RFP_C25830001_Forms.pdf

Exhibit Design and Fabrication Services Attachment A: Minimum Requirements Checklist

# Minimum Requirements Yes No

1. Was the Proposal received no later than the date and time listed in Table 1?

2. Is the Proposal typewritten and signed manually?

3. Is the Proposal no more than [100] pages in length, exclusive of the transmittal letter, resumes and references, and the Forms and Certifications?

4. Did the Proposer submit a Transmittal Letter with the following information?

a. Proof of valid and appropriate licensure as qualified to do business in the

State of California;

b. Identification of a Contract Manager;

c. Resumes for all identified Key Personnel;

d. All necessary information and forms required showing proof of small business participation;

e. Affirmation that Proposer has or is able to obtain the required insurance, specified in the Sample Agreement in Attachment C of this RFP;

f. Three references for the firm as required in Section 4.4.1.1;

g. Affirmation that Proposer has not been terminated from another contract for default and/or has not received a civil judgment or criminal conviction in the past five years; and

h. A letter of commitment from each identified Subcontractor, including relevant licenses and positions in which the Subcontractor is identified to work.

5. Did the Proposer submit all requirements of Past Performance and Experience per Section 4.4.1?

a. Three successfully completed projects demonstrating firm’s/company’s qualifications, unique capabilities and/or strengths;

b. (2) Writing Examples

c. Durability and Maintenance of Past Projects

6. Did the Proposer submit a Technical Proposal demonstrating understanding of the Scope of Work?

7. Did the Proposal submit the required Cost Proposal, separate from any other documents and not exceeding $50,000.00?

8. Form A: Bidder Declaration (GSPD 05-105)

9. Form B: Disabled Veteran Business Enterprise Declarations (DPR 486 and

STD 843)

10. Form C: Commercially Useful Function (DPR 87)

11. Cert. 1: CCC-04/2017 and DPR 88, STD 204 and/or STD 205

12. Cert. 2: Darfur Contracting Act Certification

Exhibit Design and Fabrication Services

# Minimum Requirements Yes No

13. Cert 3: Non-Collusion Certification

14. Cert 4: California Civil Rights Laws Certification

15. Cert. 5: P-05-22 Economic Sanctions Certification

Request for Proposals (Secondary) for PESCADERO MARSH NATURAL PRESERVE:

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Attachment D: Cost Proposal

Attachment D: Cost Proposal

Exhibit B, Attachment 1 – C25830001 Pescadero Marsh Exhibit Design and Fabrication

Services Page 1 of 1

COST PROPOSAL

If applicable, proposer must initial all changes made to this cost proposal.

DPR will audit computations to ensure sums are correct, indicated by proposer. If the Sub-Total Amount does not equal the sum of tasks 1-2 and 3-5, the individual task amounts will prevail. Additionally, if the Total Amount does not equal the sum of the two Sub-Total Amounts, the actual sum of the Sub-Total Amounts will prevail. Illegible amounts may be cause for proposal disqualification.

Proposers should refer to Attachment C's "Exhibit A, Attachment 1 - Detailed Scope of Work (SOW)” for all work to be performed.

Proposers shall include ALL labor, equipment, materials, supplies, applicable taxes, travel and direct or indirect expenses in the performance of providing the Pescadero Marsh Exhibit Design and Fabrication services.

A. B. C.

Task Project Start-Up Proposal Amount

Project Start-Up

• Start Up Meeting

• Management Tools $________________________

Reconnaissance

• Site Visit/Walk through

• Site Meeting $________________________

Project Start Up Sub-Total Proposal (fee proposal shall not exceed sub-total proposal) $________________________

Task Interpretive Exhibit Panels Proposal Amount

Concept Design

• Schematic Study

• Concept Design $________________________

4 Panel Artwork

• Final Artwork $________________________

Fabrication, Language Translation, and Panel Delivery

• Panels fabrication, delivery, and tax

• English and Spanish Interpretive Trail Guide in both print form and ADA-remediated digital representations (pdf) for park webpage

• Trailhead weather-resistant durable trail guide housing

Interpretive Panels /Sub-Total Proposal (fee proposal shall not exceed sub-total proposal) $________________________

Total Proposal Amount (Fee Proposal shall not exceed $50,000.00) $________________________

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Form A: GSPD 05-105- Bidder Declaration

Please complete and submit the GSPD 05-105- Bidder Declaration to document the proposed Prime, SB, DVBE, and/or subcontractors, including the nature of their work on the proposal and percent of the Proposal. The form is located here:

https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd05-105.pdf

C25830001

Signature:___________________________________ Name: ______________________________ Date:____________________________

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Form B: Disabled Veteran Business Enterprise Declarations

Form B: Disabled Veteran Business Enterprise Declarations

Please complete and submit the DPR 486 – Bidder’s DVBE Participation to document the proposed Prime and subcontractors, including their roles and responsibilities. The form is located here:

https://calparks.sharepoint.com/sites/EXT-Business_Management_Services- Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5F Management%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicita tion%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc6 82%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a

Please complete and submit the STD 843 – Disabled Veteran Business Enterprise Declarations for all DVBEs proposed. The form is located at:

https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd_843.pdf.

https://calparks.sharepoint.com/sites/EXT-Business_Management_Services-Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5FManagement%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicitation%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc682%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a https://calparks.sharepoint.com/sites/EXT-Business_Management_Services-Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5FManagement%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicitation%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc682%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a https://calparks.sharepoint.com/sites/EXT-Business_Management_Services-Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5FManagement%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicitation%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc682%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a https://calparks.sharepoint.com/sites/EXT-Business_Management_Services-Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5FManagement%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicitation%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc682%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a https://calparks.sharepoint.com/sites/EXT-Business_Management_Services-Contracts/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FEXT%2DBusiness%5FManagement%5FServices%2DContracts%2FShared%20Documents%2FTemplates%2FSolicitation%20and%20Contract%20Templates%2FRFP%20Template%20Documents&viewid=45adc682%2D61a6%2D401b%2D9ac0%2Dc14d0e8c4a1a https://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/pd_843.pdf

DPR 486 (New 1/2010)(Excel 1/26/2010)

COMPANY INFORMATION

COMPANY INFORMATION: List the information (Company Name, Contact information) of subcontractor(s) and supplier(s) proposed for DVBE. If prime contractor is a DVBE, the name must be listed for participation.

COMPLETION INSTRUCTIONS

PART 1 — SUMMARY OF DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) PARTICIPATION

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

COMPANY NAME

CONTACT

COMPANY NAME

CONTACT

I hereby certifiy that I have made a diligent effort to ascertain the facts with regard to the representations made herein. In making this certification, I am aware of Section 12650 et seq. of the Government Code providing for the imposition of treble damages for making false claims against the State and Section 10115.10 of the Public Contract Code making it a crime for intentionally making an untrue statement in this certificate.

PART 2 — BIDDER'S CERTIFICATION

BIDDING COMPANY'S NAME

SIGNATURE

DATE

TITLE (e.g. BUSINESS OWNER/CHIEF EXECUTIVE OFFICER, ETC.)

CONTRACTING WITH: Show the name of the department or company with which the company listed is contracting.

PRINT OUT: In order to claim DVBE participation credit, a printout from the eProcurement system showing their supplier ID and the status of their certification must be furnished with the bidder's bid or upon the signing of contract documents. Check mark if a copy of the printout is included.

NATURE OF WORK: Identify the proposed work (or materials or equipment) to be provided.

TIER: Bidder may count toward its participation goal the dollar value of work and supplies to be obtained by its primary subcontractors and suppliers from DVBE firms as second and third level tier subcontractors/suppliers. Contracting tier should be indicated with the following designations:

DVBE company listed for participation.

0 = Prime or Joint Contractor 1 = Primary Subcontractor or Supplier 2 = Subcontractor/Supplier of Level 1 Subcontractor/Supplier 3 = Subcontractor/Supplier of Level 2 Subcontractor/Supplier

DOLLAR VALUE: The dollar amount of the bid to be performed by the listed company’s own forces.

PERCENTAGE OF BID: The percentage of the total bid amount the dollar value represents.

CONTRACTING WITH

PERCENT OF BID

PRINT-

OUT

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

COMPANY NAME

CONTACT

CONTRACTING WITH

PERCENT OF BID

PRINT-

OUT

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

CONTRACTING WITH

PERCENT OF BID

PRINT-

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

COMPANY NAME

CONTACT

CONTRACTING WITH

PERCENT OF BID

PRINT-

TIER

NATURE OF WORK

CONTACT PHONE

DOLLAR VALUE

BIDDER'S DVBE PARTICIPATION

PRINTED NAME

OUT

OUT

SOLICITATION NUMBER

C25830001

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.

DVBE CERTIFICATION NO.: Provide the DVBE Certification Number assigned to company.

STATE OF CALIFORNIA – DEPARTMENT OF GENERAL SERVICES PROCUREMENT DIVISION

DISABLED VETERAN BUSINESS ENTERPRISE DECLARATIONS

(Rev. /20 )

Instructions: The disabled veteran (DV) owner(s) and DV manager(s) of the Disabled Veteran Business Enterprise (DVBE) must complete this declaration when a DVBE contractor or subcontractor will provide materials, supplies, services or equipment [Military and Veterans Code Section 999.2]. Violations are misdemeanors and punishable by imprisonment or fine and violators are liable for civil penalties. All signatures are made under penalty of perjury.

SECTION 1

Name of certified DVBE: DVBE Ref. Number:

Description (materials/supplies/services/equipment proposed):

Solicitation/Contract Number: SCPRS Ref. Number:__________________________

(FOR STATE USE ONLY)

SECTION 2

APPLIES TO ALL DVBEs. Check only one box in Section 2 and provide original signatures.

I (we) declare that the DVBE is not a broker or agent, as defined in Military and Veterans Code Section 999.2 (b), of materials, supplies, services or equipment listed above. Also, complete Section 3 below if renting equipment.

Pursuant to Military and Veterans Code Section 999.2 (f), I (we) declare that the DVBE is a broker or agent for the principal(s) listed below or on an attached sheet(s). (Pursuant to Military and Veterans Code 999.2 (e), State funds expended for equipment rented from equipment brokers pursuant to contracts awarded under this section shall not be credited toward the 3-percent DVBE participation goal.)

All DV owners and managers of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):

(Printed Name of DV Owner/Manager) (Signature of DV Owner/ Manager) (Date Signed)

(Printed Name of DV Owner/Manager) (Signature of DV Owner/Manager) (Date Signed)

Firm/Principal for whom the DVBE is acting as a broker or age nt:

(If more than one firm, list on extra sheets.) (Print or Type Name)

Firm/Principal Phone: Address:

SECTION 3

APPLIES TO ALL DVBEs THAT RENT EQUIPMENT AND DECLARE THE DVBE IS NOT A BROKER.

Pursuant to Military and Veterans Code Section 999.2 (c), (d) and (g), I am (we are) the DV(s) with at least 51% ownership of the DVBE, or a DV manager(s) of the DVBE. The DVBE maintains certification requirements in accordance with Military and Veterans Code Section 999 et. seq.

The undersigned owner(s) own(s) at least 51% of the quantity and value of each piece of equipment that will be rented for use in the contract identified above. I (we), the DV owners of the equipment, have submitted to the administering agency my (our) personal federal tax return(s) at time of certification and annually thereafter as defined in Military and Veterans Code 999.2, subsections (c) and (g). Failure by the disabled veteran equipment owner(s) to submit their personal federal tax return(s) to the administering agency as defined in Military and Veterans Code 999.2, subsections

(c) and (g), will result in the DVBE being deemed an equipment broker.

Disabled Veteran Owner(s) of the DVBE (attach additional pages with signature blocks for each person to sign):

(Printed Name) (Signature) (Date Signed)

(Address of Owner) (Telephone) (Tax Identification Number of Owner)

Disabled Veteran Manager(s) of the DVBE (attach additional pages with sufficient signature blocks for each person to sign):

(Printed Name of DV Manager) (Signature of DV Manager) (Date Signed)

Page of

PRINT CLEAR

C25803001

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Form C: Commercially Useful Form

Form C: Commercially Useful Function

Please complete and submit the DPR 87 – Commercially Useful Function – Bidder Declaration.

All California Certified Small Business (SB), Micro Business (MB), and Disabled Veteran Business Enterprise (DVBE) suppliers contracting and subcontracting must complete this certification form. The form is located here:

DPR087.pdf https://calparks.sharepoint.com/:b:/r/sites/DEPARTMENTFORMS/DPR%20Forms%20Library/DPR%20001-099/DPR087.pdf?csf=1&web=1&e=caBgmj

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Cert 1: CCC-04/2017 and STD 204/DPR 88

Cert. 1: CCC-04/2017 and STD 204/DPR 88

Please complete and submit the CCC-04/2017 form located at:

https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List- Folder/Standard-Contract-Language

Also complete and submit the STD 204 form located at:

https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

Contractor/Bidder Firm Name (Printed) Federal ID Number

Date Executed Executed in the County of

Contractor Certification Clauses

CCC 04/2017

CERTIFICATION

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California.

By (Authorized Signature)

Printed Name and Title of Person Signing

CONTRACTOR CERTIFICATION CLAUSES

1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.)

2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions:

a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations.

b. Establish a Drug-Free Awareness Program to inform employees about:

1) the dangers of drug abuse in the workplace;

2) the person's or organization's policy of maintaining a drug-free workplace;

3) any available counseling, rehabilitation and employee assistance programs; and,

4) penalties that may be imposed upon employees for drug abuse violations.

c. Every employee who works on the proposed Agreement will:

1) receive a copy of the company's drug-free workplace policy statement; and,

2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement.

Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.)

3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)

4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO

REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003.

Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State.

Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services.

5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California.

6. SWEATFREE CODE OF CONDUCT:

a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor.

The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.

b. The contractor agrees to cooperate fully in providing reasonable access to the contractor’s records, documents, agents or employees, or premises if reasonably http://www.dir.ca.gov/ required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor’s compliance with the requirements under paragraph (a).

7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3.

8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35.

DOING BUSINESS WITH THE STATE OF CALIFORNIA

The following laws apply to persons or entities doing business with the State of California.

1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification.

Current State Employees (Pub. Contract Code §10410):

1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment.

2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services.

Former State Employees (Pub. Contract Code §10411):

1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency.

2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service.

If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420)

Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))

2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and

Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700)

3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)

4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.

5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:

a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled.

b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax.

c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State.

6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement.

7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution.

8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity.

All suppliers doing business with the Department of Parks and Recreation must complete this form.

Upon completion, submit to the requesting department listed in box/section 6 of the attached STD. 204:

STD. 204, Payee Data Record STD. 205, Payee Data Record Supplement (If applicable) (Remit-to Address: different than Mailing, or multiple) DPR 88, Payee Data Record Supplement - Goods vs. Services

DPR 88 (Rev. 4/2021)(Excel 4/26/2021)

FOR DEPARTMENT USE ONLY

Certificate of Acceptance

Submission Checklist

Vendor Information

Authorized Representative - complete and sign (REQUIRED)

State of California - Natural Resources Agency

DEPARTMENT OF PARKS AND RECREATION

PAYEE DATA RECORD SUPPLEMENT

GOODS VS. SERVICES

PAYEE'S LEGAL BUSINESS NAME (Type or Print)

DATE

PRINTED NAME

Seller's Permit (No.

Certificate of Registration (No.

TAX ID NUMBER

When doing business with the Department of Parks and Recreation I accept and will abide by the State's IT General Provisions or General Provisions Non-IT Commodities, as applicable, located on the internet at www.pd.dgs.ca.gov/modellang/GeneralProvisions.htm.

UPLOAD TO SUPPLIER

RECORD IN FI$Cal

SUPPLIER ID. (If Known )

EXECUTED IN THE COUNTY AND STATE OF

No

NO ATTACHMENT NEEDED

- No inventory or sales staff in CA.

Will tangible goods be provided?

Attach:

Yes

No additional attachments needed.

AUTHORIZED REPRESENTATIVE'S SIGNATURE

DPR 88 (Instructions)(Rev. 4/2021)

Complete all required information and return form to the requesting department listed in Box/Section 6 of the STD.

204.

DPR 88, PAYEE DATA RECORD SUPPLEMENT (GOODS VS. SERVICES)

INSTRUCTIONS

All current and potential vendors/suppliers must have completed both the STD. 204 and DPR 88 in its entirety prior to commencing business with the Department of Parks and Recreation (DPR). STD. 205 is optional dependent upon remittance information (see form for details).

Send DPR 88, STD. 204 (with section 6 pre-filled on the STD. 204), and STD. 205 to vendor/supplier for completion.

Fill in Supplier ID if known in appropriate box in the top, right corner of the DPR 88. Once forms are returned, check for completeness. Resend to vendor/suppler if necessary until all information, signatures and attachments are included.

Once complete, upload into the FI$Cal Systems Supplier Record for FI$Cal review and approval.

Original forms must be retained in the procurement file at the District/Section level.

DPR 88 COMPLETION INSTRUCTIONS FOR VENDOR/SUPPLIER

DEPARTMENT INSTRUCTIONS

check when finished with each form

If no tangible goods provided, skip to Authorized Representative Section.If yes, complete the appropriate checkbox below

If you do NOT have inventory or sales staff in CA, check here and no additional attachments are needed.

This section must be signed with all boxes/fields completed.

If you have inventory or sales staff in CA, choose appropriate checkbox, enter permit or certificate no.

in space provided, & attach copy of permit/cert.

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

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STATE OF CALIFORNIA – STATE CONTROLLERS OFFICE

PAYEE DATA RECORD SUPPLEMENT

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

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

GENERAL INSTRUCTIONS

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

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

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

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

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

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

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

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

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

PRIVACY STATEMENT

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

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

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

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

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Cert 2: Darfur Contracting Act Certification

Cert. 2: Darfur Contracting Act Certification

PLEASE READ THE DIRECTIONS OF THIS CERTIFICATION CAREFULLY. DO NOT

COMPLETE THE SIGNATURE BOX UNLESS YOU HAVE INITIALED PARAGRAPH No. 3.

Pursuant to Public Contract Code section 10478, if a Proposer currently or within the previous three (3) years has had business activities or other operations outside of the United States, it must certify that it is not a “scrutinized” company as defined in Public Contract Code section 10476.

Therefore, to be eligible to submit a bid or proposal, please complete only one of the following three paragraphs (via initials for Paragraph No. 1 or Paragraph No. 2, or via initials and certification for Paragraph No. 3):

1. We do not currently have, or we have not had within the previous three years, business activities or other operations outside of the United States.Initials

OR

2. 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 (DGS) 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.

Initials

OR

3. We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company below as defined in Public Contract Code section 10476.

Initials

CERTIFICATION for Paragraph No. 3

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the Proposer to the clause listed above in Paragraph No. 3. This certification is made under the laws of the State of California.

Proposer Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title

Date Executed Executed in the County and State of

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Cert 3: Non-Collusion Affidavit

Cert. 3: Non-Collusion Certification

The undersigned declares:

I am the of , (Position / Title) (Company)

The party submitting the foregoing Proposal, and that the Proposal is:

• NOT made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation

• Genuine and NOT collusive or a sham.

That the Proposer has NOT directly or indirectly induced or solicited any other Proposer to:

• Put in a false or sham Proposal; and

• Colluded, conspired, connived or agreed with any Proposer or anyone else to put in a sham Proposal or that anyone shall refrain from bidding.

That the Proposer has NOT, in any manner directly or indirectly, sought by agreement, communication or conference with anyone to:

• Fix the Price Proposal of the Proposer or any other Proposer, or

• Fix any overhead, profit, or cost element, or that of any other Proposer, or

• Secure any advantage against the public body awarding the contract or anyone interested in the proposed contract.

That all statements contained in the Proposal are true.

The Proposer has not and will not, directly or indirectly, for the purposes of effectuating a collusive or sham negotiation, submitted his or her schedule of rates or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, for payment to any corporation, partnership, company, association, organization, bid depository, or any member or agent thereof.

Organization Name, Address, and Telephone

Signature of Person Certifying

Printed Name

Title

Date

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Cert 4: California Civil Rights Laws Certification

Cert. 4: California Civil Rights Laws Certification

Pursuant to Public Contract Code section 2010, if a Proposer executes or renews a contract over $100,000 on or after January 1, 2017, the bidder or proposer hereby certifies compliance with the following:

1. California Civil Rights Laws: For contracts over $100,000 executed or renewed after January 1, 2017, the Proposer certifies compliance with the Unruh Civil Rights Act (section 51 of the Civil Code) and the Fair Employment and Housing Act (section 12960 of the Government Code); and

2. Employer Discriminatory Policies: For contracts over $100,000 executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Proposer certifies that such policies are not used in violation of the Unruh Civil Rights Act (section 51 of the Civil Code) or the Fair Employment and Housing Act (section 12960 of the Government Code).

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the Proposer to the clause listed above. This certification is made under the laws of the State of California.

Title of Company Official

By (Authorized Signature)

Printed Name and Title

Date Executed Executed in the County and State of

Exhibit Design and Fabrication Services California Department of Parks and Recreation, Interpretation & Education Division

Cert 5: P-05-22 Economic Sanctions Certification

Cert. 5: P-05-22 Economic Sanctions Certification

4.4.6 Cost Proposal

4.4.6 Cost Proposal