IFB-RW2506007_Food_Grade_Carnbon_Dioxide.pdf

State of California Department of Corrections and Rehabilitation

July 22, 2025

INVITATION FOR BID (IFB)

IFB # RW2506007

Notice to Prospective Contractors

The California Prison Industry Authority (CALPIA) invites you to review and respond to this Invitation for Bid (IFB), entitled RW2506007 for FOOD GRADE CARBON DIOXIDE. 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: RW2506007 IFB Name: Food Grade Carbon Dioxide Attention: Sadaqatullah Sahak 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 August 5, 2025 by 3:00 pm (PST) CALPIA Contact: Return Sealed Bid To:

Sadaqatullah Sahak Phone: (916) 358-1504

Email: Sadaqatullah.Sahak@calpia.ca.gov

California Prison Industry Authority Attention: Sadaqatullah Sahak

560 East Natoma Street Folsom, CA 95630

This IFB covers the estimated annual requirement of Food Grade Carbon Dioxide for the California Prison Industry Authority (CALPIA) Poultry Enterprise at Avenal State Prison in Avenal, California. The carbon dioxide is held in a 60,000-pound capacity tank owned by

CALPIA.

Term: Any contract resulting from this solicitation will expire after two (2) years regardless of the amount purchased, unless extended or terminated. The contract resulting from this solicitation may be extended by one (1) additional year by mutual agreement of CALPIA and the contractor mailto:Sadaqatullah.Sahak@calpia.ca.gov

The contract award will be made on the basis of BEST VALUE as determined by CALPIA alone, under statutory authority considering the following criteria:

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 of 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.

California Prison Industry Authority (CALPIA) Food Grade Carbon Dioxide IFB No. RW2506007

California Prison Industry Authority (CALPIA)

Food Grade Carbon Dioxide

Method of Award:

This bid shall be awarded on an “All or None” basis to the bidder deemed by CALPIA, at its sole discretion, to offer the best value. Best value is defined as the lowest prices or the greatest quality or a combination of the two depending on the specific needs of CALPIA. It is anticipated that the “best value” bidder will be the lowest responsible bidder meeting specifications.

Specifications:

CALPIA uses food grade quality Carbon Dioxide in liquid bulk form. It must be USDA approved for use in food processing.

Contract Quantity:

The estimated quantity listed on the Cost Sheet is the anticipated need to be purchased over the life of the two (2) year contract. Actual quantity purchased is dependent on choices made by CALPIA customers.

Responsible Bidder:

Bidder may be required to submit evidence of their qualifications. The question of whether a particular bidder is a responsible bidder involves an evaluation of the bidder’s experience, facilities, reputation, financial resources, and other factors existing at the time of the award.

Please complete the Bidder/Supplier Responsibility Information form (Attachment 2) and return it with your bid.

Performance:

Performance is the responsibility of the contract holder and cannot be assigned to a subcontractor. The bidder shall have effective quality control procedures established to maintain uniformity of product as specified in the bid. A contact person shall be available during regular working hours to take orders and answer questions. See Cost Sheet, Supplier Contact section and provide the required information.

MSDS Requirements:

The attached “Notice of Material Safety Data Sheet Requirements” is to be completed and returned with the bid. Failure to return the form may result in your bid being considered non-responsive and it may be rejected.

Contract Dollar Value:

Any contract resulting from this bid will expire two 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 for each line item are estimated and are the anticipated contract purchase pattern. The State will not be obligated to purchase the contractor’s excess inventory of any line

IFB No. RW2506007 item if actual purchases vary from the anticipated purchase pattern. The State reserves the right to order more or less of any line item.

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.

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 enterprises.

Emergency Purchase:

In the event of an emergency as defined by the Public Contract Code (PCC) Section 1102 and as determined by CALPIA’s Procurement Officer, at CALPIA’s sole discretion, CALPIA may purchase any required line item from other than the Contractor.

Contract Modifications:

This contract may be amended, modified, or terminated at any time by mutual agreement of contracting parties, in writing. Change orders amending, modifying, or terminating the contract, including any modification of the compensation payable, may be issued only by the CALPIA Procurement Officer. Termination, as that term is used, does not include termination for default of the Contractor.

Price Adjustments:

All prices shall be firm fixed for the contract item. Including any optional year extensions, unless a price adjustment is granted.

i. Frequency/Guidelines:

Price adjustment will only be acknowledged in accordance with the following guidelines:

a) Price adjustments will not be made during the first quarter (3 months) of the contract.

California Prison Industry Authority (CALPIA)

b) Price adjustments may only be requested no more than once per quarter thereafter.

c) No price increase/decrease shall apply to quantities ordered from the contract prior to the effective date of the price adjustment. No retroactive contract price adjustment will be allowed.

d) Accepted price adjustment shall be for a minimum period of 3 months from the approved price adjustment effective date.

e) CALPIA reserves the right to request price decreases in the same manner as price increase adjustments.

ii. Request Process:

Price adjustment requests will be processed as follows:

a) Price adjustment requests must include:

1. A copy of the appropriate analysis illustrating the relevant price increase/decrease.

2. An Excel spreadsheet detailing the requested adjustment tot eh contract item.

The spreadsheet should include the CALPIA inventory number, current CALPIA contract price, percent increase/decrease, and adjusted CALPIA contract price.

b) Upon receipt of such notice, CALPIA reserves the right to:

1. Accept the adjustment as competitive with the general market price at that time, or

2. Negotiate proposed price adjustment (Note: CALPIA will notify the Contractor, in writing, its desire to negotiate. CALPIA will have ten (10) working days to complete negotiations); or

3. Deny adjustment request and continue with current CALPIA contract prices; or

4. Cancel the contract without prejudice, effective upon written notice from

CALPIA.

Ordering Procedure:

Orders are to be used by CALPIA on a Purchase Order (PIA-099) and sent directly to the Contractor. Price is per the attached price sheet.

California Prison Industry Authority (CALPIA)

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

For the purpose of this bid, only bids quoting F.O.B. Destination (freight prepaid by the vendor to the ordering facility’s receiving point) will be accepted. Bids quoting other than F.O.B.

Destination will be rejected.

Minimum Order:

The minimum order is 15 tons in liquid bulk form. Orders for less than this quantity may be considered non-contract and may be purchased from other than the Contractor.

Delivery:

The bulk carbon dioxide is to be delivered by the truckload to CALPIA’s holding tank when and as requested within 48 hours after notification by the ordering agency, Monday through Friday, 8:00 a.m. to 4:00 p.m. Weekend or holiday deliveries cannot be accepted without prior approval in writing by the ordering agency. Any single failure to deliver in a timely manner will be a material breach of this contract by the Contractor.

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.

Delivery Address:

Additional delivery sites may be added as deemed necessary by CALPIA.

Avenal State Prison 1 Kings way Avenal, CA 93204 Attn: CALPIA Warehouse

Billing Address:

Avenal State Prison P.O. Box 8 Avenal, CA 93204 Attn: CALPIA Accounting (559) 386-6062

Invoicing Requirements:

After each shipment, an invoice must be submitted to the address specified on the purchase order, and it shall reference the contract and order number, date of shipment, quantity, nit costs, and extensions. Cost on invoices shall be in accordance with unit of measure shown on the order. Unit price shall include any hazardous material surcharges. Separate charges for hazmat will not be approved on the invoice. State sales and/or tax is to be added to each invoice.

Corrective Action Plan:

Should there be any issue with quality of the product, CALPIA can request a written Corrective Action Plan (CAP) from the Contractor. A CAP will be provided no later than three (3) business days from time that the incident is reported to the Contractor. The CAP will contain the nature of the reported issue, what immediate actions are taking place to correct the problem, and actions implemented to prevent the problem from reoccurring. The CAP can also contain any other relevant information that the Contractor deems necessary to explain the situation. Depending on the circumstances, CALPIA may issue a Vendor Performance Report (Form BSS-F024).

Breach of Contract:

Any single late or non-compliant delivery will be deemed a material breach of contract of the contract and may initiate default proceedings in accordance with the General Provisions Section 61, Rights and Remedies of State for Default and Section 72, Termination for Default. Prior to default, a cure notice will be issued with specific demands for the supplier. Failure to comply will result in default of the contract. Any additional breach of the terms of the contract may result in immediate termination of the contract.

Payment:

Payment terms for this contract are Net forty-five (45) days. 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 forty-five (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.

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 into 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.

California Prison Industry Authority (CALPIA)

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 must notify the State in writing if it: (1) intends to provide GenAI as a deliverable to the State; or (2), intends to utilize GenAI, including GenAI from third parties, to complete all or a portion of any deliverable that materially impacts: (i) functionality of a State system, (ii) risk to the State, or (iii) Contract performance. For avoidance of doubt, the term “materially impacts” shall have the meaning set forth in State Administrative Manual (SAM) § 4986.2 Definitions for GenAI.

Failure to report GenAI to the State may result in disqualification. The State reserves the right to seek any and all relief to which it may be entitled to as a result of such non-disclosure.

Upon notification by a Bidder / Offeror of GenAI as required, 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.

Government Code 11549.64 defines “Generative Artificial Intelligence (GenAI)” as an artificial intelligence system that can generate derived synthetic content, including text, images, video, and audio that emulates the structure and characteristics of the system’s training data.

CALIFORNIA PRISON INDUSTRY AUTHORITY

INVITATION FOR BID RW2506007

FOOD GRADE CARBON DIOXIDE

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

______ MSDS Notice of Material Safety Data Sheet Requirements

California Prison Industry Authority (CALPIA) Food Grade Carbon Dioxide

Exhibit 1

CONTRACT PRICE SHEET

The estimated quantities indicated below is the anticipated need over the course of a two-year period. It will be used solely for computing the cost as a fair and equitable formula to determine the best value bidder; however, it is not binding upon the contracting agency. The actual costs quoted by the bidder shall be binding for the term of the Agreement unless an increase or decrease has been granted..

In case of discrepancy between the unit price and the total set forth for a unit basis item, the unit price shall prevail.

NOTE: 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.

ITEM

NO. QUANTITY UNIT DESCRIPTION UNIT PRICE EXTENSION

1 4,800 Ton Carbon Dioxide Food Grade Quality Liquid Bulk Form USDA approved for use in food processing

$_______/Ton $__________

Non-Award Factor Note: Bidder to provide the cost per ton for delivery of carbon dioxide in quantities of less than 15 tons.

1 to 5 tons $_____________ per ton 6 to 11 tons $_____________ per ton 12 to 14 tons $_____________ per ton

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

Company Name:

Street Address:

City/State/Zip:

Phone: Fax:

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: ______________________________________________________________

California Prison Industry Authority (CALPIA)

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:

California Prison Industry Authority (CALPIA)

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 the 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.

California Prison Industry Authority (CALPIA)

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:

California Prison Industry Authority (CALPIA)

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.

4 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.

5 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.

6 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.

8 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.

9 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.

10 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 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.

California Prison Industry Authority (CALPIA)

04/10/2025, Rev. F 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 a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and

b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

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)

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

Exhibit 4

California Prison Industry Authority (CALPIA)

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

Exhibit 5

California Prison Industry Authority (CALPIA) Food Grade Carbon Dioxide IFB No. RW2506007 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 – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

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

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

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

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

TAX ID NUMBER (Required)

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

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

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

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

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

REMITTANCE ADDRESS

CITY STATE ZIP CODE

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

CONTACT NAME

TELEPHONE (Include area code) EMAIL

CONTACT NAME

TELEPHONE EMAIL

CONTACT NAME

TELEPHONE EMAIL

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

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

NAME OF AUTHORIZED PAYEE REPRESENTATIVE

(Print or Type name)

TITLE E-MAIL ADDRESS

SIGNATURE

X___________________________________________

DATE TELEPHONE (Include area code)

Print Form Reset FormCalifornia Prison Industry Authority (CALPIA)

STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

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

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

GENERAL INSTRUCTIONS

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

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

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

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

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

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

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

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

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

PRIVACY STATEMENT

Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.

It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and state law imposes noncompliance penalties of up to $20,000.

You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

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

California Prison Industry Authority (CALPIA)

NOTICE OF MATERIAL SAFETY DATA

SHEET REQUIREMENTS

State Law (Labor Code Section 6360 et seq.) requires employers to have information regarding hazardous or potentially hazardous substances in the workplace on file or readily available to them. In order to assist employers to comply with this requirement, the Department of Industrial Relations has compiled a list of hazardous substances.

Some or all of the products listed on this Invitation for Bid appear on the Hazardous Substances List. Consequently, the successful bidder may be required to finish a Material Safety Data Sheet (MSDS) for these products. A Material Safety Data Sheet is supplied by the manufacturer of a substance and lists the manufacturer’s name and address, the name, chemical and physical properties of the material, and the potential hazards, safeguards and procedures to follow in case of accident or overexposure.

Vendor agrees to send a Material Safety Data Sheet for each applicable product to the Procurement Division and to each State or local agency to which the product is delivered, per Purchase Order instructions (PIA-099), which will be provided with the Purchase Order award.

_______YES _______NO

Failure to agree to this requirement may result in your bid being considered non-responsive and it may be rejected.

California Prison Industry Authority (CALPIA)