R2324-12_Restrooms_Doors_Attachment_3A-3F_and_4.pdf

Attachment 3-A General Certifications

ATTACMENT 3-A

GENERAL CERTIFICATIONS

Check the box below, if agreed, and sign this attachment. Please note that the JBE will reject a proposal from a Proposer that does not indicate acceptance of these clauses.

Conflict of Interest. Contractor has no interest that would constitute a conflict of interest under California Public Contract Code (PCC) sections 10365.5, 10410 or 10411; Government Code sections 1090 et seq. or 87100 et seq.; or California Rules of Court, rule 10.103 or 10.104, which restrict employees and former employees from contracting with judicial branch entities.

Suspension or Debarment. Contractor certifies that neither Contractor nor any of Contractor’s intended subcontractors is on the California Department of General Services’ list of firms and persons that have been suspended or debarred from contracting with the state because of a violation of PCC 10115.10, regarding disabled veteran business enterprises.

Tax Delinquency. Contractor certifies that it is not on either (i) the California Franchise Tax Board’s list of 500 largest state income tax delinquencies, or (ii) the California Department of Tax and Fee Administration’s list of 500 largest delinquent sales and use tax accounts.

Conflict Minerals. Contractor certifies that either (i) it is not a scrutinized company as defined in PCC 10490(b), or (ii) the goods or services the Contractor would provide to the JBE are not related to products or services that are the reason the Contractor must comply with Section 13(p) of the Securities Exchange Act of 1934. (Note: PCC 10490(b) defines a “scrutinized company” as “a person that has been found to be in violation of Section 13(p) of the Securities Exchange Act of 1934 by final judgment or settlement entered in a civil or administrative action brought by the Securities and Exchange Commission and the person has not remedied or cured the violation in a manner accepted by the commission on or before final judgment or settlement.”)

Workers’ Compensation. Labor Code section 3700 in relevant part provides that every employer except the State shall secure the payment of compensation in one or more of the following ways: (i) by being insured against liability to pay compensation by one or more insurers duly authorized to write compensation insurance in this state; or (ii) by securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any compensation that may become due to his employees. Contractor certifies it is aware of the provisions of section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and will comply with such provisions before commencing the performance of any work.

Solicitation. Contractor certifies that no official or employee of the Court, nor any business entity in which an official of the Court has an interest, has been employed or retained to solicit or assist in the procuring of the resulting contract, nor that any such person will be employed in the performance of any contract without immediate divulgence of this fact to the Court.

☐ Check this box to indicate acceptance of the clauses above.

PROPER NAME OF CONTRACTOR / SUBCONTRACTOR (Printed) FEDERAL ID NUMBER

BY (Authorized Signature)

PRINTED NAME AND TITLE OF PERSON SIGNING DATE EXECUTED

Attachment 3-B Darfur Contracting Act Certifications

ATTACMENT 3-B

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.

PROPER NAME OF CONTRACTOR / SUBCONTRACTOR (Printed) FEDERAL ID NUMBER

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.

PROPER NAME OF CONTRACTOR / SUBCONTRACTOR (Printed) FEDERAL ID NUMBER

Attachment 3-C Iran Contracting Act Certification

ATTACMENT 3-C

IRAN CONTRACTING ACT CERTIFICATE

Pursuant to California Public Contract Code Section 2200 et seq., (the "Iran Contracting Act of 2010"), Contractor certifies that:

(1) Contractor is not identified on the list created by the California Department of General Services ("DGS") pursuant to Public Contract Code Section 2203(b) as a Person engaging in investment activities in Iran; and

(2) Contractor is not a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another Person, for 45 days or more, if that Person will use the credit to provide goods or services in the energy sector in Iran and is identified on the DGS list made pursuant to Public Contract Code Section 2203(b).

As used herein, "Person" shall mean a person as defined in Public Contract Code Section 2202(e).

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY, that I am duly authorized to legally bind the Contractor to this Certification, which is made under the laws of the State of California.

Attachment 3-D Unruh Civil Rights Act and California “FEHA” Certification

ATTACMENT 3-D

UNRUH CIVIL RIGHTS ACT AND CALIFORNIA FAIR EMPLOYMENT AND HOUSING ACT

CERTIFICATION

Pursuant to Public Contract Code (PCC) section 2010, the following certifications must be provided when

(i) submitting a bid or proposal to the JCC for a solicitation of goods or services of $100,000 or more, or

(ii) entering into or renewing a contract with the JCC for the purchase of goods or services of $100,000 or more.

CERTIFICATIONS:

1. We are in compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code);

2. We are in compliance with the California Fair Employment and Housing Act (Chapter 7

(commencing with Section 12960) of Part 2.8 of Division 3 of the Title 2 of the Government Code);

3. We do not have any policy against any sovereign nation or peoples recognized by the government of the United States, including, but not limited to, the nation and people of Israel, that is used to discriminate in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the California Fair Employment and Housing Act (Chapter 7 (commencing with Section 12960) of Part

2.8 of Division 3 of Title 2 of the Government Code); and

4. Any policy adopted by a person or actions taken thereunder that are reasonably necessary to comply with federal or state sanctions or laws affecting sovereign nations or their nationals shall not be construed as unlawful discrimination in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the California Fair Employment and Housing Act (Chapter 7 (commencing with Section 12960) of Part 2.8 of Division 3 of Title 2 of the Government Code).

The certifications made in this document are made under penalty of perjury under the laws of the State of California. I, the official named below, certify that I am duly authorized to legally bind the proposer/bidder/vendor to certifications made in this document.

PROPER NAME OF CONTRACTOR / SUBCONTRACTOR (Printed) FEDERAL ID NUMBER

BY (Authorized Signature)

PRINTED NAME AND TITLE OF PERSON SIGNING DATE EXECUTED

Executed in the County of ___________________ in the State of

Attachment 3-E Prevailing Wage Certification

ATTACHMENT 3-E

Prevailing Wage

PREVAILING WAGE AND

RELATED LABOR REQUIREMENTS CERTIFICATION

PROJECT/CONTRACT NO.: CONTRACT NUMBER between the Superior Court of California, County of Imperial of California (“Court” or “JBE”) and (the “Contractor”) (the “Contract” or the “Project”).

I hereby certify that I will conform to the State of California Public Works Contract requirements regarding prevailing wages, benefits, on-site audits with 48-hours’ notice, payroll records, and apprentice and trainee employment requirements, for all Work on the Project including, without limitation, the requirement that Contractor and all of its Subcontractors are registered pursuant to Labor Code section 1771, et seq.

THIS FORM MUST BE COMPLETED BY THE CONTRACTOR AND ALL SUBCONTRACTORS

Attachment 3-F CARB Certification

ATTACHMENT 3-F

CALIFORNIA AIR RESOURCES BOARD

IN-USE OFF-ROAD DIESEL-FUELED FLEETS

CERTIFICATION

1. Instructions: Check the box below, if agreed, and sign this attachment. Please note that the JBE will reject a proposal from a Contractor that does not indicate conformance to the California Air Resources Board (“CARB”) In-Use Off-Road Diesel-Fueled Fleets requirements (Title 13 CCR sections 2449, 2449.1 and 2449.2).

☐ I hereby certify that I will conform to the CARB In-Use Off-Road Diesel-Fueled Fleets requirements for all Work on the Project involving the use of vehicles subject to the regulations, including, without limitation, the Contracting Requirements in Title 13 CCR section 2449, subdivision (i), subparts (1) – (4) and as applicable, the Prime Contractor Requirements in Title 13 CCR section 2449, subdivision (j), subparts (1) – (5).

2. Instructions: Check one (1) box below.

☐ Contractor’s current CARB issued Certificate of Reported Compliance is provided with this Certification.

☐ Contractor certifies that its Work on the Project does not involve the use of vehicles subject to the CARB In-Use Off-Road Diesel-Fueled Fleets requirements.

I, the official named below certify that I am duly authorized to legally bind the Contractor to the certifications made in this document. This certification is made under the laws of the State of California.

PROPER NAME OF CONTRACTOR / SUBCONTRACTOR (Printed) FEDERAL ID NUMBER

THIS FORM MUST BE COMPLETED BY THE CONTRACTOR AND ALL SUBCONTRACTORS

PERFORMING WORK INVOLVING THE USE OF VEHICLES SUBJECT TO THE REGULATION

Attachment 4 Subcontractor Listing Form

ATTACMENT 4

SUBCONTRACTOR LISTING FORM

Set forth the name and location of place of business, California contractor license number and public works contractor registration number issued pursuant to Section 1725.5 of the Labor Code for each subcontractor who will perform a portion of the Contract work in an amount in excess of 1/2 of 1 percent of the total contract price.

PORTION OF

WORK

NAME LOCATION LICENSE # DIR#