IFB__RW2609001_Sausage_Casings.pdf

State of California Department of Corrections and Rehabilitation

May 22, 2026

INVITATION FOR BID (IFB)

IFB # RW2609001

SAUSAGE CASINGS

Notice to Prospective Contractors

The California Correctional Training and Rehabilitation Authority (CALCTRA) invites you to review and respond to this Invitation for Bid (IFB), entitled RW2609001 for SAUSAGE CASINGS. In submitting your bid, you must comply with the instructions found herein.

CALCTRA 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. CALCTRA’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: RW2609001 IFB Name: SAUSAGE CASINGS Attention: Sadaqatullah Sahak, Contract Analyst Bid Submittal: Do Not Open

In the opinion of CALCTRA, 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: June 4, 2026 by 3:00 pm (PST) CALCTRA Contact: Return Sealed Bid To:

Sadaqatullah Sahak

Phone: (279) 235-5863 Email: Sadqatullah.Sahak@calctra.ca.gov

California Correctional Training and Rehabilitation Authority

Attention: Sadaqatullah Sahak 560 East Natoma Street

Folsom, CA 95630

This IFB covers the estimated two (2) year requirement of SAUSAGE CASINGS for the California Correctional Training and Rehabilitation Authority (CALCTRA) Meat Processing Enterprise at Mule Creek State Prison in Ione, California.

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 mutual agreement of CALCTRA and the Contractor mailto:Sadqatullah.Sahak@calctra.ca.gov

The contract award will be made on the basis of BEST VALUE as determined by CALCTRA 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.

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

In the interest of achieving best value, CALCTRA 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 CALCTRA as part of our ongoing mission to change lives through opportunities.

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

Method of Award: This bid shall be awarded by line item or a total of both line items, whichever is deemed by CALCTRA at its sole discretion to offer the best value.

Product Requirements:

Dimensions that vary from those listed below must be noted on the cost sheet.

Line 1: cellulose Wienie Casing, Clear with Black Striping Must be a minimum of 24 mm x 95 ft, but CALCTRA will also accept 25 mm x 95 ft closed ended strands.

Line 2: Cellulose Sausage Casing, Clear with Black Striping, non-edible Must be a minimum of 32 mm x 84 ft, but CALCTRA will also accept 33 mm x 84 ft.

Closed ended strands

Storage and Shelf Life:

CALCTRA will store the casings in a cool, dry warehouse. The shelf life shall be a minimum of six (6) months after receipt from contractor. Bidders shall provide warranty terms either as an attachment to the bid package or as a statement on the Contract Price Sheet.

Non-Compliant Product:

Any product received by CALCTRA that is deemed non-compliant will be returned to the vendor at the vendor’s expense and replaced with compliant product.

Cost to Cover:

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

Emergency Extension Option

In the event of an emergency, upon mutual agreement with the contractor(s), CALCTRA 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 CALCTRA procurement staff, or other circumstances that would otherwise cause an unanticipated disruption to CALCTRA’s Meat Processing Enterprise.

Emergency Purchase

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

Minimum Order:

The minimum order is 20 cases of either line item. Orders for less than these quantities shall be considered non-contract and may be purchased from other sources unless otherwise agreed upon.

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.

Delivery:

The clear cellulose casings are to be delivered when and as requested within 60 calendar days after notification by the ordering agency for the initial order, and within 30 days for all subsequent orders. The casings are to be delivered Monday through Friday, 8:00 a.m. to 2:30 p.m. Weekend or holiday deliveries cannot be accepted without prior approval in writing by ordering agency.

It shall be the contractor’s responsibility to notify CALCTRA of any late deliveries (per purchase order).

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 CALCTRA.

Mule Creek State Prison

4001 Highway 104 Ione, California 95640-9099 Attn: Meat Processing Plant

Manuel Higuera, Supt. II

(209) 274-4911 Ext. 6707

Packaging and Labeling:

All packaging materials used in shipment must be of recyclable material and food grade quality.

Exterior packaging is to show the contents and the purchase order number. All packaging shall conform to the applicable freight classifications, I.C.C. and/or postal regulations, and is to be of a quality to assure final delivery without damage to the contents.

A packing slip shall accompany each shipment and show the contract number, contents, quantity shipped and should utilize CALCTRA’s numbers (PO #’s, stocking #’s, etc.) for ease of identification.

Contract Dollar Value:

Any contract resulting from this bid will expire one year 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 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.

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 CALCTRA be subject to late payment fees or interest charges.

Samples:

Samples may be required prior to bid award. If requested, such samples must be delivered to the address specified within 14 calendar days after notification. If the samples do not meet specifications, the bid will be rejected. The bidder will not be allowed to re-submit corrected samples. If awarded, the contractor will provide the same product submitted under this sample provision for the duration of the contract.

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.

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 CORRECTIONAL TRAINING AND REHABILITATION AUTHORITY

Invitation for Bid RW2609001

SAUSAGE CASINGS

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

Exhibit 1

CONTRACT PRICE SHEET

The estimated two (2) year quantities indicated below will be used solely for computing the cost as a fair and equitable formula to determine the best value bidder. These quantities are not binding upon the contracting agency. However, the actual costs quoted by the bidder shall be binding for the term of the Agreement. Bidders are not required to quote both line items to be considered responsive.

The extension price is calculated by multiplying the quantity for the line item by its unit price. In case of a discrepancy between the unit price and the total set forth for the extended price, the unit price shall prevail. Bidders will choose the casing thickness they are quoting for each line item.

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

1 150 CASE

CASINGS, WIENIE, CELLULOSE

Clear with black striping 95 ft closed ended strands

Manufacturer or Brand: ___________

Number of strands per case: ___________

Number of feet per strand: ___________

A. $________ / CS

(24mm x 95ft)

OR

B. $________ / CS

(25mm x 95ft)

OR

2 1,200 CASE

CASINGS, SAUSAGE, CELLULOSE

Clear with black striping 84 ft closed ended strands

Manufacturer or Brand: ___________

Number of strands per case: ___________

Number of feet per strand: ___________

A. $________ / CS

(32mm x 84ft)

OR

B. $________ / CS

(33mm x 84ft)

OR

Total Bid Price (Sum of Extended Prices for Lines 1 and 2): $__________________

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:

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 CALCTRA concludes that a specified brand name is the only one that will meet the needs of CALCTRA, 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, CALCTRA’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 CALCTRA’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 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.

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:

Page 2 of 2 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 CALCTRA 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.

04/16/2026, Rev. G 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

9/9/2025, Rev. C 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 CALCTRA, 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 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 Correctional Training and Rehabilitation Authority Business Services Section (BSS)

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

Folsom CA 95630 bsshelpdesk@calctra.ca.gov

Print Form Reset Form

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)

Print Form Reset 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.)

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.