivered as specified on the order.

Cost to Cover:

Any failure to perform its obligations under the contract by the contractor shall, in addition to any other remedies available to CALPIA, entitle CALPIA to recover from the contractor the difference between the contractor’s price and an alternate supplier’s higher price in the event that CALPIA chooses to pay an alternate supplier a higher price for goods or services that the contractor fails to provide in a timely manner.

Non-Compliant Product:

Any milk delivered to Corcoran dairy must be at or below 45֯ F at the time of delivery. CALPIA staff will test and record the temperature at the time of delivery. Any product rejected by CALPIA as non-compliant shall be returned at the expense of the supplier and replaced with a compliant product.

Corrective Action Plan (CAP):

Should there be any issue with quality, food safety and/or damage to the final product, CALPIA can request a written Correction Action Plan (CAP). A CAP will be provided to CALPIA from the vendor no later than 3 business days from the time that the incident is reported to the vendor contact. The CAP will contain the nature of the reported issue, what immediate actions are planned to correct the problem, and how the problem is going to be prevented from happening again. The CAP can also contain any other relevant information that the vendor feels is necessary to explain the situation. CALPIA may issue a vendor performance report based on the circumstances.

IFB #RW2401016 Page 5 of 7

Freight on Board (F.O.B.) Point:

For the purpose of this bid, only bids quoting F.O.B. Destination will be accepted. Bids quoting other than F.O.B. Destination will be rejected. The unit price for milk must include the cost of shipping; additional charges for shipping will not be paid.

Packaging:

All packaging shall conform to the applicable freight classifications, I.C.C. and/or postal regulations, and be of a quality to ensure final delivery without damage to the contents. A packing slip shall accompany each shipment and show the contract and order numbers, contents, and the quantity shipped.

Half-pint cartons must be packaged in milk crates with 70 cartons per crate. Half-gallon containers must be packaged in milk crates with 12 containers per crate. Any deviations from these packaging configurations by the Contractor without prior notification to CALPIA will be considered a material breach of any contract that ensues from this solicitation.

The crates must be stacked on an industry standard pallet that has 2-way or 4-way entry for hand pallet jacks and forklifts. The stacks need to be built in a manner that will not promote crushing and leakage of product. Bidder will quote the replacement cost for shipping crates and pallets on the Cost Sheet (Exhibit 1). CALPIA will be credited with that same amount for each shipping crate and pallet returned to the vendor.

Delivery:

All products shall be delivered to the locations listed below Monday through Friday between 8:00 a.m. and noon. Weekend or holiday deliveries cannot be accepted without prior approval in writing by the ordering agency. Deliveries must be made within 72 hours from time of order notification request by CALPIA. Any single failure to deliver in a timely manner by the Contractor will be a material breach of any contract that ensues from this solicitation.

It shall be the contractor’s responsibility to obtain proper clearance for delivery drivers prior to any and all deliveries. Contact the institution listed for the driver clearance procedure.

Note: CALPIA trucks may be near the contractor’s shipping point with empty trailers and able to transport milk back to the CALPIA facility. Please indicate in Section 4 of the Contract Price Sheet (Exhibit 1) the unit rate per line item if CALPIA provides transportation between the contractor’s location and CALPIA facility.

Delivery Locations: CALPIA reserves the right to add delivery locations if needed.

CALPIA On Time Delivery (OTD) -North 8861 Younger Creek Drive Sacramento, CA 95828 Attn: Michael Philkill (916) 413-0460

California State Prison-Corcoran On Time Delivery (OTD) -Central 4001 King Avenue Corcoran, CA 93212 Attn: Greg Baronian (559) 410-0023

IFB #RW2401016 Page 6 of 7

California Institute for Men-Chino On Time Delivery (OTD) -South 14901 Central Avenue Chino, CA 91710 Attn: Davion Combs (916) 413-4038

Milk Crates and Pallets:

The contractor is required to backhaul the empty milk crates and pallets left from previous deliveries when making new deliveries. If CALPIA has arranged to pick up product from the contractor’s shipping point, CALPIA will deliver any empty crates and pallets on hand at the time of the arranged pickup.

Payment Terms:

Payment terms for this contract are net forty-five (45) days unless otherwise specified on the Cost Sheet (Exhibit 1). Payment will be made in accordance with the provisions of the California Prompt Payment Act, Government Code Section 927 etc. seq. Unless expressly exempted by statute, the Act requires State agencies to pay properly submitted, undisputed invoices not more than 45 days after (a) the date of acceptance of goods or performance of services or (b) receipt of an undisputed invoice, whichever is later. Under no circumstances will CALPIA be subject to late payment fees or interest charges.

Cash Discounts:

For the purpose of this bid, CALPIA will consider cash discounts for bid evaluation purposes.

Bidder may offer any cash discount desired; however, for the purpose of bid evaluation, when the cash discount offered exceeds five (5) percent, it will be calculated as five (5) percent in determining the lowest bidder. For example, if the bidder offers a cash discount of six (6) percent, for bid evaluation only, CALPIA will calculate the cash discount at five (5) percent when determining the lowest bidder.

For the purpose of bid evaluation only, if the bidder offers a cash discount of less than twenty

(20) days or less than one half (1/2) of one (1) percent, CALPIA will not adjust their bid for cash discount.

CALPIA has a history of taking cash discounts and intends to take advantage of cash discounts offered in response to this IFB when they are in the best interest of CALPIA.

Executive Order N-6-22 – Russia Sanctions:

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals. “Economic Sanctions” refers to sanctions imposed by the U.S. government in response to Russia’s actions in Ukraine, as well as any sanctions imposed under state law. The EO directs state agencies to terminate contracts with, and to refrain from entering any new contracts with, individuals or entities that are determined to be a target of Economic Sanctions. Accordingly, should the State determine Contractor is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that shall be grounds for termination of this agreement. The State shall provide Contractor with advance written notice of such termination, allowing Contractor at least 30 calendar days to provide a written response. Termination shall be at the sole discretion of the State.

IFB #RW2401016 Page 7 of 7

Executive Order N-12-23 – Generative Artificial Intelligence (GenAI):

The State of California seeks to realize the potential benefits of GenAI, through the development and deployment of GenAI tools, while balancing the risks of these new technologies. Bidder / Offeror / Contractor must notify the State in writing if their solution or service includes, or makes available, any GenAI technology, including GenAI from third parties or subcontractors.

The State has developed a GenAI Disclosure & Factsheet (STD 1000) to be completed by the Bidder / Offeror / Contractor. Failure to submit the GenAI Reporting and Factsheet (STD 1000) will result in disqualification of the Bidder / Offeror / Contractor.

Failure to report GenAI to the State may void any resulting contract. The State reserves its right to seek any and all relief it may be entitled to as a result of such non-disclosure.

Upon receipt of a Bidder / Offeror / Contractor GenAI Reporting and Factsheet (STD 1000), the state reserves the right to incorporate GenAI Special Provisions into the final contract or reject bids/offers that present an unacceptable level of risk to the state.

IFB #RW2401016 Page 8 of 7

CALIFORNIA PRISON INDUSTRY AUTHORITY

Invitation for Bid RW2401016

PACKAGED PROCESSED MILK PRODUCTS

REQUIRED ATTACHMENT CHECK LIST

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

Complete this checklist to confirm that the items listed below have been included with your bid.

Place a check mark or “X” next to each item that you are submitting. For your bid to be responsive, all required attachments must be returned. This checklist should also be returned with your bid package.

BIDDER’S COMPANY NAME:

Attachments Attachment Name/Description

_____ Exhibit 1 Contract Price Sheet _____ Exhibit 2 Bidder/Supplier Responsibility

Information _____ Exhibit 3 Bid/Bidder Certification Sheet

_____ Exhibit 4 Darfur Certificate

_____ Exhibit 5 Economic Sanctions Certification

_____ STD 204 Payee Data Record

_____ STD 205 Payee Data Record Supplement NOTE: For use only if additional remittance addresses or additional authorized representatives need to be identified

_____ STD 1000 GenAI Reporting & Factsheet Form

IFB #RW2401016 Exhibit 1

CONTRACT PRICE SHEET

The contract resulting from this solicitation is intended to provide a backup supply when CALPIA’s production cannot meet customer demand. The estimated annual quantities indicated below for each location will be used solely for computing the cost as a fair and equitable formula to determine the best value bidder. Those quantities are not binding upon the contracting agency. The Differential Rate quoted by the bidder shall be binding for the term of the Agreement.

Note: Once the contract is awarded, the base price for each product will be taken from the USDA California Marketing Area Federal Milk Order 51 for the month that the delivery is to occur. The weekly base price will be added to the differential rate quoted below to determine the invoice unit price on each order.

Bidders are not required to bid on every delivery location listed below. However, bidders must bid every line item for the desired location in order to be considered responsive.

The Extended Price is calculated by multiplying the Estimated Quantity by the Differential Rate for each line item. In case of discrepancy between the Differential Rate and the calculated extended price set forth, the Differential Rate shall prevail. As stated above, the Differential Rate is not intended to reflect the total unit price for the product, only the required amount to be added to the market price at the time of invoicing.

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

1. DELIVERY TO OTD-N (SACRAMENTO)

LINE

NO.

CALPIA

ITEM NO. UOM DESCRIPTION OF

PRODUCT

ESTIMATED

QTY (EA)

DIFFERENTIAL

RATE

EXTENDED

PRICE

A. 299200.B000 EA ½ PINT NON-FAT 300,000 $_________ $_____________

B. 299400.B000 EA ½ PINT LOW-FAT 1% 20,000,000 $_________ $_____________

C. 299500.B010 EA ½ PINT LOW-FAT 1%

CHOCOLATE 360,000 $_________ $_____________

D. 299200.B010 EA ½ GALLON NON-FAT 5,000 $_________ $_____________

E. 299400.B010 EA ½ GALLON LOW-FAT 1% 1,500 $_________ $_____________

F. 299100.B010 EA ½ GALLON WHOLE MILK 7,500 $_________ $_____________

SUBTOTAL FOR OTD-N: $_____________

CONTRACT PRICE SHEET

2. DELIVERY TO OTD-C (CORCORAN)

LINE

NO.

CALPIA

ITEM NO. UOM DESCRIPTION OF

PRODUCT

ESTIMATED

QTY (EA)

DIFFERENTIAL

RATE

EXTENDED

PRICE

A. 299200.B000 EA ½ PINT NON-FAT 300,000 $_________ $_____________

B. 299400.B000 EA ½ PINT LOW-FAT 1% 20,000,000 $_________ $_____________

C. 299500.B010 EA ½ PINT LOW-FAT 1%

CHOCOLATE 360,000 $_________ $_____________

D. 299200.B010 EA ½ GALLON NON-FAT 5,000 $_________ $_____________

E. 299400.B010 EA ½ GALLON LOW-FAT 1% 1,500 $_________ $_____________

SUBTOTAL FOR OTD-C: $_____________

3. DELIVERY TO OTD-S (CHINO)

NO.

CALPIA

ITEM NO. UOM DESCRIPTION OF

PRODUCT

ESTIMATED

QTY (EA)

DIFFERENTIAL

RATE

EXTENDED

PRICE

A. 299200.B000 EA ½ PINT NON-FAT 300,000 $_________ $_____________

B. 299400.B000 EA ½ PINT LOW-FAT 1% 20,000,000 $_________ $_____________

C. 299500.B010 EA ½ PINT LOW-FAT 1%

CHOCOLATE 360,000 $_________ $_____________

D. 299200.B010 EA ½ GALLON NON-FAT 5,000 $_________ $_____________

E. 299400.B010 EA ½ GALLON LOW-FAT 1% 1,500 $_________ $_____________

F. 299100.B010 EA ½ GALLON WHOLE MILK 7,500 $_________ $_____________

SUBTOTAL FOR OTD-S: $_____________

CONTRACT PRICE SHEET

4. CALPIA PICK UP FROM VENDOR’S PLANT

NO.

CALPIA

ITEM NO. UOM DESCRIPTION OF

PRODUCT

ESTIMATED

QTY (EA)

DIFFERENTIAL

RATE

EXTENDED

PRICE

A. 299200.B000 EA ½ PINT NON-FAT 300,000 $_________ $_____________

B. 299400.B000 EA ½ PINT LOW-FAT 1% 20,000,000 $_________ $_____________

C. 299500.B010 EA ½ PINT LOW-FAT 1%

CHOCOLATE 360,000 $_________ $_____________

D. 299200.B010 EA ½ GALLON NON-FAT 5,000 $_________ $_____________

E. 299400.B010 EA ½ GALLON LOW-FAT 1% 1,500 $_________ $_____________

SUBTOTAL FOR PICKUP FROM VENDOR’S PLANT: $_____________

SUBTOTAL SECTION 1 EXTENDED PRICE: $__________________

SUBTOTAL SECTION 2 EXTENDED PRICE: $__________________

SUBTOTAL SECTION 3 EXTENDED PRICE: $__________________

SUBTOTAL SECTION 4 EXTENDED PRICE: $__________________

TOTAL BID PRICE: $__________________

Additional Charges

Charge per shipping crate (to be credited to CALPIA upon return) $___________

Charge per shipping pallet (to be credited to CALPIA upon return) $___________

Payment terms for this contract are Net forty-five (45) days unless otherwise specified:

CONTRACT PRICE SHEET

Bidder to complete: Contact Name and Address to which orders are to be sent:

Company Name:

Street Address:

City/State/Zip:

Phone: Fax:

Email Address:

Supplier Contact:

Contractor shall have, preferably in California, a contact person available during the hours of 8:00 A.M. to 5:00 P.M. on weekdays to answer questions regarding product, orders, or other areas in relation to the contract and the State’s needs.

All questions shall be answered within twenty-four (24) hours (except on weekends or holidays).

Contact person:

Phone Number: Fax number:

Email Address:

Exhibit 2

Bidder/Supplier – Materials, Responsibility Information

The intent of these questions is to establish that the bidder has secured the necessary production, distribution, and financial resources to fulfil the contract being proposed.

Except in cases when CALPIA concludes that a specified brand name is the only one that will meet the needs of CALPIA, all commodities shall be entered into with the best value bidder meeting all specifications. Responsibility in this context relates to the bidder’s qualifications and capability to successfully fulfill the requirements of the Invitation for Bid (IFB). A bidder is deemed not responsible when they have demonstrated a lack of reliability in complying with and completing previously awarded State/Private contracts. Prior to awarding the contract related to this IFB, CALPIA’s Authorized Representative will determine whether the proposed awardee is responsible. In order to obtain information necessary to establish a bidder’s responsibility, each bidder shall complete the information requested below.

Failure to complete these questions may cause your offer to be rejected as non-responsive. Incomplete, vague or misleading responses could cause your offer to be rejected as non-responsible. Use additional sheets as necessary to provide all the requested information.

Bidders who are manufacturers should be able to directly respond to the questions. Non-manufacturers may need to consult with their supply chain to properly complete each question. The burden of proof lies with the bidder to prove, to CALPIA’s satisfaction, that the bidder has adequate knowledge and control of the supply chain being utilized.

1. (A) If you are not the manufacturer, please list your role in the supply chain and list all points of business interaction(s) between the manufacturer and your firm. (Manufacturer/Producer, wholesaler/broker, warehousing/distribution)

Please be prepared to provide a written agreement between your firm and your supplier upon request. If your supplier is not the manufacturer, please be prepared to provide a written agreement between the manufacturer and your supplier. If there is no written agreement between these two parties, provide upon request supporting documents showing that they have worked together in the past.

1. (B) Name and address of the manufacturer and any other key parties utilized:

Exhibit 2

2.) How long has your firm been part of this supply chain? If less than 2 years, then please provide the names of all the suppliers relative to this solicitation with whom you have worked in the past 2 years:

3.) How much business have you successfully completed as part of the supply chain described above? (Total dollar values, length of contract, product types, and geographic areas supplied.

4.) Names(s) of packaging and shipping firms(s) to be utilized for this contract.

5.) Have you ever had a contract terminated prior to its designated end date/term? If yes, please explain circumstances for each such contract termination.

6.) Using the format below, list contracts that you were awarded within the last five years with a value of at least 50% of the value of the contract to be awarded herein, which demonstrate your ability to meet the requirements of the proposed contract.

Contract Number: ____________________________________________________________________________________________ Description of product/services: _________________________________________________________________________________ Contract Value ($): ____________________________________________________________________________________________ Contract Award Date: _________________________________________________________________________________________ Required Delivery or Completion Date: ___________________________________________________________________________ Actual Delivery or Completion Date: _____________________________________________________________________________ Customer Contact Information (Name, phone number and email): ______________________________________________________

The Business Services Section will review your past performance. A history of late or non-compliant deliveries on past or present contracts may cause your bid to be rejected.

Exhibit 3

BID/BIDDER CERTIFICATION SHEET

This Bid/Bidder Certification Sheet must be signed and returned along with other bid/quote documents as an entire package with original signatures

A. ____% Cash discount for payment within __________ days of receipt. (See Bidders Instructions Item 26 for complete instructions on offering Cash Discounts.)

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

C. The signature affixed hereon and dated is authorized to bind the bidding firm contractually and certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification.

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

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

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/SSN) 8. California

Corporation No.

9. Indicate applicable license and/or certification information:

Contractor’s State Licensing Board Number:

10. PUC License Number CAL- T:

11. Other Licenses:

12. Bidder’s Name (Print) 13. Title

14. Signature 15. Date

16. For accounting reporting purposes, please provide the following information: Are you certified with the California Department of General Services, Office of Small Business Certification and Resources (OSBCR) as:

a. California Small Business Micro Business

Yes No Yes No If yes, enter certification number below: Expiration Date:

b. Disabled Veteran Business Enterprise Yes No

If yes, enter your service code below:

Qualifying Experience:

Exhibit 3

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, 2a, 2b, 3

Must be completed. 1. Enter your name if sole proprietor or independent contractor. All other 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.

7 Enter your federal employee tax identification number.

If you are a corporation: Enter your corporation number assigned by the California Secretary of State’s Office. This information is used to check 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 be 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.

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

12, 13, 14, 15 Must be completed. These items are self-explanatory.

This information is requested by CALPIA Accounting. If certified as a Small Business Enterprise/Micro Business, place a check in the "Yes" box, and enter your certification number on the line. If certified as a Disabled Veteran 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.

11/16, Rev. E BSS-F017 Page 1 of 1

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.

OPTION #1 – DOMESTIC ONLY

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, initial here and submit with your bid package. (Initial ______)

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 the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and 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

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

Initials of Submitter

Printed Name and Title of Person Initialing

EXHIBIT 4

5/5/2022, Rev. B BSS-F069 Page 1 of 1

ECONOMIC SANCTIONS CERTIFICATION

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (EO) regarding sanctions against Russia and Russian entities and individuals. The EO is located at https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf.

As a potential vendor, contractor, or grantee, compliance with the economic sanctions imposed in response to Russia’s actions in Ukraine is required, including with respect to, but not limited to, the federal executive orders identified in the EO and the sanctions identified on the U.S. Department of the Treasury websites (https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions and https://home.treasury.gov/news/press-releases/jy0608). Failure to comply may result in the termination of purchase orders, contracts, or grants, as applicable.

In order to be eligible to submit a bid, proposal, or conduct business with CALPIA, please complete the following certification and return with your bid documents or as otherwise requested.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that the prospective proposer/bidder named below is in compliance with the economic sanctions imposed by the U.S.

government in response to Russia’s actions in Ukraine, as well as sanctions imposed under state law, if any, and 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

Date Executed Executed in the County and State of https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf https://www.gov.ca.gov/wp-content/uploads/2022/03/3.4.22-Russia-Ukraine-Executive-Order.pdf https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions https://home.treasury.gov/policy-issues/financial-sanctions/sanctions-programs-and-country-information/ukraine-russia-related-sanctions https://home.treasury.gov/news/press-releases/jy0608

STATE OF CALIFORNIA – DEPARTMENT OF FINANCE

PAYEE DATA RECORD

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

Section 1 – Payee Information NAME (This is required. Do not leave this line blank. Must match the payee’s federal tax return)

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

MAILING ADDRESS (number, street, apt. or suite no.) (See instructions on Page 2)

CITY, STATE, ZIP CODE E-MAIL ADDRESS

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

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

PARTNERSHIP

ESTATE OR TRUST

LEGAL (e.g., attorney services)

EXEMPT (e.g., nonprofit)

ALL OTHERS

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

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

For Individuals, enter SSN.

If you are a Resident Alien, and you do not have and are not eligible to get an SSN, enter your ITIN.

Grantor Trusts (such as a Revocable Living Trust while the grantors are alive) may not have a separate FEIN. Those trusts must enter the individual grantor’s SSN.

For Sole Proprietor or Single Member LLC (disregarded entity), in which the sole member is an individual, enter SSN (ITIN if applicable) or FEIN (FTB prefers SSN).

For Single Member LLC (disregarded entity), in which the sole member is a business entity, enter the owner entity’s FEIN. Do not use the disregarded entity’s FEIN.

For all other entities including LLC that is taxed as a corporation or partnership, estates/trusts (with FEINs), enter the entity’s FEIN.

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

OR

Federal Employer Identification Number

(FEIN)

Section 4 – Payee Residency Status (See instructions)

CALIFORNIA RESIDENT – Qualified to do business in California or maintains a permanent place of business in California.

CALIFORNIA NONRESIDENT – Payments to nonresidents for services may be subject to state income tax withholding.

No services performed in California

Copy of Franchise Tax Board waiver of state withholding is attached.

Section 5 – Certification I hereby certify under penalty of perjury that the information provided on this document is true and correct.

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

NAME OF AUTHORIZED PAYEE REPRESENTATIVE TITLE E-MAIL ADDRESS

SIGNATURE DATE TELEPHONE (include area code)

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

STATE AGENCY/DEPARTMENT OFFICE UNIT/SECTION

MAILING ADDRESS FAX TELEPHONE (include area code)

CITY STATE ZIP CODE E-MAIL ADDRESS

California Prison Industry Authority (CALPIA) Business Services Section (BSS)

560 East Natoma Street (916) 358-1811 (916) 358-2755

Folsom CA 95630 bsshelpdesk@calpia.ca.gov

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STATE OF CALIFORNIA – DEPARTMENT OF FINANCE

PAYEE DATA RECORD

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6.

Prompt return of this fully completed form will prevent delays when processing payments.

Information provided in this form will be used by California state agencies/departments to prepare Information Returns (Form1099).

NOTE: Completion of this form is optional for Government entities, i.e. federal, state, local, and special districts.

A completed Payee Data Record, STD 204 form, is required for all payees (non-governmental entities or individuals) entering into a transaction that may lead to a payment from the state. Each state agency requires a completed, signed, and dated STD 204 on file; therefore, it is possible for you to receive this form from multiple state agencies with which you do business.

Payees who do not wish to complete the STD 204 may elect not to do business with the state. If the payee does not complete the STD 204 and the required payee data is not otherwise provided, payment may be reduced for federal and state backup withholding. Amounts reported on Information Returns (Form 1099) are in accordance with the Internal Revenue Code (IRC) and the California Revenue and Taxation Code (R&TC).

Section 1 – Payee Information Name – Enter the name that appears on the payee's federal tax return. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

Sole Proprietor/Individual/Revocable Trusts – enter the name shown on your federal tax return.

Single Member Limited Liability Companies (LLCs) that is disregarded as an entity separate from its owner for federal tax purposes - enter the name of the individual or business entity that is tax liable for the business in section 1. Enter the DBA, LLC name, trade, or fictitious name under Business Name.

Note: for the State of California tax purposes, a Single Member LLC is not disregarded from its owner, even if they may be disregarded at the Federal level.

Partnerships, Estates/Trusts, or Corporations – enter the entity name as shown on the entity’s federal tax return. The name provided in Section 1 must match to the TIN provided in section 3. Enter any DBA, trade, or fictitious business names under Business Name.

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

Mailing Address – The mailing address is the address where the payee will receive information returns. Use form STD 205, Payee Data Record Supplement to provide a remittance address if different from the mailing address for information returns, or make subsequent changes to the remittance address.

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

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

Corporation-Medical

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

Corporation-Legal

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

Corporation-All Other

Section 3 – Tax Identification Number The State of California requires that all parties entering into business transactions that may lead to payment(s) from the state provide their Taxpayer Identification Number (TIN). The TIN is required by R&TC sections 18646 and 18661 to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

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

A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary of State to do business in California.

A partnership is considered a resident partnership if it has a permanent place of business in California.

An estate is a resident if the decedent was a California resident at time of death.

A trust is a resident if at least one trustee is a California resident.

o For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:

Withholding Services and Compliance Section: 1-888-792-4900 E-mail address: wscs.gen@ftb.ca.gov For hearing impaired with TDD, call: 1-800-822-6268 Website: www.ftb.ca.gov

Section 5 – Certification Provide the name, title, email address, signature, and telephone number of individual completing this form and date completed. In the event that a SSN or ITIN is provided, the individual identified as the tax liable party must certify the form. Note: the signee may differ from the tax liable party in this situation if the signee can provide a power of attorney documented for the individual.

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

Privacy Statement Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it. It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and state law imposes noncompliance penalties of up to $20,000. You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

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

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

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

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

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

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

TAX ID NUMBER (Required)

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

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

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

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

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

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

CONTACT NAME

TELEPHONE (Include area code) EMAIL

CONTACT NAME

TELEPHONE EMAIL

CONTACT NAME

TELEPHONE EMAIL

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

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

NAME OF AUTHORIZED PAYEE REPRESENTATIVE

(Print or Type name)

TITLE E-MAIL ADDRESS

SIGNATURE

X___________________________________________

DATE TELEPHONE (Include area code)

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STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

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

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

GENERAL INSTRUCTIONS

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

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

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