IFB__V92812508_Joint_Venture_Program_(JVP)_Savings_Accounts.pdf

State of California Department of Corrections and Rehabilitation

December 18, 2025

INVITATION FOR BID (IFB)

IFB No. V92812508

JOINT VENURE PROGRAM (JVP) SAVINGS ACCOUNTS

Notice to Prospective Contractors

The California Prison Industry Authority (CALPIA) invites you to review and respond to this Invitation for Bid (IFB), entitled JOINT VENTURE PROGRAM (JVP) SAVINGS ACCOUNTS, IFB NO.

V92812508. In submitting your bid, you must comply with the instructions found herein and the Bidders Instructions REV-524 located on the CALPIA website (www.calpia.ca.gov, select About tab and then Doing Business with CALPIA).

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: December 30, 2025 by 3:00 PM CALPIA Contact SUBMIT BID TO:

Sadaqatullah Sahak, Contract Analyst Phone: (916) 358-1504

Email: Sadaqatullah.Sahak@calpia.ca.gov

California Prison Industry Authority Attention: Sadaqatullah Sahak, Contract Analyst

560 East Natoma Street Folsom, CA 95630

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.

Term: The CALPIA anticipates that the proposed contract term will be for a period of two (2) years with the option to extend for an additional two (2) years.

Any agreement resulting from this solicitation shall be of no force or effect until it is signed by both parties and approved by CALPIA. The Contractor is not to begin work until a contract has been made, all approvals have been obtained, and the contract has been fully executed. Should work begin before all approvals are obtained, services shall be considered voluntary.

http://www.calpia.ca.gov/ mailto:Sadaqatullah.Sahak@calpia.ca.gov

TABLE OF CONTENTS

SECTION PAGE

A. Purpose and Description of Service 3 B. Bid Information 3 C. Bidder’s Submittal Requirements 4 D. Licenses and Permits 5 E. Standard Language 5 F. Bid Attachments 5

Attachment 1: Bid Document Submittal Check List 6 Attachment 2: Sample Standard Agreement (STD 213), Statement of

Work 7

Attachment 3A: Payee Data Record (STD 204) 15 Attachment 3B: Payee Data Record Supplement (STD 205) 17 Attachment 4: Darfur Certification 19 Attachment 5: Appropriate Attire Policy 20 Attachment 6: Experience/Past Performance (References) 22 Attachment 7: Contractor Certification Clauses (CCC’s) 23 Attachment 8: Economic Sanctions Certification 27

Bid Submittal Documents:

Attachment 1: Bid Document Submittal Check List 1 page Attachment 3A: Payee Data Record (STD 204) 2 pages Attachment 3B: Payee Data Record Supplement (STD 205) 2 pages Attachment 4: Darfur Certification 1 page Attachment 6: Experience/Past Performance (References) 1 page Attachment 7: Contractor Certification Clauses (CCC’s) 4 pages Attachment 8: Economic Sanctions Certification 1 page

Bidder Instructions and Contract Provisions:

Bidders Instructions REV-524* 10 pages General Provisions REV-0524* 21 pages Security Provisions REV-0325* 5 pages

NOTE: Items shown with an Asterisk (*), are hereby incorporated by reference and are located on our website at the following link http://www.calpia.ca.gov select About tab, then select Doing Business with CALPIA.

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

IFB No. V92812508

A. Purpose and Description of Service The California Prison Industry Authority (CALPIA) is required to open and maintain blocked bank savings deposit accounts for the saving portion of certain eligible incarcerated individual compensation.

Refer to the Sample STD 213, Statement of Work attached to this IFB as Attachment 2.

CALPIA reserves the right, before the conclusion of the contract term to extend the contract for an additional two-years period. A written and approved amendment will be required to extend the contract prior to contract expiration.

B. Bid Information

1. Time Schedule

It is recognized that time is of the essence. All bidders are hereby advised of the following schedule and will be expected to adhere to the required dates and times. All times are Pacific Standard Time (PST)/Pacific Daylight Time (PDT).

*estimated timeframes

2. Bid Submittal

Bids must be received via U.S. Mail, common carrier, or hand delivered; no other method of response will be accepted. Bids not submitted under sealed cover may be rejected. Submit one (1) copy of the bid to the address and Contract Analyst on page 1 of this document. The interior sealed envelope 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:

EVENT DATE

TIME

(Pacific STD /Daylight Time)

IFB available to prospective bidders December 18, 2025 Final Date for Bid Submission/Bid Opening 12/30/2025 By 3:00 PM Successful Bidder Letter and Posting of Intent to Award* 12/31/2025 5:00 PM Last Day to Appeal Intent to Award* 1/7/2026 5:00 PM Proposed Start Date of Agreement* January 10, 2026

Company Name Company Address

IFB Number: V92812508 IFB Name: Joint Venture Program (JVP) Savings Accounts Attention: Sadaqatullah Sahak

BID SUBMITTAL – DO NOT OPEN

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

IFB No. V92812508

C. Bidder’s Submittal Requirements

Experience: Contractor must provide proof of Five (5) years of experience with services similar in nature to the services identified in the attached Scope of Work. Experience will be determined by documentation submitted by the Contractor and further information provided by the references submitted under the Past Performance requirement below. Experience is defined as the kind and amount of work a Contractor has done relevant to the work contemplated by this procurement.

Past Performance: Contractor will be evaluated on prior performance through Contractor’s references (Attachment 6), on three (3) projects similar in nature within the last three (3) years.

Past performance is defined as the Contractor’s record of conforming to standards of good workmanship; Contractor’s record of forecasting and controlling costs; Contractor’s adherence to contract schedules, including the administrative aspects of performance; Contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and the Contractor’s business-like concern for the interest of the customer.

Licenses/Permits: The Contractor shall provide copies of all required license(s) and permit(s) as required by the city, county, or both as determined by bidder’s place of business.

Executive Order N-6-22 – Russia Sanctions:

CALPIA requires Bidders to include a completed Economic Sanctions Certification form (BSS- F069) as required by Executive Order N-6-22 in order to be eligible to conduct business with the State of California.

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 (CALPIA) Joint Venture Program (JVP) Savings Account

D. Licenses and Permits

During the term of the contract, the Contractor must maintain all required licenses and/or permits in full force and effect. If and when the State learns that the Contractor has failed to do so, the State may, in addition to any other remedy it may have, immediately terminate this contract without any cost or liability to the State. If, after bid submission, the Contractor replaces or renews a required license or permit or obtains a newly-applicable license or permit, the Contractor shall provide the State with a copy of the renewed or replaced or newly-obtained license or permit within 20 days following the Contractor's receipt of same.

E. Standard Language

CALPIA does not accept alternate contract language from a prospective contractor. A bid with such language will be considered a counter proposal and will be rejected. CALPIA’s General Provisions (GP’s) are not negotiable.

F. Bid Attachments

Refer to the following pages for additional required attachments that are a part of this IFB.

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

ATTACHMENT 1

BID DOCUMENT SUBMITTAL CHECK LIST

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

Complete this checklist to confirm the items listed below have been included in 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 be returned with your bid package.

NAME OF BIDDER:

COMPANY NAME:

Attachment Name/Description

_____ Attachment 1: Bid Document Submittal Check List _____ Attachment 4A: Payee Data Record (STD 204) NOTE: If company is incorporated, Payee’s Legal business name on the STD 204 must match the name registered with the Secretary of State of California.

_____ Attachment 4B: Payee Data Record Supplement (STD 205) NOTE: For use if additional remittance addresses are needed or if additional authorized representatives need to be identified.

_____ Attachment 5: Darfur Certification _____ Attachment 6: Experience/Past Performance (References) _____ Attachment 7: Contractor’s Certification Clauses _____ Attachment 8: PREA Volunteer/Contractor Information Sheet _____ Attachment 9: Economic Sanctions Certification

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

STATE OF CALIFORNIA

STANDARD AGREEMENT

STD 213 (Rev 6/21/06) AGREEMENT NUMBER

IFB No. V92812508

REGISTRATION NUMBER

JOINT VENTURE PROGRAM (JVP) SAVINGS ACCOUNTS

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

STATE AGENCY'S NAME

CALIFORNIA PRISON INDUSTRY AUTHORITY

CONTRACTOR'S NAME

TBD

2. The term of this

XXXX XX, 20206 or upon approval, whichever is the later, through XXXX XX, 2028 Agreement is:

3. The maximum amount $0.00 of this Agreement is: No Maximum, Zero Dollars and No Cents

4. The parties agree to comply with the terms and conditions of the following exhibits that by this reference made a part of the Agreement.

Attachment 2 - Scope of Work 1 page

Attachment A – Joint Venture Program Savings Account Agreement 5 pages

Attachment B – Durable Special Power of Attorney (on file with vendor) 3 pages

General Provisions REV-0524* 21 pages

Security Provisions REV-0325* 5 pages

NOTE: Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached These documents can be viewed at http://www.calpia.ca.gov, (select About tab, then select Doing Business with CALPIA).

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

CONTRACTOR

CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.)

BY (Authorized Signature)

DATE SIGNED(Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING

ADDRESS

STATE OF CALIFORNIA

AGENCY NAME

California Prison Industry Authority BY (Authorized Signature)

DATE SIGNED(Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING

ADDRESS

560 East Natoma Street, Folsom, CA 95630

SCOPE OF WORK

I. SCOPE OF WORK

1. Contractor agrees to provide the California Prison Industry Authority (CALPIA) with blocked bank savings deposit accounts for the saving portion of certain eligible incarcerated individual compensation in accordance with the California Code of Regulations, Title 15, Division 3, Chapter 1, Subchapter 5, Article 9.

2. 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 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.

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

GenAI Technology Use & Reporting

During the term of the contract, Contractor must notify the State in writing if their services or any work under this contract includes, or makes available, any previously unreported GenAI technology, including GenAI from third parties or subcontractors. At the direction of the State, Contractor shall discontinue the use of any new or previously undisclosed GenAI technology that materially impacts functionality, risk or contract performance, until use of such GenAI technology has been approved by the State.

The State reserves the right to amend the contract, without additional cost, to incorporate GenAI Special Provisions into the contract at its sole discretion and/or terminate any contract that presents an unacceptable level of risk to the State.

4. CALPIA reserves the right to amend the agreement, prior to expiration, in writing on the STD 213A. CALPIA may adjust the terms of the agreement including but not limited to the following:

A. Term extension up to two (2) years.

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

ATTACHMENT A

JOINT VENTURE PROGRAM

SAVINGS ACCOUNT AGREEMENT

This Joint Venture Program Savings Account Agreement (“Agreement”) is entered into by and between the California Prison Industry Authority (“CALPIA”) and TBD (“Bank”). In accordance with the California Code of Regulations, Title 15, Division 3, Chapter 1 Subchapter 5, Article 9, under the Joint Venture Program (“Program”) CALPIA is required to open and maintain blocked bank savings deposit accounts (“Account(s)”) for the savings portion of certain eligible incarcerated individual-employee(s) (“Recipient” or "Recipients") compensation. Consistent with the Program, Recipients are not to have access to these accounts until the Recipients are released from their current incarceration in the California prison system, or as otherwise provided under 15 USC 3485, as amended. The Administrator (as defined below) and not the Bank will be responsible for monitoring any transaction activity in compliance with the restrictions. Upon such release, CALPIA will make available to the Recipients the proceeds on deposit in the Accounts established for a Recipient under the Program.

The Accounts established under the Program and pursuant to this Agreement will also be subject to the terms and conditions of the Bank’s deposit account terms and conditions, including applicable fees, documentation and withholding certification requirements (collectively “Deposit Agreements”). To the extent there are inconsistencies between the terms of this Agreement and the Deposit Agreements, this Agreement will prevail.

1. CALPIA RIGHTS, REPRESENTATIONS AND RESPONSIBILITIES: The Bank agrees to allow CALPIA to establish an interest-bearing savings account ("Account") for each Recipient under the Program pursuant to the following conditions:

a. Administrator: Each account will only be established by an administrator (“Administrator”) designated by CALPIA and who has been authorized under a power of attorney for each Recipient (“Power of Attorney”), in a form acceptable to the Bank, to open and maintain an Account under the Program for the particular Recipient. The Power of Attorney will contain the name of the Administrator at the moment in time that the Power of Attorney is executed. It is the understanding of the Bank and CALPIA, that when there is a change in Administrator’s, that Powers of Attorney executed during their appointment will be executed with their name, as with their successors. The Administrator is authorized to administer all Accounts, inclusive of those with Powers of Attorney executed by prior Administrators.

CALPIA shall notify the Bank when there is a change in assigned Administrator.

The Administrator will also be responsible for qualifying all withdrawals and will notify the Bank prior to authorizing withdrawals consistent with this Agreement and the Program.

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

b. Account Documentation: CALPIA will provide the Bank with the appropriate documentation, including the Power of Attorney that defines the responsibilities of the Administrator to open and close each account. The Administrator will ensure that each Recipient signs the Bank’s required signature card (“Signature Card”) for each Account opened and established for a Recipient under the Program, with the signature of the Recipient acknowledged before two adult witnesses utilizing the form witness certificate provided or otherwise required by the Bank. In lieu of Notary Public, CALPIA shall use a two (2) witness method for the Powers of Attorney and the Signature Card.

c. Vesting Account Disclosures: The Accounts to be opened will be titled in the name of each Recipient on whose behalf the Account has been established under the Program. The Signature Card vesting will include a reference to the Account being a blocked account under and subject to the requirements of the Program.

d. Verification of Recipient Social Security Number: CALPIA shall be responsible for verifying the social security numbers for each Recipient on whose behalf an Account is established under the Program and subject to this Agreement. CALPIA acknowledges and represents that a Recipient cannot be employed under the Program unless his or her social security number is verified by CALPIA.

e. Compliance with CIP: Under the Bank's Customer Information Program (CIP), the Bank will rely on CALPIA to perform the services of (1) providing notice, (2) identifying the Recipient and (3) maintaining said records for 5 years after account closing. By opening each Account, CALPIA is certifying to the Bank that CALPIA has complied with the Bank’s CIP procedural requirements to identify the Recipient, which includes obtaining the following information on the Recipient:

1) Name.

2) Mother’s maiden name.

3) Place and date of birth.

4) Physical address.

5) A taxpayer identification number or social security number.

f. Execution of Documents: In connection with Paragraph e. above, CALPIA will provide to the Bank all signed documents and CIP information requested by the Bank and otherwise necessary to establish the Accounts and necessary to satisfy the Bank’s CIP policy and program. This will include, without limitation, an appropriate Signature Card.

IFB No. V92812508California Prison Industry Authority (CALPIA)

CALPIA hereby acknowledges and represents that it will obtain all appropriate prior permissions and authorizations necessary from each Recipient for the deposit of checks to, or otherwise receiving credits to, the Account established for the benefit of the particular Recipients.

g. Hold Harmless: CALPIA agrees to hold the other party harmless from and against, all costs, damages, judgments, reasonable outside attorney fees, expenses, obligations and liabilities of any kind or nature which are caused by or arises out of CALPIA’s responsibilities as stated in the CIP process (Section 1) of this document.

2. BANK RIGHTS, REPRESENTATIONS AND RESPONSIBILITIES: The Accounts established by CALPIA with the Bank under the Program are subject to the following terms and conditions:

a. Interest: Any interest paid by the Bank for an Account will be subject to the Bank’s prevailing interest rates in effect at the time each particular Account is established for a Recipient. The Bank makes no representations or warranties concerning the amount of any interest rate that may be available for an Account.

b. Withdrawals: Any withdrawals upon a Recipient’s parole or release, and special circumstances are as follows:

1) All contact with the Bank, including requests for disbursements, will be from the current CALPIA Administrator only and not the Recipients.

2) CALPIA will provide disbursement instructions to the Bank, and the Bank will be entitled to comply with such instructions without any consent or instruction of the Recipient on whose behalf the Account is maintained. Disbursement instructions will be by Cashier’s Check.

3) In the event of a Recipient's death the Bank will rely upon instructions from CALPIA to remit the proceeds remaining on deposit in an Account of that decedent Recipient, for distribution by CALPIA to the legally entitled party(ies).

Legally entitled parties will be verified by CALPIA via the California Department of Corrections and Rehabilitation, Strategic Offender Management System (SOMS). Funds will be disbursed in the same time frame as other withdrawals.

4) The Bank will comply with the instructions for withdrawal received from the Administrator and provide Cashier's Check(s) to the Administrator as follows:

• Request received by the Bank before 2:00pm – same day as request

• Request received by the Bank after 2:00pm – next Bank business day

c. Account Statements: The Administrator will be responsible for providing statements to the recipients in whose name the Account was established. Bank will provide a list of all accounts and balances, via email, to the current Administrator, by the 10th of each month. The Bank will make the Account statements available to the Administrator as follows:

• Accounts currently receiving Direct Deposits – monthly

• Accounts active that have no current activity - quarterly

d. Refusal to Open Account: The Bank reserves the right, in the Bank’s sole discretion and for any reason, to refuse to open any Account requested to be opened by CALPIA on behalf of a Recipient, including but not limited to, if the Recipient's identification or new account documentation does not meet the requirements to comply with applicable banking regulations or the Bank's policy.

e. Legal Process: The Bank will comply with any order, judgment, decree or injunction, or a garnishment, restraining notice or other legal process against or naming a Recipient (“Legal Process”) served on the Bank and which the Bank determines in its sole discretion and in good faith to be valid, directing, prohibiting or otherwise restricting the disposition of the funds in held in the name of or for benefit of a Recipient, including those in an Account. In the event of such service, the funds in the Account may not be available to CALPIA or the Recipient unless and until the Bank receives written notice that the Legal Process has been appropriately released. The Bank will notify the Administrator via email of any such levy’s or orders within 48 hours of receipt.

f. Income Tax Reporting: For purposes of IRS form 1099 and reportable interest income, the appropriate IRS form 1099 showing interest income as being attributable to the Recipient on whose behalf an Account is established, will be mailed to the address designated by CALPIA and reported by the Bank to the IRS as required by appropriate IRS regulation.

3. INDEMNITY AND HOLD HARMLESS: Bank and CALPIA agree to indemnify and hold the other party harmless from and against, all costs, damages, judgments, reasonable outside attorneys fees, expenses, obligations and liabilities of any kind or nature which, in good faith, the indemnified party may incur or sustain in connection with or arising out of the indemnifying party’s failure to perform in accordance with, or otherwise comply with the provisions of, this Agreement and any agreement applicable to the Accounts.

4. MISCELLANEOUS TERMS AND CONDITIONS:

a. Annual Review: This Agreement will be reviewed annually by the Bank and CALPIA from the date of signature to determine whether the Bank will continue to permit Accounts to be established under the Program at the request of CALPIA.

b. Right to Terminate: This Agreement may be terminated at any time upon thirty

(30) days written notice by either party for any reason. The written notice will be delivered to the other party to the address of that party identified below.

b. Force Majeure: The Bank shall not be liable for any delay or failure to act as may be required hereunder when such delay or failure is due to fire, earthquake, any act of God, interruption or suspension of any communication or wire facilities or services, war, emergency conditions or other circumstances beyond its control, provided it exercises such diligence as the circumstances may reasonably require.

c. Scope: The Bank shall have no duties or obligations hereunder except those specifically set forth herein and such duties and obligations shall be determined solely by the express provisions of this Agreement.

d. Governing Law: This Agreement shall be governed, construed, regulated, and administered under the laws of the State of California.

e. Invalid Provisions: It is not the intention of any party to this Agreement to violate any statute, regulation, ruling, judicial decision, or other legal provision applicable to this Agreement or the performance thereof If any term of this Agreement, or any act or omission in the performance thereof, is or becomes violative of any such provision, such term, act or omission shall be of no force or effect and any such term shall be severed from this Agreement. Any such invalid term, act or omission shall not affect the validity of any other term of this Agreement that is otherwise valid, nor the validity of any otherwise valid act or omission in the performance thereof, unless such invalidity prevents accomplishment of the objectives and purposes of this Agreement. In the event any such term, act or omission is determined to be illegal or otherwise invalid, the necessary steps to remedy such illegality or invalidity shall be taken immediately by the parties.

f. Counterparts: This Agreement may be executed in several counterparts, each of which shall be deemed an original and said counterparts shall constitute but one and the same instrument, which may be sufficiently evidenced by any one counterpart.

g. Successors and Assigns: This Agreement shall ensure the benefit of, and be binding upon, the parties hereto and their successors and assigns, except as it is expressly provided to the contrary herein.

i. Amendments: CALPIA and Contractor may agree to amend the agreement, prior to expiration, in writing on the STD 213A. The terms of the agreement may be amended by agreement of CALPIA and Contractor including, but not limited to the following:

1) Contract term extensions shall be in two (2) year increments.

5. CONTRACT ADMINISTRATORS: For the term of this agreement shall be designated by Contractor and Agency, and initially shall be as follows:

Bank’s Contract Administrator:

Contractor:

Attention:

Address:

Phone:

Email:

CALPIA Contract Administrator:

Agency:

Attention:

Address:

Phone:

Email:

6. INVOICING AND PAYMENT: This is a $0.00 (Zero Dollar) contract. There are no invoicing or payment provisions required.

DURABLE SPECIAL POWER OF ATTORNEY

(California Probate Code Section 4400 et seq.)

WARNING TO PERSON EXECUTING THIS DOCUMENT:

This is an important legal document. It creates a power of attorney that provides the person you designate as your attorney-in-fact with the broad powers it sets forth. You have the right to terminate this power of attorney. If there is anything about this form that you do not understand, you should ask a lawyer to explain it to you.

NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS SUCH ATTORNEY-IN-FACT

By acting or agreeing to act as the agent (attorney-in-fact) under this power of attorney you assume the fiduciary and other legal responsibilities of an agent. These responsibilities include:

1. The legal duty to act solely in the interest of the principal and to avoid conflicts of interest.

2. The legal duty to keep the principal’s property separate and distinct from any other property owned or controlled by you.

You may not transfer the principal’s property to yourself without full and adequate consideration or accept a gift of the principal’s property unless this power of attorney specifically authorizes you to transfer property to yourself or accept a gift of the principal’s property. If you transfer the principal’s property to yourself without specific authorization in the power of attorney, you may be prosecuted for fraud and/or embezzlement. If the principal is 65 years of age or older at the time that the property is transferred to you without authority, you may also be prosecuted for elder abuse under Penal Code Section 368. In addition, to criminal prosecution you may also be sued in civil court.

I have read the foregoing notice and I understand the legal and fiduciary duties that I assume by acting or agreeing to act as the agent (attorney-in-fact) under the terms of this power of attorney.

Date:

(Signature of agent/attorney in fact)

(Print name of agent/attorney in fact)

Attachment B

I, ____________________________________, (principal)

[your name and address]

Appoint: _____________________________________ (Agent)

995 Folsom Lake Crossing, Folsom, CA 95630 [name and address of the person appointed, or of each person appointed if you want to designate more than one] as my Agent (Attorney-in-fact) to act for me in any lawful way with respect to the specific matter stated in this Power of Attorney.

This Power of Attorney is only effective to permit my Agent to take any and all actions necessary on my behalf to open, maintain and close a blocked savings deposit account in my name for the savings portion of my eligible incarcerated individual-employee compensation in accordance with the California Code of Regulations, Title 15, Subchapter 5, Article 9, under the Joint Venture Programs. These powers shall include the following authority:

• To continue, modify, and terminate any account or other banking arrangement made by or on behalf of the principal.

• Withdraw by check, order, or otherwise money or property of the principal deposited with or left in the custody of a financial institution.

• Receive bank statements, vouchers, notices, and similar documents from a financial institution and act with respect to them

Principal hereby grants to said attorney-in-fact full power and authority to do and perform each and every act and thing which may be necessary, or convenient, in connection with any of the foregoing, as fully, to all intents and purposes, as principal might or could do if personally present, hereby ratifying and confirming all that our said attorney, in fact, shall lawfully do or cause to be done by authority hereof.

This Power of Attorney will continue to be effective even though I become incapacitated.

I agree that any third party who receives a copy of this document may act under it according to the specific provisions set forth in this Power of Attorney. Revocation of this Power of Attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree o indemnify the third party for any claims that arise against the third party because of reliance on this Power of Attorney.

Signed this _________ day of _______________, 20_____

[signature]

PRINCIPAL [print name]

WITNESS CERTIFICATE

I, _________________________, am currently employed by __________________________________, located at

_______________________________ [street address]. In the City of ________________________ [city], California and I hereby acknowledge that:

1. I witnessed the signing of the within Power of Attorney of _________________________ (Principal) dated this

________ day of _________________, 20____.

2. ______________________________ (Principal) proved to me to be the person whose is named in the signature card and provided to me an unexpired government identification.

3. I am an adult with capacity to witness the signing of the Power of Attorney and I am the subscribing witness thereto.

4. In my opinion, ________________________ (Principal) had the capacity to understand the nature and effect of the Power of Attorney at the time the Power of Attorney was signed, and the principal signed it freely and voluntarily without any compulsion or influence from any person.

5. I am not the Attorney-in-fact named in the Power of Attorney nor am I the Attorney-in-fact’s spouse or other family members.

Dated: ______________ ______, 20______

[Witness Signature]

Witness [Print Name]

WITNESS CERTIFICATE

I, ___________________________, am currently employed by __________________________________, located at

_______________________________ [street address]. In the City of __________________________ [city], California and I hereby acknowledge that:

1. I witnessed the signing of the within Power of Attorney of _________________________ (Principal) dated this

________ day of _________________, 20____.

2. ______________________________ (Principal) proved to me to be the person whose is named in the signature card and provided to me an unexpired government identification.

3. I am an adult with capacity to witness the signing of the Power of Attorney and I am the subscribing witness thereto.

4. In my opinion, __________________________ (Principal) had the capacity to understand the nature and effect of the Power of Attorney at the time the Power of Attorney was signed and the principal signed it freely and voluntarily without any compulsion or influence from any person.

5. I am not the Attorney-in-fact named in the Power of Attorney nor am I the Attorney-in-fact’s spouse or other family member.

Dated: ______________ _____, 20______

[Witness Signature]

Witness [Print Name]

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

Print Form Reset FormCalifornia Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

IFB No. V92812508

ATTACHMENT 3A

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 signe e 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.

California Prison Industry Authority (CALPIA) Joint Venture Program (JVP) Savings Account

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) Joint Venture Program (JVP) Savings Account

IFB No. V92812508

ATTACHMENT 3B

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…