DATE: 9/14/2026

TO: PROSPECTIVE OFFEROR

RFQ #: 900-09102026

RFQ TITLE: 900-09102026

PRODUCT/SERVICE DESCRIPTION: RISO High-Capacity Printers

OFFER DUE: Monday, September 28, 2026 at 5:00PM Pacific Standard Time

You are invited to review and respond to this Request for Quote (RFQ) entitled RFQ# 900-09102026.

By submitting your bid, you agree to comply with the instructions found herein and with the State's Bidder Instructions (GSPD-451), which are included by reference and may be viewed and downloaded at:

http://www.documents.dgs.ca.gov/pd/modellang/GSPD451-110911.pdf 401 General Provisions - Cloud Computing Software as a Service (SaaS) that may be viewed and downloaded at: https://www.dgs.ca.gov/- /media/Divisions/PD/PTCS/OPPL/Model- Language/CloudComputing_SaaSGeneralProvisions062122.pdf

Attachment 1 - Required Attachment Check List, attached herein, lists all the required documents which should be submitted by due date and time.

If a response is missing information required in any section and attachment, it may be deemed non-responsive.

Award will be based on low cost.

If interested or have any questions, please email your offer to IT Goods Unit at ITPurchasing@dss.ca.gov by the above due date and time.

Joshua Phillips IT Purchasing Unit

IT Procurement Analyst

Attachments http://www.documents.dgs.ca.gov/pd/modellang/GSPD451-110911.pdf mailto:ITPurchasing@dss.ca.gov

RFQ# 900-09102026

California Department of Social Services

Attachment 1

REQUIRED ATTACHMENT CHECK LIST

Company Name:

REQUIRED ATTACHMENT CHECK LIST

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

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

Attachment

Attachment 1

Attachment 2

Attachment 3

Attachment 4

Attachment 5

Attachment 6

Attachment 7

Attachment 8

Attachment 9

Attachment 10

Attachment 11

Attachment Name/Description

Required Attachment Check List

Offer/Offeror Certification Sheet

Statement of Work

Bidder Declaration (GSPD-05-105)

Payee Data Record (STD 204)

Commercially Useful Function Documentation (if applicable)

Cost Worksheet

California Civil Rights Laws Certification

Disabled Veteran Business Enterprise Declarations (STD 843) (If applicable)

GEN 1000

Darfur Contracting Act Certification

Additional Documentation that must be submitted:

Seller’s Permit

No Offer (if applicable)

Attachment 2

RFQ# 900-09102026

California Department of Social Services

OFFER/OFFEROR CERTIFICATION SHEET

This Offer/Offeror Certification Sheet must be signed and returned along with all the "required attachments" as an entire package with scanned original signatures. The offer must be transmitted via email in accordance with RFO instructions.

A. Our all-inclusive offer is submitted as detailed in Attachment 7, Cost Worksheet.

B. All required attachments are included with this Offer/Offer Certification Sheet.

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

An Unsigned Offer/Offeror Certification Sheet May Be Cause for Rejection

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

2b. Email Address

3. Address

Indicate your organization type:

4. Sole Proprietorship 5. Partnership 6. Corporation

Indicate the applicable employee and/or corporation number:

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

9. Indicate applicable license and/or certification information:

10. Offeror’s Name (Print) 11. Title

12. Signature 13. Date

14. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran Business Enterprise Services (OSDS) as:

a. California Small Business

Yes No If yes, enter certification number:

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

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

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

(Company Name)_________________________will comply with all RFQ requirements and agrees to all contractual terms and conditions under the RFQ Contract.

Attachment 2 RFQ# 900-09102026 California Department of Social Services Page 2 of 2

Completion Instructions for Offer/Offeror Certification Sheet

Complete the numbered items on the Offer/Offeror Certification Sheet by following the instructions below.

Item Number s

Instructions

1, 2, 2a, 2b, 3

Must be completed. These items are self-explanatory.

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

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

5 Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit.

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

7 Enter your federal employee tax identification number.

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

9 Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required for the type of services being procured.

10, 11, 12, 13

Must be completed. These items are self-explanatory.

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

RFQ# 900-09102026 Attachment 3

Statement of Work (SOW)

Acquisition of Two RISO High-Capacity Printers with Equipment Service and Maintenance Disability Determination Service Division (DDSD)

1.0 Scope

The purpose of this Statement of Work (SOW) is to establish the requirements for the purchase, delivery, installation, training, maintenance, and ongoing support of two (2) RISO high-capacity production printers for DDSD. The Contractor shall provide all labor, equipment, materials, transportation, and expertise necessary to fulfill the requirements outlined herein.

2.0 Applicable Documents

The Contractor shall comply with all applicable federal, state, and local regulations, and the following documents as applicable:

• Manufacturer specifications for RISO production printers

• Agency IT/security policies

• Occupational Safety and Health Administration (OSHA) requirements

• Americans with Disabilities Act (ADA) facility compliance standards

3.0 Requirements

3.1 Equipment Procurement

The Contractor shall provide:

• Two (2) new RISO high-capacity production printers Model: RISO ComColor GL7430

• All required accessories, including high-capacity feeders, high-capacity stackers, power cables, and OEM consumables for initial operation

• Manufacturer-approved controller and interface software

3.2 Delivery and Installation

The Contractor shall:

• Deliver equipment to: 1st RISO Unit to Central Valley/Sierra DDS located at 377 W. Spruce Ave, Ste 101-102 in Clovis, CA 93611 and the 2nd RISO Unit to Sacramento DDS located at 2420 Del Paso Rd. Ste 200 in Sacramento, CA 95834.

• Coordinate delivery scheduling with Agency

• Install printers in designated locations

• Ensure full operational integration with Agency’s network environment

• Conduct functional testing to validate performance per manufacturer specifications

3.3 End-User Training

The Contractor shall provide on-site training for Agency personnel, including:

• Basic operational training

• Advanced job programming and print management

• Paper/loading procedures

• Troubleshooting and routine maintenance (non-technical)

• Safety precautions and proper handling

Training materials shall be provided in both printed and electronic formats.

A minimum of two (2) training sessions shall be conducted, one for each site location

3.4 Maintenance and Service Requirements

The Contractor shall provide full maintenance services for the printing equipment for the duration of the contract term, including:

• Quarterly preventive maintenance

• Replacement of worn or defective parts

• Software/firmware updates

• Priority repair services with a guaranteed on-site response time of 48 hours

All maintenance shall comply with RISO manufacturer standards.

3.5 Ongoing Technical Support

The Contractor shall provide:

• Telephone and email support services during normal business hours

• Remote diagnostics where applicable

• Support for print quality, network printing issues, and feature optimization

• Guidance on recommended consumables and operational best practices

3.6 Warranty

The Contractor shall provide a minimum 12-month warranty covering parts, labor, and on-site service. Warranty terms shall comply with or exceed standard manufacturer coverage.

4.0 Contractor Personnel

The Contractor shall ensure that all personnel assigned to this project:

• Are trained and certified by the manufacturer

• Comply with all facility access requirements

• Adhere to Agency safety, security, and conduct standards

5.0 Period of Performance

The period of performance shall begin on the date of contract award and continue through:

• Delivery/installation: Within 30 business days of award

• Training completion: Within 15 business days of installation

• Maintenance/support services: As specified in contract terms

6.0 Deliverables

The Contractor shall provide the following deliverables:

• Delivery and installation confirmation

• Equipment test and performance report

• End-user training completion certification

• Maintenance logs (quarterly)

• Technical support activity reports upon request

• Final acceptance documentation

7.0 Acceptance Criteria

The Agency will accept equipment and services when:

• Both printers are installed, fully operational, and tested

• Training sessions have been completed

• All documentation has been provided

• Functional performance meets or exceeds manufacturer specifications

8.0 Government-Furnished Property (GFP)

The Agency will provide:

• Physical installation space

• Electrical and network access

• Staff availability for training

No additional government-furnished equipment or tools will be provided.

9.0 Security Requirements

The Contractor shall comply with all Agency security procedures, including:

• Visitor check-in and identification requirements

• Escort procedures as applicable

• Restrictions on access to sensitive areas

Contractor technicians shall not store, retain, or access any Agency data.

10.0 Invoicing and Payment

The Contractor shall submit invoices in accordance with Agency guidelines. Invoices must include:

• Contract number

• Itemized cost breakdown

• Description of services rendered

Payment shall be made Net 30 days following approval of deliverables.

11.0 Contractual Terms and Conditions

All work shall be performed in accordance with the terms and conditions set forth in the base contract, including but not limited to:

• Compliance with Equal Employment Opportunity (EEO) requirements

• Adherence to labor laws and safety regulations

• Termination and modification clauses

• Non-disclosure and confidentiality provisions

12. POINT OF CONTACT

Supplier’s Primary Contact:

Supplier is to complete with response:

Name:

Address:

Telephone:

Fax:

Email

State’s Primary Contact

Admin Division 744 P Street, MS 8-5-41 Sacramento, CA 95814 ATTN: Joshua Phillips (Joshua.Phillips@dss.ca.gov)

Contract’s Primary Contact California Department of Social Services Department of Developmental Services 2420 Del Paso Rd, Suite 150A, MS 19-32 Sacramento CA 95834 ATTN: Louie Balbuena mailto:Joshua.Phillips@dss.ca.gov

California Department of Social Services Attachment 4

State of California—Department of General Services, Procurement Division

GSPD–05–105 (REV 08/09)

BIDDER DECLARATION

Solicitation Number

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

a. Identify current California certification(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 firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary.

c. If you are a California certified 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 certification 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 Certification (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

Attachment 4

State of California—Department of General Services, Procurement Division

GSPD–05–105 (REV 08/09) Instructions

BIDDER DECLARATION Instructions

All prime bidders (the firm submitting the bid) must complete the Bidder Declaration.

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

• Microbusiness (MB)

• Small Business (SB)

• Nonprofit Veteran Service Agency (NVSA)

• Disabled Veteran Business Enterprise (DVBE)

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 certified as MB, SB, NVSA, and/or DVBE must provide a commercially useful function as defined in

Military and Veterans Code Section 999 for DVBEs and Government Code Section 14837(d)(4)(A) for small/ microbusinesses.

Bids must propose that certified 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 official identified in the solicitation.

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

1.c. This item is only to be completed by businesses certified 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) defines“broker” or“agent” as a certified 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 certification 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 Name, Contact Person, Phone Number & Fax Number—List each element for all subcontractors.

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

CA Certification (MB, SB, NVSA, DVBE or None)—If the subcontractor possesses a current State of

California certification(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. Certified subcontractors must provide a commercially useful function for the contract. (See paragraph 1.b above for code citations regarding the definition of commercially useful function.) If a certified 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 verified that the subcontractor(s) is in good standing for all of the following:

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

• 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 certified 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.

Enter“No” if the subcontractor is a California certified 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.

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

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

Print Form Reset Form California Department of Social Services

RFQ# 900-09102026

Attachment 5

STATE OF CALIFORNIA – DEPARTMENT OF FINANCE

PAYEE DATA RECORD

(Required when receiving payment from the State of California in lieu of IRS W-9 or W-7) STD 204 (Rev. 03/2021)

GENERAL INSTRUCTIONS

Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6.

Prompt return of this fully completed form will prevent delays when processing payments.

Information provided in this form will be used by California state agencies/departments to prepare Information Returns (Form1099).

NOTE: Completion of this form is optional for Government entities, i.e. federal, state, local, and special districts.

A completed Payee Data Record, STD 204 form, is required for all payees (non-governmental entities or individuals) entering into a transaction that may lead to a payment from the state. Each state agency requires a completed, signed, and dated STD 204 on file; therefore, it is possible for you to receive this form from multiple state agencies with which you do business.

Payees who do not wish to complete the STD 204 may elect not to do business with the state. If the payee does not complete the STD 204 and the required payee data is not otherwise provided, payment may be reduced for federal and state backup withholding. Amounts reported on Information Returns (Form 1099) are in accordance with the Internal Revenue Code (IRC) and the California Revenue and Taxation Code (R&TC).

Section 1 – Payee Information Name – Enter the name that appears on the payee's federal tax return. The name provided shall be the tax liable party and is subject to IRS TIN matching (when applicable).

Sole Proprietor/Individual/Revocable Trusts – enter the name shown on your federal tax return.

Single Member Limited Liability Companies (LLCs) that is disregarded as an entity separate from its owner for federal tax purposes - enter the name of the individual or business entity that is tax liable for the business in section 1. Enter the DBA, LLC name, trade, or fictitious name under Business Name.

Note: for the State of California tax purposes, a Single Member LLC is not disregarded from its owner, even if they may be disregarded at the Federal level.

Partnerships, Estates/Trusts, or Corporations – enter the entity name as shown on the entity’s federal tax return. The name provided in Section 1 must match to the TIN provided in section 3. Enter any DBA, trade, or fictitious business names under Business Name.

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

Mailing Address – The mailing address is the address where the payee will receive information returns. Use form STD 205, Payee Data Record Supplement to provide a remittance address if different from the mailing address for information returns, or make subsequent changes to the remittance address.

Section 2 – Entity Type If the Payee in Section 1 is a(n)… THEN Select the Box for…

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

Corporation-Medical

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

Corporation-Legal

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

Corporation-All Other

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

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

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

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

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

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

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

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

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

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

California Department of Social Services

RFQ# 900-09102026

Attachment 5

Commercially Useful Function Questionnaire

Attachment 6

All Small Business (SB) and Disabled Veteran Business Enterprise (DVBE) applicants must include this completed Commercially Useful Function (CUF) form with their submittal.

1. BUSINESS NAME

“DOING BUSINESS AS” (DBA) NAME OSDS REF # (CURRENTLY CERTIFIED FIRMS ONLY)

All certified Small Business, Microbusiness, and/or DVBE contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837(d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).

Answer the following questions as they apply to the applicant firm when fulfilling a contract or purchase order.

1 Is the applicant firm responsible for the execution of a distinct element of the work of the contract or purchase order? Yes No

2 Will the applicant firm carry out its obligation on a contract or purchase order by actually performing, managing, or supervising the work involved? Yes No

3 Will the applicant firm perform work on a contract or purchase order that is normal for its business, services and functions? Yes No

4 Does the applicant firm perform the work themselves, rather than further subcontracting a portion of the work that is greater than would be expected by normal industry practices? Yes No

Does the applicant firm add value by performing the work themselves, rather than being an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation?

Yes No

The signatory of this document must be the certified firm’s owner (or officer in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.

(Rev. 9/08/16)

2. COMMERCIALLY USEFUL FUNCTION (CUF)

AUTHORIZING SIGNATURE (REQUIRED)

OWNER’S/OFFICER’S SIGNATURE

RFO# 900-09102026

California Department of Social Services COST WORKSHEET

Attachment 7

PART#

# PART NUMBER EA PART DESCRIPTION

2 EA RISO COM Color GL 7430 Main Unit 2 EA Control Card Kit GL 7430 2 EA Face Down Tray G10 (500-Sheet Capacity) 2 EA Power Cord 2 EA Power Guard Service Package 2 EA ComColor Express FS2100C (Fiery) 2 EA Fiery Upgrade Kit 2 EA High-Capacity Feeder 2 EA High-Capacity Stacker (With 1 Stacker Cart) 2 EA Paper Ejection Attachment G10 2 EA GL CMYKG Full Ink Package 2 EA IT Support / Installation

2 EA Standard SLA - Equipment Service Agreement (for RISO ComColor GL Series) Term - 12 months

SUBTOTAL

TAX

GRAND

TOTAL

ELECTRONIC DELIVERY (if applicable)

COMPANY NAME:

COMPANY ADDRESS:

Signature: ___________________________ Date: ___________________

TAXABLE

YES OR NOQTY DESCRIPTION UNIT PRICE EXTENSIONUNIT

Attachment 8 RFQ# 900-09102026 California Department of Social Services Page 1 of 1

UNRUH CIVIL RIGHTS ACT AND CALIFORNIA FAIR EMPLOYMENT AND HOUSING

ACT CERTIFICATION

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 CDSS for a solicitation of goods or services of $100,000 or more, or (ii) entering into or renewing a contract with CDSS 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); and

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).

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.

Company Name (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 ____________

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)

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PRINT CLEAR

Attachment 9

California Health & Human Services Agency California Department of Social Services

GEN 1000 (8/25)

GENERATIVE ARTIFICIAL INTELLIGENCE (GENAI) DISCLOSURE

Section 1:

Solicitation/Contract Number: Bidder ID/Vendor ID (optional):

Business Name: Business Telephone Number:

Business Email:

Product Name and Description of Purchase:

Section 2: Disclosure

1. Does the product, service and/or solution you are providing incorporate GENAI technology?

content, including text, images, video, and audio that emulates the structure and characteristics of the system’s training data. (Gov. Code § 11549.64.)

Yes

2. If yes, do you intend to use the GenAI technology in the delivery of the product, service, and/or solution?

Yes No

3. If yes, is Access Control established to permanently disable the GENAI technology in the product or solution, or to prevent its use in the delivery of a service?

Yes No

4.

Product Vendor All

GENAI please refer to Gov Code 11549.64.

will complete an updated GEN 1000 and submit to the State or CDSS.

(Signature) (Date)

Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.

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

OPTION #1 - CERTIFICATION

If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

OPTION #2 – WRITTEN PERMISSION FROM DGS

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

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

Company/Vendor Name (Printed) Federal ID Number

Printed Name and Title of Person

Page 1 of 1RFQ# 900-09102026

“NO OFFER” RESPONSE FORM

If you will not be submitting an offer in response to RFQ# 900-09102026, please complete and e-mail this form to Joshua Phillips at Joshua.Phillips@dss.ca.gov by Monday, September 28, 2026, at 5:00 PM Pacific Standard Time.

VENDOR INFORMATION

BUSINESS NAME:

RFQ NUMBER:

CONTACT PERSON:

TELEPHONE NUMBER:

SIGNATURE:

REASON FOR NOT SUBMITTING OFFER:

_____ Not available during the proposed term.

_____ Unable to meet timeframe and/or requirements.

_____ Requested service not able to provide.

_____ Other (Please specify):

Thank you for your response

N. Generative Artificial Intelligence (GenAI) Safeguards.