Optometry_IFB.pdf

STATE OF CALIFORNIA--HEALTH AND HUMAN SERVICES AGENCY GAVIN NEWSOM, Governor

PORTERVILLE DEVELOPMENTAL CENTER

P.O. BOX 2000, PORTERVILLE, CA 93258-2000

(559) 782-2222

TDD 781-7822

INVITATION FOR BID

Notice to Prospective Bidders

You are invited to review and respond to this Invitation for Bid (IFB), entitled PR269002, Optometry Services. In submitting your bid, you must comply with these instructions.

Note that all agreements entered into with the State of California will include by reference General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at Internet site https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-

Contract-Language. If you do not have Internet access, a hard copy can be provided by contacting the person listed below.

The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract.

In the opinion of Porterville Developmental Center, this Invitation for Bid is complete and without need of explanation.

However, if you have questions, or should you need any clarifying information, the contact person for this IFB is:

Brandi McElhaney

Porterville Developmental Center brandi.mcelhaney@pdc.dds.ca.gov

The term of this contract is July 1, 2026 (or when fully executed) through June 30, 2029. The State has the option of extending the term for one or two additional one-year period (s) at the same rates as proposed by the Contractor.

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

Brandi McElhaney Contract Analyst mailto:brandi.mcelhaney@pdc.dds.ca.gov

Optometry Services

PR269002

Table of Contents

Section Page

A) Purpose and Description of Services

B) Bidder Minimum Qualifications

C) Bid Requirements and Information

1) Key Action Dates ………………………………………………………………………….…3

2) Submission of Bid………………………………………………………………………….…4

3) Evaluation and Selection…………………………………………………………….………4

4) Award and Protest……………………………………………………………………….…..5

5) Disposition of Bid……………………………………………………………………….…...6

6) Agreement Execution and Performance ………………………………………………

D) Preference Programs

1) Small Business Preference….………………………………………………………………7

E) Required Attachments

1) Required Attachment Check List

2) Bid/Bidder Certification Sheet

3) Sample Cost Sheet

4) Bidder References

5) Darfur Contracting Act

6) CA Civil Rights Law Attachment…………………………………………………………..14

F) Sample Standard Agreement (STD 213)

1) Exhibit A, Scope of Work

2) Exhibit B, Budget Detail and Payment Provisions

3) Exhibit C, General Terms and Conditions – Refer to Internet site: www.dgs.ca.gov/contracts

4) Exhibit D, Special Terms and Conditions

5) Exhibit E, Health Insurance Portability and Accountability Act (HIPAA) http://www.dgs.ca.gov/contracts

A) Purpose and Description of Services

Contractor will provide optometry services to Porterville Developmental Center (PDC) individuals. Contractor providing services will be duly licensed and must have expertise in the field of Optometry. See Exhibit A of the IFB for the description of required services. The terms of this Agreement will be July 1, 2026 through June 30, 2029.

B) Bidder Minimum Qualifications

All bidders must meet the following requirements to be considered responsible and responsive to this IFB.

1. Contractor must be licensed in the field of Optometry.

2. No bidder may bid for work of any kind that the bidder is not properly licensed to perform. Any such bid received will be disqualified. Copies of all licenses must be included with the BID documents.

3. Bidder must be able to supply all specified items and services to Porterville Developmental Center (PDC) in accordance with the attached Sample Agreement.

4. Bidder must have 5 years’ experience working in a State Hospital, Developmental Center and/or Prison setting.

Staffing Agencies must have qualified personnel in place at the time of bid and must provide license.

5. Contractor needs to be cognizant of the special needs of the developmentally disabled.

C) Bid Requirements and Information

1) Key Action Dates

Event Date

IFB available to prospective bidders Monday April 20, 2026

Emailed questions submittal date Friday April 24, 2026 by 3:00 PM PDT

Answered questions submitted to contractors Monday April 27, 2026 by end of day And posted to CSPRS

Final Date for Bid Submission Tuesday May 5, 2026 @ 10:00 AM PDT

Bid Opening Tuesday May 5, 2026 @ 10:30 AM PDT

Notice of Intent to Award Wednesday May 6, 2026

Proposed Award Date Wednesday May 13, 2026

2) Submission of Bid

a) All bids must be submitted under sealed cover and sent to Porterville Developmental Center, Attention

Brandi McElhaney, by dates and times shown in Section C, Bid Requirements and Information, Item 1) Key Action Dates, (page 3). The sealed cover must be plainly marked with the IFB number and title, must show your firm’s name and address, and must be marked with "DO NOT OPEN", as shown in the following example:

Porterville Developmental Center

26501 Avenue 140 Porterville, CA 93257

DO NOT OPEN

Bids not submitted under sealed cover may be rejected. A minimum of one copy of the bid must be submitted.

b) All bids shall include the documents identified in Section E, Required Attachment Checklist (see page #12).

Bids not including the proper "required attachments" shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements.

c) All documents requiring a signature must bear an original signature of a person authorized to bind the bidding firm.

d) Email, mail or deliver bids to the following address:

U.S. Postal Service Deliveries

(UPS, Express Mail, Federal Express)

Porterville Developmental Center Attn: Brandi McElhaney – Contract Analyst 26501 Avenue 140 Porterville, CA 93257 brandi.mcelhaney@pdc.dds.ca.gov mailto:brandi.mcelhaney@pdc.dds.ca.gov

e) Bids must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and will cause a bid to be rejected.

f) A bid may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all bids and may waive an immaterial deviation in a bid.

The State's waiver of an immaterial deviation shall in no way modify the IFB document or excuse the bidder from full compliance with all requirements if awarded the agreement.

g) Costs incurred for developing bids and in anticipation of award of the agreement are entirely the responsibility of the bidder and shall not be charged to the State of California.

h) An individual who is authorized to bind the bidder contractually shall sign the Bid/Bidder Certification Sheet, page #13. The signature should indicate the title or position that the individual holds in the firm. An unsigned bid may be rejected.

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

j) A bidder may withdraw its bid by submitting a written withdrawal request to the State, signed by the bidder or an authorized agent. A bidder may thereafter submit a new bid prior to the bid submission deadline. Bids may not be withdrawn without cause subsequent to bid submission deadline.

k) The awarding agency may modify the IFB prior to the date fixed for submission of bids by the issuance of an addendum to all parties who received a bid package.

l) The awarding agency reserves the right to reject all bids. The agency is not required to award an agreement.

m) Before submitting a response to this solicitation, bidders should review, correct all errors and confirm compliance with the IFB requirements.

n) Where applicable, bidder should carefully examine work sites and specifications. Bidder shall investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered.

No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications.

o) The State 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. The State’s General Terms and Conditions (GTC) are not negotiable.

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

4) Evaluation and Selection

a) At the time of bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this IFB.

b) The State will evaluate each bid to determine its responsiveness to the published requirements.

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

d) Award if made, will be to the lowest responsive responsible bidder.

5) Award and Protest

a) Whenever an agreement is awarded under a procedure which provides for competitive bidding, but the agreement is not to be awarded to the low bidder, the low bidder shall be notified by email, electronic facsimile transmission, overnight courier, or personal delivery five (5) working days prior to the award of the agreement.

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

c) If any bidder, prior to the award of agreement, files a written protest with the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, CA 95605 and the (insert name of awarding agency) on the grounds that the (protesting) bidder is the lowest responsive responsible bidder, the agreement shall not be awarded until either the protest has been withdrawn or the Department of General Services has decided the matter.

d) Within five (5) days after filing the initial protest, the protesting bidder shall file with the Department of General

Services and the awarding agency with a detailed written statement specifying the grounds for the protest.

The written protest must be sent to the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, California 95605. A copy of the detailed written statement should be mailed to the awarding agency. It is suggested that you submit any protest by certified or registered mail.

e) Upon resolution of the protest and award of the agreement, Contractor must complete and submit to the awarding agency the Payee Data Record (STD 204), to determine if the Contractor is subject to state income tax withholding pursuant to California Revenue and Taxation Code Sections 18662 and 26131. This form can be found on the Internet at www.osp.dgs.ca.gov under the heading FORMS MANAGEMENT CENTER. No payment shall be made unless a completed STD 204 has been returned to the awarding agency.

f) Upon resolution of the protest and award of the agreement, Contractor must sign and submit to the awarding agency, page one (1) of the Contractor Certification Clauses (CCC), which can be found on the Internet at www.ols.dgs.ca.gov/Standard+Language. This document is only required if the bidder has not submitted this form to the awarding agency within the last three (3) years.

6) Disposition of Bids

a) Upon bid opening, all documents submitted in response to this IFB will become the property of the State of California and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by the public.

b) Bid packages may be returned only at the bidder's expense, unless such expense is waived by the awarding agency.

7) Agreement Execution and Performance

a) Performance shall start no later than the express date set by the awarding agency and the Contractor, after all approvals have been obtained and the agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, the awarding agency, upon five (5) days written notice to the Contractor, reserves the right to terminate the agreement. In addition, the Contractor shall be liable to the State for the difference between Contractor's bid price and the actual cost of performing work by the second lowest bidder or by another contractor.

http://www.osp.dgs.ca.gov/ http://www.ols.dgs.ca.gov/Standard+Language

b) All performance under the agreement shall be completed on or before the termination date of the agreement.

c) If necessary to maintain continuity of care for the residents of the Porterville Developmental Center, the State retains the option to extend the contract for up to one (1) year at the same rates as proposed in the solicitation.

D) Preference Programs

1) Small Business Preference: : https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division- Services-List-Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise. The Small Business incentive is in effect for this IFB.

Although the mandatory requirement has been waived such incentives are still applicable under qualifying conditions.

In accordance with Government Code Section 14838.5, et seq. and California Code of Regulations, Title 2, Section 1896, et seq., a five (5) percent preference will be granted to bidders properly certified as a California Small Business (SB), Microbusiness (MB), or Non-Small Business (NSB) with a Small Business subcontracting for a minimal of 25% of the bid amount. A five (5) percent preference will be granted to bidders certified as a Non-Profit Veteran Service Agency in accordance with the Military and Veterans Code Section 999.50. Applications must be on file at the office of Small Business and Disabled Veteran Business Enterprise Certification by 5:00 p.m. on bid opening day. The preference adjustment for awards based on low price cannot exceed $50,000.00.

For solicitations where bidders are asked to submit hourly rates, the preference shall be calculated solely on the basis of that rate.

a. Small Business Preference Example (Single Award):

Bidder A Bidder B Bidder C

Bidder Status NSB NSB w/ 25% SB

Preference Applicable? X X

Original Bid Amount $100,000 $105,000 $102,500

Apparent Low Bid X

Pref. Amount (5% of Low Bidder) $0 $5,000 $5,000

Revised Bid $100,000 $100,000 $97,500

Revised Lowest Bidder X

b. Explanation of Example:

The lowest bidder at the time of bid opening is Bidder A, which is a Non-Small Business not claiming a Small Business subcontracting preference. Since both Bidder B and Bidder C claim a Small Business Preference, five (5) percent of Bidder A’s bid is subtracted from those of Bidder B and C. In the example above, five (5) percent of $100,000 is $5,000. After applying these preferences, Bidder C’s revised bid ($97,500) is less than the other bids, making them the revised apparent low bidder.

https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-%20%20%20Services-List-Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-%20%20%20Services-List-Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise

Note: since the preferences are used only for computation purposes to determine the successful bidder, if an agreement was awarded to Bidder C, it would be at the original $102,500 amount.

2) Disabled Veteran Business Enterprise Program and Incentive:

a. The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract however, the DVBE incentive is in effect for this IFB. DVBE Participation Program can be found at https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List- Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise

1. The State hereby waives the mandatory Disabled Veteran Business Enterprise (DVBE) participation requirement for this IFB.

2. An incentive for bidders who include DVBE participation is available and encouraged for this

IFB. For evaluation purposes only, the State shall apply an incentive to bids that include California certified DVBE participation and confirmed by the State. The incentive amount will vary in conjunction with the percentage of DVBE participation in accordance with the following formula:

DVBE Incentive Participation DVBE Incentive

5% or Over 5%

4% to 4.99% Inclusive 4%

3% to 3.99% Inclusive 3%

2% to 2.99% Inclusive 2%

1% to 1.99% Inclusive 1%

For solicitations where bidders are asked to submit hourly rates, the incentive shall be calculated solely on the basis of that rate.

3. The net bid price of responsive bids with DVBE participation will be reduced (for evaluation purposes only) by the amount of DVBE incentive as applied to the lowest responsive net bid price. If the #1 ranked, responsive, responsible bid is a California certified small business, the only bidders eligible for the incentive will be other California certified small businesses. The incentive adjustment for awards based on low price cannot exceed 5% or $50,000.00, whichever is less, of the #1 ranked net bid price. When used in combination with a Small Business preference adjustment, the cumulative adjustment amount cannot exceed $100,000.00.

4. Information submitted by the bidder to claim the DVBE incentive will be verified by the State. Only the

DVBEs who shall perform a commercially useful function relevant to the Scope of Work included in this IFB may be used to qualify the bidder for a DVBE incentive. All DVBE bidders and their proposed subcontractors must submit a copy of the DVBE Declarations Form (Std. 843). See Attachment 9.

5. Disabled Veteran Business Enterprise Inventive Example (Single Award):

6.

Bidder A Bidder B Bidder C

Bidder Status NSB NSB w/ 3% DVBE

Incentive Applicable? X X

Original Bid Amount $100,000 $105,000 $102,500

Apparent Low Bid X

Incentive Qualified 3% 5%

Incent. Amount (% of Low Bidder) $0 $3,000 $5,000

Revised Bid $100,000 $102,000 $97,500

7. Explanation of Example:

The lowest bidder at the time of bid opening is Bidder A, which is a Non-Small Business not claiming a DVBE subcontracting incentive. Bidder B claims (and qualifies for) a DVBE incentive of three (3) percent. Bidder C is a DVBE, which qualifies them for a five (5) percent incentive. To apply the incentive, three (3) percent of Bidder A’s bid is subtracted from Bidder B’s bid, resulting in a revised bid of $102,000. Five (5) percent of Bidder A’s bid is subtracted from Bidder C’s bid, resulting in a revised bid of $97,500. After applying the incentives, Bidder C’s revised bid ($97,500) is less than the other bids, making them the revised apparent low bidder.

Note: since the preferences are used only for computation purposes to determine the successful bidder, if an agreement was awarded to Bidder C, it would be at the original $102,500 amount.

3) Calculation of Multiple Preferences:

a. In the event that bidders qualify for the Small Business preferences and/or the Disabled Veteran

Business Enterprise incentive, the SB preference shall be calculated first. In circumstances where DSH will award a single agreement as a result of this solicitation, in accordance with Government Code Section 14838(f), the DVBE incentive will not be calculated if, after the application of the SB preference, a SB bidder is the apparent low bidder unless another SB bidder is also a DVBE or has subcontracted with DVBE firms.

Note: in accordance with Government Code Section 14838(f), in the event of a precise tie between a small business or microbusiness, and a disabled veteran-owned small business or microbusiness, the agreement shall be awarded to the disabled veteran-owned small business or microbusiness.

b. Example of the Calculation of Multiple Preferences:

Bidder A Bidder B Bidder C Bidder D

Bidder Status NSB NSB w/ 25% DVBE SB

SB Pref. Applicable? X X

Original Bid Amount $100,000 $105,500 $103,000 $106,000

Apparent Low Bid X

SB Pref. Amt. (5% of Low Bid) $0 $5,000 $0 $5,000

Revised Bid $100,000 $100,500 $103,000 $101,000

Revised Lowest Bidder X

DVBE Incentive Applicable? X

Incentive Qualified 5%

Incent. Amt. (% of Low Bid) $0 $0 $5,000 $0

Revised Bid $100,000 $100,500 $98,000 $101,000

4) Other Preference Programs:

Additional preference programs exist and may be applicable. Specifically:

o Target Area Agreement Preference Act (TACPA)

For information regarding these programs please see the following website:

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

5) Additional Small Business and Disabled Veteran Enterprise Information:

a. Adherence to the DVBE Requirements:

Failure of Contractor to seek substitution and adhere to the DVBE participation level identified in the bid or offer may be cause for agreement termination, recovery of damages under rights and remedies due to the State, and penalties as outlined in Military & Veterans Code § 999.9; Public Contract Code (PCC) § 10115.10 or PCC § 4110 (applies to public works only). Contractor must immediately notify the Department’s SB/DVBE advocate that substitution of a DVBE subcontractor is requested.

b. Commercially Useful Function (CUF) Disclaimer

Each certified SB/MB or DVBE must perform a commercially useful function. Bidders who are found to not be performing a CUF will have their bids deemed non-responsive. A SB/MB or DVBE is deemed to perform a commercially useful function when the business does all of the following:

i. Is responsible for the execution of a distinct element of the work of the agreement.

ii. Carries out its obligation by actually performing, managing, or supervising the work involved.

iii. Performs work that is normal for its business services and functions.

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

iv. Is responsible, with respect to products, inventories, materials, and supplies required for the agreement, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment.

v. Is not further subcontracting a portion of the work that is greater than that expected to be subcontracted by normal industry practices.

Agreements resulting from this solicitation shall afterwards be monitored for compliance with CUF for the duration of the agreement.

E) Required Attachments

1) The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract. https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List- Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise

Refer to the following pages for additional Required Attachments that are a part of this agreement.

https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Certify-or-Re-apply-as-Small-Business-Disabled-Veteran-Business-Enterprise

ATTACHMENT 1

REQUIRED ATTACHMENT CHECK LIST

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

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

Attachment Attachment Name/Description

_____ Attachment 1 Required Attachment Check List

_____ Attachment 2 Bid/Bidder Certification Sheet

_____ Attachment 3 Cost Sheet

_____ Attachment 4 Bidder References

_____ Attachment 5 Darfur Contracting Act (if applicable)

_____ Attachment 6 CA Civil Rights Law Attachment

_____ Attachment 7 Copy of Current Medical Insurance

_____ Attachment 8 Copy of Current Licensing

ATTACHMENT 2

BID/BIDDER CERTIFICATION SHEET

This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as a complete package with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.

Do not return Section C, Bid Requirements and Information (pages #1 through #11) nor the "Sample Agreement" at the end of this IFB.

A. Our all-inclusive bid is submitted as detailed in Attachment 3, Cost Sheet.

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

C. The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract.

D. The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification.

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

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

3. Address Email:

Indicate your organization type:

4. Sole Proprietorship 5. Partnership 6. Corporation

Indicate the applicable employee and/or corporation number:

7. Federal Employee ID No. (FEIN) 8. California Corporation No.

9. Indicate applicable license and/or certification information:

10. Bidder’s Name (Print) 11. Title

12. Signature 13. Date

14. Are you certified with the Department of General Services, Office of Small Business Certification and Resources (OSBCR) as:

a. California Small Business Yes No

If yes, enter certification number:

b. Disabled Veteran Business Enterprise Yes No If yes, enter your service code below:

NOTE: A copy of your Certification is required to be included if either of the above items is checked “Yes”.

Date application was submitted to OSBCR, if an application is pending:

Completion Instructions for Bid/Bidder Certification Sheet

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

Item Number s

Instructions

1, 2, 2a, Must be completed. These items are self-explanatory.

Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation.

The sole proprietor is solely liable for all the debts of the business.

Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent people 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 people to carry on, as co-owners, a business for profit.

Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.

Enter your federal employee tax identification number.

Enter your corporation number assigned by the California Secretary of State’s Office. This information is used to check if a corporation is in good standing and qualified to conduct business in California.

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.

10, 11, 12, 13

Must be completed. These items are self-explanatory.

If certified as a California Small Business, place a check in the "Yes" box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the "Yes" box and enter your service code on the line. If you are not certified to one or both, place a check in the "No" box. If your certification is pending, enter the date your application was submitted to OSBCR.

ATTACHMENT 3

SAMPLE COST SHEET

In compliance with your Invitation For Bid for Optometry Services, I hereby propose to perform the work, as specified and described based on the calculations stated below which requires no more than a total of 185 clinics during the term July 1, 2026, through June 30, 2029, for the total sum of $___________.

The estimated total sum indicated above will be used solely for computing the cost as a fair and equitable formula to determine the low bidder and is not binding on the contracting agency. However, the actual cost quoted above by the bidder shall be binding for the term of the Agreement.

Payment for optometry services will be based on a maximum total of 185 clinics for the term of July 1, 2026, through June 30, 2029.

$________ per clinic

Billing cycle:

Monthly Quarterly Semi-Annually Annually

Note: All services performed are paid in arrears according to billing cycle indicated above.

Bidders Name (Print) Bidders Title (Print)

Bidders Signature Date

ATTACHMENT 4

BIDDER REFERENCES

Submission of this attachment is mandatory. Failure to complete and return this attachment with your bid will cause your bid to be rejected and deemed nonresponsive.

List below three references for services performed within the last five years, which are similar to the scope of work to be performed in this contract.

UNSATISFACTORY REFERENCES MAY RESULT IN YOUR BID BEING DISQUALIFIED.

REFERENCE 1

Name of Firm

Street Address City State Zip Code

Contact Person Telephone Number

Dates of Service Value or Cost of Service

Brief Description of Service Provided

REFERENCE 2

Street Address City State Zip Code

Contact Person Telephone Number

REFERENCE 3

Street Address City State Zip Code

Contact Person Telephone Number

ATTACHMENT 5

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.

If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.

OPTION #1 - 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 #2 – WRITTEN PERMISSION FROM DGS

Pursuant to Public Contract Code section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.

We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477(b).

A copy of the written permission from DGS is included with our bid or proposal.

Company/Vendor Name (Printed) Federal ID Number

Initials of Submitter

Printed Name and Title of Person Initialing

Attachment 6