RFQ_23-281,_Addendum_3.docx

Request for Quotation (RFQ) Informal Competitive (Open Market) – Over $50K

A. RFQ INFORMATION

Addendum Reason (when applicable)

Crime-lite forensic light source kits or equivalent.

Addendum 1 is to add RFQ and Cost worksheet attachments to CSCR advertisement.

Addendum 2 is to extend the bid response deadline, change the warranty for the Crime-Lite X10 from 1 year to 2 years, change the required delivery date to 60 days, and update the key action dates.

Addendum 3 is to extend the bid response deadline.

B. BID RESPONSE SUBMISSION DUE DATE

Responses received after this time will be rejected 3:00 pm (PDT)

C. SUBMISSION OF RFQ’S RESPONSE DOCUMENTS

RFQ responses that reference a supplier’s own terms and conditions or provisions may be considered non-responsive and subjected to rejection.

Only RFQ responses quoted on the State’s own Attachment A - Cost Worksheet form will be considered. Unless otherwise specified, RFQ response shall be submitted via email.

Be advised, your response will become public record once the award becomes final. DOJ will provide access to all records upon request unless the law provides an exemption from mandatory disclosure or a court order is provided.

D. BIDDER INFORMATION

California-certified Small Business #:

Section 14838 et seq. of the California Government Code requires that a 5% preference be given to bidders who qualify as a small business as a non-small business claiming at least 25% California certified small business participation for requirements. See Title 2, California Code of Regulations Section 1896 et seq. The requirements for nonprofit veteran service agencies qualifying as a small business are contained in Section 999.50 et seq. of the Military and Veterans code.

California-certified

DVBE #:

E. PRODUCT SHIPMENT

Hardware Delivery Instructions:

9737 Tanqueray Court Redding, CA 96003

For the purposes of this RFQ, only RFQ responses quoting F.O.B Destination will be accepted.

Software Delivery Instructions (Bidder, please select one of the following):

☐ Software will be delivered via Electronic Download. No sales tax applies. All software product(s) information must be sent electronic download to CITPR@doj.ca.gov.

☐ No software product(s) will be delivered. No sales tax applies. Send order confirmation to CITPR@doj.ca.gov.

☐ Tangible software will be shipped F.O.B. Destination. Sales tax will apply.

All tangible software product(s) must be delivered to:

F. BIDDER ACKNOWLEDGEMENT

Bidder agrees if their response is accepted within 45 calendar days following the date the response is due to furnish all the items upon which prices are quoted, at the prices set opposite each item, delivered at the designated point(s) by the method of delivery and within the times specified and subject to the attached General Provisions.

DECLARATIONS UNDER PENALTY OF PERJURY; By signing above, with inclusion of the date of signature, the above signed bidder DECLARES UNDER PENALTY OF PERJURY under the laws of the State of California as follows: (1) (STATEMENT OF COMPLIANCE). The above signed as complied with the non-discrimination program requirements of Government Code 12990 and Title 2, California Administrative Code Section 8103, and such declaration is true and correct. (2) The National Labor Relations Board declaration set forth in Paragraph 48 of the General Provisions is true and correct. (3) If a claim is made for the Small Business or Disabled Veterans Business preference, the information set forth within is true and correct.

By signing above, with inclusion of the date of signature, the above signed bidder accepts the terms and conditions referenced within the RFQ. The terms and conditions may be viewed via the referenced links within the RFQ. These terms and conditions are non-negotiable and no other terms and conditions will be accepted.

1. KEY ACTION DATES

*After Bidder RFQ Response submission, all key action dates are subject to change without the issuance of an addendum.

STATE OF CALIFORNIA

DEPARTMENT OF JUSTICE

RFQ Revised 07/12/2024

RFQ # 23-281 Page 1 DOJ

2. BIDDER RESPONSE REQUIREMENTS

The following documents are considered part of this RFQ and must be returned with the bidder’s RFQ response or the RFQ response may be considered invalid and be rejected.

RFQ Solicitation All bidders must complete Sections A through L, where applicable, and sign the RFQ.

ATTACHMENT A. Cost Worksheet All bidders are required to submit the Attachment A – Cost Worksheet. The Cost Worksheet must be complete with pricing for all items requested.

ATTACHMENT B. GSPD-05-105 - Bidder Declaration All bidders are required to submit the Bidder Declaration. When completing the declaration, bidders must identify all subcontractors proposed for participation in the contract. Bidders awarded a contract are contractually obligated to use the subcontractors for the corresponding work identified unless the State agrees to a substitution and it is incorporated by amendment to the contract.

At the State’s option prior to award, bidders may be required to submit additional written clarifying information. Failure to submit the required written information as specified may be grounds for RFQ response rejection.

If claiming the non-small business subcontractor preference, the form must list all of the California certified small businesses with which you commit to subcontract in an amount of at least twenty-give percent (25%) of the net bid price. All certified small businesses must perform a “commercially useful function” in the performance of the contract as defined in Government Code Section 14837(d)(4).

ATTACHMENT C. STD 204 - Payee Data Record and STD 205 – Payee Data Record Supplement All bidders are required to submit a STD 204 – Payee Data Record listing their Taxpayer Identification Number. Business address must match invoice remit address.

A STD 205 is optional and is used to provide remittance address information if different than the mailing address on the STD 204.

ATTACHMENT D. California Secretary of State (SOS) Certificate You must provide your company’s California Secretary of State Certificate if you do business in the State of California. SOS certification must be approved an in “Active” status prior to award per the California Secretary of State website:

https://bizfileonline.sos.ca.gov/search/business

Not required for foreign companies (non-California) who provide electronic download software purchases, sole proprietary or partnership businesses.

ATTACHMENT E. California Seller’s Permit You must provide your company’s California seller’s permit or certification of registration and, if applicable, the permit or certification of all participating affiliates, issued by California’s State Board of Equalization (BOE), pursuant to all requirements as set form in Sections 6487, 7101 and sections 6452.1, 6487.3, 18510 of the Revenue and Taxation Code, and Section 10295.1 of the Public Contract code. In order to expedite the process of verifying the validity of the permit, provide the BOE permit number in the space in above Section D – Bidder Information.

ATTACHMENT F. CalRecycle 74 – Postconsumer Recycled-Content Certification State agencies are required to report purchases in many product categories. In order to comply with those requirements, bidders are required to complete and return the attached Recycled Content Certification form with their RFQ response for orders that contain tangible products. Failure to complete and return the form may disqualify your RFQ response from consideration.

ATTACHMENT G. STD 843 – Disabled Veteran Business Enterprise Declaration Bidders who have been certified by California as a DVBE (or who are bidding rental equipment and have obtained the participation of subcontractors certified by California as a DVBE) must also submit a completed form(s) STD. 843 - Disabled Veteran Business Enterprise Declaration. All disabled veteran owners and disabled veteran managers of the DVBE(s) must sign the form(s).

ATTACHMENT H. Commercially Useful Function (CUF) Compliance Form Bidders who have been certified by California as a Small Business, Micro Business, or DVBE, must provide a written, signed statement detailing the role and services the Bidder and/or Subcontractor(s) will provide to meet the CUF requirement. A separate form (see attached) must be provided for each small businesses, micro businesses, and DVBE. If neither a small business nor a DVBE will be participating in the offer then this form is not required.

ATTACHMENT I. TACPA Preference Request The Bidder’s RFQ response need not contain the TACPA form if there is no intention to claim this preference.

This RFQ contains the Target Area Contract Preference Act (TACPA) Preference Request form. Please carefully review the form and requirements. If applying for this preference, bidders must submit the preference request form. Denial of TACPA preference requests is not a basis for rejection of the bid.

The State, as part of its evaluation process reserves the right to verify, validate, and clarify all information contained in the bid. This may include, but is not limited to, information from bidders, manufacturers, subcontractors and any other sources available at the time of bid evaluation. Bidder refusal to agree to and/or comply with these terms, or failure to provide additional supporting information at the State’s request may result in the denial of the preference requested.

Contracts awarded with applied preference will be monitored throughout the life of the contract for compliance with statutory, regulatory, and contractual requirements. The State will take appropriate corrective action and apply sanctions as necessary to enforce the preference program.

Any questions regarding TACPA preference should be directed to the Department of General Services, Procurement Division at TACPA@dgs.ca.gov.

TACPA Standard Form 830 https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std830.pdf

Manufacturer’s Summary of Contract Activities and Labor Hours (Form DGS/PD 525) http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd0525.pdf

Bidder’s Summary of Contract Activities and Labor Hours (Form DGS/PD 526) http://www.documents.dgs.ca.gov/dgs/fmc/gs/pd/gspd0526.pdf

ATTACHMENT K. California Civil Rights Certification For bids exceeding $100,000, bidders must provide signed certification certifying they are in compliance with Unruh Civil Rights Act (Section 51 of the Civil Code) and 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).

ATTACHMENT L. Generative Artificial Intelligence (GenAI) Reporting & Factsheet 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 / Contractor must notify the State in writing if their solution or service includes, or makes available, any GenAI, including GenAI from third parties or subcontractors.

The State has developed a GenAI Reporting and Factsheet (STD 1000) to be completed by the Bidder / Offeror / Contractor .

Failure to submit the GenAI Reporting and Factsheet (STD 1000) will result in disqualification of the Bidder / Offeror / Contractor.

Failure to report GenAI to the State may void any resulting contract. The State reserves its right to seek any and all relief it may be entitled to as a result of such non-disclosure.

Upon receipt of a Bidder / Offeror / Contractor GenAI Reporting and Factsheet (STD 1000), 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. Find required STD 1000 here or attached below.

Assumptions and Constraints There shall be no assumptions, conditions, or constraints included in the bidder’s response. 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.

3. BIDDER’S RESPONSE ASSESSMENT

Assessment Information For assessment purposes, the method of award will be based on the following criteria:

· Lowest Cost

Cash Discounts Cash discounts will not be considered when evaluating RFQ responses for award purposes. However, cash discounts may be offered and taken by departments processing invoices within the timeframe specified.

Responsive and Responsible Bidder A bidder who is responsible and submits a responsive bid is one who clearly indicates compliance without material deviation from the solicitation’s terms and conditions and who possesses the experience, facilities, reputation, financial resources and other factors existing at the time of contract award.

The Department of Justice may require bidder(s) to submit evidence of their qualifications at such times and under conditions, as it may deem necessary. The question of whether a particular bidder is a responsible bidder may involve an evaluation of the bidder’s experience, type of facility, expertise or financial resources regarding the particular items requested by the pertinent RFQ. If a bidder has been determined to be non-responsible, the RFQ response shall be rejected.

Tie Break Process In the event of a precise tie, if GC §14838(f) does not apply to the Bidders, award will be made to the first responsive bidder with the lowest price.

4. AWARD OF CONTRACT

Award of contract, if made, will be made to a responsible bidder whose RFQ response complies with all the requirements of the RFQ documents and an addenda thereto, except for such immaterial defects as may be waived by the State.

Award, if made, will be made within forty-five (45) days after the scheduled date for Contract Award as specified in the RFQ; however, bidder may extend the offer beyond 45 days in the event of a delay of contract award.

The State reserves the right to determine the successful bidder(s) either on the basis of individual items or on the basis of all items included in its RFQ, unless otherwise expressly provided in the State’s RFQ. Unless the bidder specifies otherwise in its RFQ response, the State may accept any item or group of items of any RFQ response. The State reserves the right to modify or cancel in whole or in part its RFQ.

Written notification of the State’s intent to award will be made to all bidders. If a bidder, having submitted an RFQ response, can show that its RFQ response, instead of the RFQ response selected by the State, should be selected for contract award, the bidder will be allowed five (5) working days to submit a protest to the Intent to Award, according to the instructions contained in the paragraph titled “Protests” of this RFQ.

Protests Any bidder’s issues regarding RFQ requirements must be resolved (or attempts to resolve them must have been made) before a protest may be submitted according to the procedure below. These issues will first be resolved by the contact for the RFQ (the buyer) or if they result in a protest, the protest will be submitted to DGS Procurement Division Deputy Director to hear and resolve issues and whose decision will be final.

If a bidder has submitted a bid which it believes to be responsive to the requirements of the RFQ and to be the bid that should have been selected according to the evaluation procedures in the solicitation and the bidder believes the State has incorrectly selected another bidder for award, the bidder may submit a protest of the selection as described below.

All protests of award must be made in writing, signed by an individual authorized to bind the bidder contractually and financially, and contain a statement of the reason(s) for protest; citing the law, rule, regulation or procedure on which the protest is based. The protester must provide facts and evidence to support the claim. RFQ Contact (the buyer) must be notified via email if you submit a protest. Protests must be mailed or delivered to:

Street and Mailing Address:

Department of General Services Deputy Director Procurement Division 707 Third Street, Second Floor South West Sacramento, CA 95605 Facsimile No.: (916) 375-4611

All protests to the RFQ or protests concerning the evaluation, recommendation, or other aspects of the selection process must be received by the DGS Procurement Division Deputy Director as promptly as possible, but not later than the date indicated in the Notification of Intent to Award. Certified or registered mail must be used unless delivered in person, in which case the protester should obtain a receipt of delivery.

5. STATE OF CALIFORNIA TERMS AND CONDITIONS

The following documents are incorporated by reference and may be viewed at the website listed.

1. Bidders Instructions (GSPD-451), Effective 11/09/11 (For the purposes of this solicitation #21 does not apply) https://www.dgs.ca.gov/-/media/Divisions/PD/PTCS/OPPL/Model-Language/IT/GSPD451-110911.ashx?la=en&hash=9EED86E70D634F5F89087ACE5A3583FB0D79C347

2. General Provisions-Information Technology (GSPD-401IT), Effective 6/21/22 https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts?search=gspd%20401

Amendment The Vendor will allow amendment(s) to the subsequent purchase order to increase time, funding or quantity for an additional cost at the same rates or lower as stated in Attachment A – Cost Worksheet. All other terms and conditions will remain the same.

Contract Audit When a department awards a contract subject to participation goals in accordance with Public Contract Code § 10115.2, the Contractor agrees that the awarding department or its designee will have the right to review, obtain, and copy all records pertaining to performance of the contract. Contractor agrees to provide the awarding department or its designee with any relevant information requested and shall permit the awarding department or its designee access to its premises, upon reasonable notice, during normal business hours for the purpose of interviewing employees and inspecting and copying such books, records, accounts, and other material that may be relevant to a matter under investigation for the purpose of determining compliance with Public Contract Code §§ 10115 et seq. and §§ 1896.60 et seq. of these regulations. Contractor further agrees to maintain such records for a period of three (3) years after final payment under the contract.

6. CALIFORNIA DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)

PROGRAM REQUIREMENTS

California Disabled Veteran Business Enterprise (DVBE) Program Requirements For the purpose of this RFQ, the DVBE participation requirement was waived; however, this RFQ does provide an incentive for DVBE participation.

CA DVBE Participation Requirement Packet The following link directs you to the CA DVBE Participation Requirement Packet dated 4/15/20 which includes the DVBE Incentive table:

https://www.dgs.ca.gov/-/media/Divisions/PD/OSDS/Certification/DVBE/DVBEIncentiveRequireGoodIT.pdf

DVBE Subcontractor Contractor understands and agrees that should award of this contract be based in part on their commitment to use the DVBE subcontractor(s) identified in their bid or offer, per Military and Veterans Code section 999.5 (e), a DVBE subcontractor may only be replaced by another DVBE subcontractor and must be approved by the Department of General Services (DGS). Changes to the statement of work that impact the DVBE subcontractor(s) identified in the bid or offer and approved DVBE substitutions will be documented by contract amendment.

Failure of Contractor to seek substitution and adhere to the DVBE participation level identified in the bid or offer may be cause for contract termination, recovery of damages under rights and remedies due to the State, and penalties as outlined in M&VC section 999.9; Public Contract Code (PCC) section 10115.10.

7. CALIFORNIA SMALL BUSINESS REQUIREMENTS

Small Business Certification Bidders claiming the small business preference must be certified by California as a small business or must commit to subcontract at least 25% of the net bid price with one or more California certified small businesses. Completed certification applications and required support documents must be submitted to the Office of Small Business and DVBE Services (OSDS) no later than 5:00 p.m. on the RFQ due date, and the OSDS must be able to approve the application as submitted.

Small business nonprofit veteran service agencies (SB/NVSA) claiming the small business preference must possess certification by California prior to the day and time RFQ responses are due.

Questions regarding certification should be directed to the OSDS at (916) 375-4940.

Small Business Regulations The Small Business regulations, located in the California Code of Regulations (Title 2, Division 2, Chapter 3, Subchapter 8, Section 1896 et. seq.), concerning the application and calculation of the small business preference, small business certification, responsibilities of small business, department certification, and appeals are revised, effective 09/09/04.

Non-Small Business Subcontractor Preference A 5% bid preference is now available to a non-small business claiming 25% California certified small business subcontractor participation. If applicable, claim the preference in the box on the right hand side of the first page of this RFQ.

Small Business Nonprofit Veteran Service Agencies (SB/NVSA) SB/NVSA prime bidders meeting requirements specified in the Military and Veterans Code Section 999.50 et seq. and obtaining a California certification as a small business are eligible for the 5% small business preference. If applicable, claim the preference in the box on the right hand side of the first page of this RFQ.

8. INVOICING

An invoice can only be submitted for items noted on the Purchase Order (PO) and must be submitted to the “Bill To” address and person listed on the PO. The invoice shall include the following:

image1.emf

RFQ 23-281, Addendum 3 Attachment A - Cost Worksheet.xlsm Cost Worksheet

California Department of Justice Notes to Bidder:

Attachment A - Cost Worksheet Quotation Award - For the purposes of this solicitation, bidders are required to provide pricing for all items. Partial quotes will not be accepted.

Solicitation #: RFQ 23-281, Addendum 3

Term Date: 2-year warranty on Crime-lite X10 and Crime-Lite Auto If your bid proposes an “equivalent” good(s) other than listed in this Cost Worksheet, please list the “equivalent” brand name(s) and provide specifications describing how the “equivalent” good(s) are equivalent.

Invoice Payment Terms: Net 45

Vendor Name:

Vendor Contact Name: All equipment to be provided in response to a State of California solicitation shall be new and latest model in current production. USED, SHOPWORN, DEMONSTRATOR, PROTOTYPE OR DISCONTINUED MODELS ARE NOT ACCEPTABLE.

Date:

GRAND TOTAL

Non-Taxable Subtotal $ - 0

Taxable Subtotal $ - 0

Sales Tax Rate 7.250%

Sales Tax $ - 0

Grand Total $ - 0

1 EA CRIME-LITE AUTO KIT WITH OBLIQUE AND COAX NO SAMPLES or equivalent QCL/AUTO/KIT/SOC/NOS-120V 6 $ - 0 Y $ - 0

2 EA INTERACTIVE EVIDENCE SAMPLE KIT or equivalent QCL/AUTO/INT -SAMPLES 4 $ - 0 Y $ - 0

3 EA CRIME-LITE X10 FULL SPECTRAL KIT or equivalent QCL/X/KIT/A 3 $ - 0 Y $ - 0

4 EA PRODUCT TRAINING

-1-day site visit by product specialist at 3 DOJ locations in Redding, Ripon, and Fresno, CA.

-Includes unpacking and setup of equipment, followed by comprehensive operator training and optional testing.

-Training to cover both theory and practical applications, using realistic samples and scenarios, equipment safety and maintenance. Costs include training certificates and associated expenses for the product specialist. n/a 1 $ - 0 N $ - 0

(please provide any applicable discounts and include shipping in the pricing of items)

DOJ USE ONLY

FOR DOJ USE ONLY

FY PO Cost Code Object Code Cost Sum of Cost Column Labels

21/22 Original 860 4352 500 505 505 Total 735 735 Total 860 860 Total 861 861 Total Grand Total

21/22 Amendment #1 860 4451 1000 Row Labels 4457 4455 4352 4451 4455

22/23 735 4455 10000 21/22 500 1000 1500 1500

22/23 861 4455 15000 22/23 10000 10000 15000 15000 25000

23/24 505 4457 1000 23/24 1000 1000 12000 12000 13000

23/24 860 4352 12000 Grand Total 1000 1000 10000 10000 12500 1000 13500 15000 15000 39500

21/22 860 4352

List

List

Invoice Payment Terms

Full Payment Upfront

Monthly In Arrears

Quaterly In Arrears

Annually In Arrears

Deliverables-Based

Time & Materials-Based image2.emf

GSPD-05-105 Bidder Declaration REV 08.09.pdf

State of California—Department of General Services, Procurement Division Solicitation Number_____________________

GSPD–05–105 (REV 08/09)

BIDDER DECLARATION

1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form):

a. Identify current California certifcation(s) (MB, SB, NVSA, DVBE): ____________ or None ____ (If “None”, go to Item #2)

b. Will subcontractors be used for this contract? Yes ___ No ___ (If yes, indicate the distinct element of work your frm will perform in this contract e.g., list the proposed products produced by your frm, state if your frm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your frm will perform, etc.). Use additional sheets, as necessary.

c. If you are a California certifed DVBE: (1) Are you a broker or agent? Yes ___ No ___

(2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes ___ No ___ N/A ___

2. If no subcontractors will be used, skip to certifcation below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary):

Subcontractor Name, Contact Person, Phone Number & Fax Number

Subcontractor Address & Email Address

CA Certifcation (MB, SB, NVSA, DVBE or None)

Work performed or goods provided for this contract

Corresponding % of bid price

Good Standing?

51% Rental?

CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct.

Page_____ of _____

Subcontractor Name, Contact Person, Phone Number & Fax Number—List each element for all subcontractors.

• Possesses valid license(s) for any license(s) or permits required by the solicitation or by law

Enter “No” if the subcontractor is a California certifed DVBE providing rental equipment but the sub-contractor does NOT own at least 51% of the rental equipment (quantity and value) it will be providing.

State of California—Department of General Services, Procurement Division GSPD–05–105 (REV 08/09) Instructions

BIDDER DECLARATION Instructions All prime bidders (the frm submitting the bid) must complete the Bidder Declaration.

1.a. Identify all current certifcations issued by the State of California. If the prime bidder has no California certifcation(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certifcations, enter the applicable certifcation(s) on the line:

1.b. Mark either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors.

Bidders certifed as MB, SB, NVSA, and/or DVBE must provide a commercially useful function as defned in Military and Veterans Code Section 999 for DVBEs and Government Code Section 14837(d)(4)(A) for small/ microbusinesses.

Bids must propose that certifed bidders provide a commercially useful function for the resulting contract or the bid will be deemed non-responsive and rejected by the State. For questions regarding the solicitation, contact the procurement offcial identifed in the solicitation.

Note: A subcontractor is any person, frm, corporation, or organization contracting to perform part of the prime’s contract.

1.c. This item is only to be completed by businesses certifed by California as a DVBE.

(1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or “No”. The Military and Veterans Code Section 999.2 (b) defnes “broker” or “agent” as a certifed DVBE contractor or subcon-tractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract.

(2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark “N/A” for “not applicable.”

2. If no subcontractors are proposed, do not complete the table. Read the certifcation at the bottom of the form and complete “Page ___ of ___” on the form.

If subcontractors will be used, complete the table listing all subcontractors. If necessary, attach additional pages and complete the “Page ___ of ___” accordingly.

2. (continued) Column Labels

Subcontractor Address & Email Address—Enter the address and if available, an Email address.

CA Certifcation (MB, SB, NVSA, DVBE or None)—If the subcontractor possesses a current State of California certifcation(s), verify on this website (www.eprocure.pd.dgs.ca.gov).

Work performed or goods provided for this contract—Identify the distinct element of work contained in the contract to be performed or the goods to be provided by each subcontractor. Certifed subcontractors must provide a commercially useful function for the contract. (See paragraph 1.b above for code citations regarding the defnition of commercially useful function.) If a certifed subcontractor is further subcontract-ing a greater portion of the work or goods provided for the resulting contract than would be expected by normal industry practices, attach a separate sheet of paper explaining the situation.

Corresponding % of bid price—Enter the corresponding percentage of the total bid price for the goods and/or services to be provided by each subcontractor. Do not enter a dollar amount.

Good Standing?—Provide a response for each subcontractor listed. Enter either “Yes” or “No” to indicate that the prime bidder has verifed that the subcontractor(s) is in good standing for all of the following:

• If a corporation, the company is qualified to do business in California and designated by the State of California Secretary of State to be in good standing

• Possesses valid State of California certification(s) if claiming MB, SB, NVSA, and/or DVBE status

51% Rental?—This pertains to the applicability of rental equipment. Based on the following parameters, enter either “N/A” (not applicable),“Yes” or “No” for each subcontractor listed.

Enter “N/A” if the:

• Subcontractor is NOT a DVBE (regardless of whether or not rental equipment is provided by the subcontractor) or

• Subcontractor is NOT providing rental equipment (regardless of whether or not subcontractor is a

DVBE)

Enter “Yes” if the subcontractor is a California certifed DVBE providing rental equipment and the subcontractor owns at least 51% of the rental equipment (quantity and value) it will be providing for the contract.

Read the certifcation at the bottom of the page and complete the “Page ___ of ___” accordingly.

https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx

Check Box1: Off

Check Box2: Off

Check Box3: Off

Product list:

Check Box4: Off

Check Box5: Off

Check Box6: Off

Check Box7: Off

Check Box8: Off page:

of #:

Solicitaion #:

Name, phone, fax:

Address, email:

Certification:

Good standing: Off

51% rental: Off

Name, phone, fax 2:

Name, phone, fax 3:

Address, email 2:

Address, email 3:

Certification 2:

Certification 3:

% 2:

% 3:

Good standing 2: Off

Good standing 3: Off

51% rental 2: Off

51% rental 3: Off

Work or goods:

Work or goods 2:

Work or goods 3:

Text1:

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STD 204 - Payee Data Record - Rev. 03-21.pdf

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

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… Individual ● Sole Proprietorship ● Grantor (Revocable Living) Trust disregarded for federal tax purposes Sole Proprietor/Individual Limited Liability Company (LLC) owned by an individual and is disregarded for federal tax purposes Single Member LLC-owned by an individual Partnerships ● Limited Liability Partnerships (LLP) ● and, LLC treated as a Partnership Partnerships Estate ● Trust (other than disregarded Grantor Trust) Estate or Trust Corporation that is medical in nature (e.g., medical and healthcare services, physician care, nursery care, dentistry, etc. ● LLC that is to be taxed like a Corporation and is medical in nature

Corporation-Medical

Corporation that is legal in nature (e.g., services of attorneys, arbitrators, notary publics involving legal or law related matters, etc.) ● LLC that is to be taxed like a Corporation and is legal in nature

Corporation-Legal

Corporation that qualifies for an Exempt status, including 501(c) 3 and domestic non-profit corporations. Corporation-Exempt Corporation that does not meet the qualifications of any of the other corporation types listed above ● LLC that is to be taxed as a Corporation and does not meet any of the other corporation types listed above

Corporation-All Other

Section 3 – Tax Identification Number The State of California requires that all parties entering into business transactions that may lead to payment(s) from the state provide their Taxpayer Identification Number (TIN). The TIN is required by R&TC sections 18646 and 18661 to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information returns as required by the IRC section 6109(a) and R&TC section 18662 and its regulations.

Section 4 – Payee Residency Status Are you a California resident or nonresident?

• A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary of State to do business in

California.

• A partnership is considered a resident partnership if it has a permanent place of business in California.

• An estate is a resident if the decedent was a California resident at time of death.

• A trust is a resident if at least one trustee is a California resident.

o For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:

Withholding Services and Compliance Section: 1-888-792-4900 E-mail address: wscs.gen@ftb.ca.gov For hearing impaired with TDD, call: 1-800-822-6268 Website: www.ftb.ca.gov

Section 5 – Certification Provide the name, title, email address, signature, and telephone number of individual completing this form and date completed. In the event that a SSN or ITIN is provided, the individual identified as the tax liable party must certify the form. Note: the signee may differ from the tax liable party in this situation if the signee can provide a power of attorney documented for the individual.

Section 6 – Paying State Agency This section must be completed by the state agency/department requesting the STD 204.

Privacy Statement Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it. It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and state law imposes noncompliance penalties of up to $20,000. You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

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

www.ftb.ca.gov mailto:wscs.gen@ftb.ca.gov

CITY STATE ZIP CODE:

EMAIL ADDRESS:

NAME OF AUTHORIZED PAYEE REPRESENTATIVE:

TITLE:

EMAIL ADDRESS_2:

DATE:

TELEPHONE include area code:

STATE AGENCYDEPARTMENT OFFICE:

UNITSECTION:

MAILING ADDRESS:

FAX:

TELEPHONE include area code_2:

CITY:

STATE:

ZIP CODE:

EMAIL ADDRESS_3:

MAILING ADDRESS (number, street, apt:

or suite no:

) (See instructions on Page 2):

BUSINESS NAME, DBA NAME or DISREGARDED SINGLE MEMBER LLC NAME (If different from above):

NAME (This is required:

Do not leave this line blank:

Must match the payee’s federal tax return):

Social Security Number (SSN) or:

Federal Employer Identification Number (FEIN):

sole: Off single: Off partnership: Off estate: Off corpMedical: Off corpLegal: Off corpExempt: Off corpOthers: Off calRes: Off calNonRes: Off calNonResNo: Off calNonResCopy: Off

ResetForm:

PrintForm:

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STD 205 - Payee Data Record Supplement - Rev. 03-21.pdf

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.)

STD 205 (New 03/2021)

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

Additional Contact Information Use the fields below to provide additional Authorized Representatives for the Payee if applicable.

CONTACT NAME

TELEPHONE (Include area code) EMAIL

TELEPHONE EMAIL

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)

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.)

STD 205 (New 03/2021)

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.