RFQ_P2540001_KNWR_Portable_Toilets.pdf

State of California – Natural Resources Agency GAVIN NEWSOM, Governor DEPARTMENT OF FISH AND WILDLIFE CHARLTON H. BONHAM, Director Director’s Office P.O. Box 944209 Sacramento, CA 94244-2090 www.wildlife.ca.gov

Conserving California’s Wildlife Since 1870

REQUEST FOR QUOTE

(Small Business Option)

Notice to Prospective Bidders

June 2, 2025

RFQ Number and Name: P2540001, Kern National Wildlife Refuge Portable Toilets RFQ Due Date/Time: June 16, 2025, 5:00 PM (PT)

The California Department of Fish and Wildlife (CDFW) invites you to review and respond to this Request for Quote (RFQ). In submitting your quote, you must comply with the instructions found herein.

Before submitting a response to this solicitation, interested parties should read and review the entire solicitation including any attachments, all referenced web addresses, and any regulations, orders, and statutes cited.

Pursuant to Government Code Section 14838.5 et seq., this RFQ authorizes a state agency to award a contract to a California Certified Small Business Enterprises (SBE) as long as the agency obtains price quotations from two or more certified SBEs, including microbusinesses, or from two or more DVBEs.

Protest provisions, small business preferences, DVBE incentives, evaluation criteria, advertising, etc. are not applicable under this method (GC § 14838.5.).

In the opinion of the CDFW, this RFQ is complete and without need of explanation. However, if you have questions, or should you need any clarifying information, the contact person for this RFQ is:

CDFW Contact

Elbertlyn Cantey

Elbertlyn.Cantey@wildlife.ca.gov

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

Elbertlyn Cantey, Contract Analyst Contracts Unit Business Management Branch

RFQ P2540001

KNWR Portable Toilets

CDFW RFQ (05/2024)

TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

A. DESCRIPTION AND LOCATION OF SERVICES

B. CONTRACT TERM

C. CONTRACT BUDGET AMOUNT

D. QUESTIONS REGARDING RFQ

E. ELIGIBLE BIDDERS

F. EXECUTIVE ORDER N-6-22 – RUSSIA SANCTIONS

G. EXECUTIVE ORDER N-12-23 – GENERATIVE ARTIFICIAL INTELLIGENCE (GENAI) DISCLOSURE

H. LOSS LEADER

I. BIDDER MINIMUM QUALIFICATIONS

J. INSURANCE REQUIREMENTS

SECTION 2: SUBMISSION REQUIREMENTS

K. KEY ACTION DATES:

L. SUBMISSION OF BID

M. COMMERCIALLY USEFUL FUNCTION DEFINITION

SECTION 3: EVALUATION AND AWARD PROCESS

N. EVALUATION AND SELECTION

O. BASIS OF AWARD

P. DISPOSITION OF BID

Q. AGREEMENT EXECUTION AND PERFORMANCE

SECTION 4: SUBMITTAL CHECKLIST AND REQUIRED ATTACHMENTS

Attachment 1 - Submittal Check List Attachment 2 - Bid/Bidder Certification Sheet Attachment 3 - Payee Data Record (STD 204/205) Attachment 4 - Bid Cost Sheet Attachment 5 - Darfur Contracting Act Certification Attachment 6 - Contractor Certification Clauses (CCC 04/2017) Attachment 7 - Commercially Useful Function (CUF) Certification

Sample Standard Agreement (Std 213) ....................... Included as a separate document

Section 1: General Information

A. Description and Location of Services

Description: The CDFW owns and operates the Kern National Wildlife Refuge (KNWR), which is open for public visitation during the Waterfowl Season. The Waterfowl Season runs from the third Saturday in October through the first weekend in February each year. It is necessary to provide portable toilet facilities for visitors to KNWR in order to provide for a safe and sanitary recreational environment

For a detailed description of work to be performed, see Exhibit A, Scope of Work, which is attached hereto within the sample STD. 213 standard agreement and made a part of this solicitation.

Location of Services: Kern National Wildlife Refuge, 10811 Corcoran Road, Delona, CA 93215, Kern County

B. Contract Term

1. The contract term will be from October 1, 2025 or upon contract approval, whichever is later, through February 15, 2028.

2. Extensions of Terms: The resulting Agreement may be amended to extend the term by one (1) year if it is determined to be in the best interest of the State. Upon signing the amendment, the bidder hereby agrees to provide services for the extended period at the rates specified in the original Agreement.

C. Contract Budget Amount

The contract will be awarded for a maximum budget established by the selected bidder’s Total Basis of Award amount identified on Attachment 4, Bid Cost Sheet.

D. Questions Regarding RFQ

All questions concerning this RFQ must be submitted directly to Elbertlyn Cantey by email at Elbertlyn.Cantey@wildlife.ca.gov on or before June 6, 2025. When submitting questions, indicate the RFQ number in the subject line. Answers provided by anyone other than the RFQ contact named above are not binding upon the State. Questions via fax or telephone will not be accepted. Answers may be provided via an addendum to this RFQ.

E. Eligible Bidders

The bidder must be legally constituted and qualified to do business within the State of California (registered with the Secretary of State) and a Certified Small Business.

F. Executive Order N-6-22 – Russia Sanctions

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals.

“Economic Sanctions” refers to sanctions imposed by the U.S. government in response to Russia’s actions in Ukraine, as well as any sanctions imposed under state law. By submitting a bid or proposal, Contractor represents that it is not a target of Economic Sanctions. Should the State determine Contractor is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that shall be grounds for rejection of the Contractor’s bid/proposal any time prior to contract execution, or, if determined after contract execution, shall be grounds for termination by the State.

G. Executive Order N-12-23 – Generative Artificial Intelligence (GenAI) Disclosure

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 must notify the State in writing if it: (1) intends to provide GenAI as a deliverable to the State; or (2), intends to utilize GenAI, including GenAI from third parties, to complete all or a portion of any deliverable that materially impacts: (i) functionality of a State system, (ii) risk to the State, or (iii) Contract performance. For avoidance of doubt, the term “materially impacts” shall have the meaning set forth in State Administrative Manual (SAM) § 4986.2 Definitions for GenAI.

Failure to report GenAI to the State may result in disqualification. The State reserves the right to seek any and all relief to which it may be entitled to as a result of such non-disclosure.

Upon notification by a Bidder / Offeror of GenAI as required, 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.

Government Code 11549.64 defines “Generative Artificial Intelligence (GenAI)” as an artificial intelligence system that can generate derived synthetic content, including text, images, video, and audio that emulates the structure and characteristics of the system’s training data.

H. Loss Leader

It is unlawful for any person engaged in business within this state to sell or use any article or product as a “loss leader” as defined in Section 17030 of the Business and Professions Code. A "loss leader" is any article or product sold at less than cost: (a) Where the purpose is to induce, promote or encourage the purchase of other merchandise; or (b) Where the effect is a tendency or capacity to mislead or deceive purchasers or prospective purchasers;

or (c) Where the effect is to divert trade from or otherwise injure competitors.

I. Bidder Minimum Qualifications

Bidder must be actively registered as a California Small Business or Microbusiness with the Department of General Services.

A. The Contractor must comply with and ensure that all employees, subcontractors, and agents comply with all requirements of the Department of Transportation (DOT) regulations regarding waste transportation under this contract. Information regarding complete compliance with these regulations must be carried on transport vehicles and maintained at facilities where wastes are received, stored, or handled during transportation.

B. The Contractor and subcontractor must comply with the California Vehicle Code, California Highway Patrol (CHP), Title 13, California Code of Regulations; the California Fire Marshal regulations, Title 19, California Code of Regulations; and United States Department of Transportation regulations (49 CFR). The Contractor and subcontractor must comply with the California Health and Safety Code and Title 22, California Code of Regulations administered by the California Department of Toxic Substance Control and any other laws and regulations affecting the work under this contract.

J. Insurance Requirements

The below required insurance documents will be requested upon award only. The awarded Contractor will be required to maintain the following proof of coverage throughout the duration of the agreement. Required insurance includes:

1. Commercial General Liability.

The Contractor must maintain general liability on an occurrence form with limits not less than $1,000,000.00 per occurrence for bodily injury and property damage liability combined with a $2,000,000.00 annual policy aggregate. The policy must include coverage for liabilities arising out of premises, operations, independent contractors, products, completed operations, personal and advertising injury, and liability assumed under an insure contract. This insurance shall apply separately to each insured against whom claim is made or suit is brought subject to the Contractor’s limit of liability.

2. Automobile Liability

The Contractor shall maintain motor vehicle liability with limits not less than $1,000,000.00 combined single limit per accident. Such insurance shall cover liability arising out of a motor vehicle including owned, hired and non-owned motor vehicles.

3. Pollution Liability

Contractor shall maintain pollution liability with Limits no less than $1,000,000.00 each occurrence and $2,000,000.00 aggregate which may include Pesticide/Herbicide Applicator Coverage if applicable, or its equivalent.

4. Workers Compensation and Employers Liability

The Contractor shall maintain statutory worker’s compensation and employer’s liability coverage for all its employees who will be engaged in the performance of the contract. Employer’s liability limits of $1,000,000.00 are required.

The above policies must each be endorsed to include “the State of California, its officers, agents and employees as additional insured but only with respect to work performed under the Contract”. If the insurance documents including endorsements are not received by the date listed on Notice of Intent to the awarded bidder, CDFW may rescind the award for the contract and award the contract to the next lowest cost vendor.

Section 2: Submission Requirements

K. Key Action Dates:

EVENT DATE TIME

RFQ Posted/Emailed to Bidders June 2, 2025 4:00 PM Final Date for Question Submission June 6, 2025 Final Date for Quote Submission June 16, 2025 5:00 PM Proposed Award Date June 17, 2025

L. Submission of Bid

1. All quotes must be submitted to the CDFW by email on or before the date and time identified in Section 2. Submission Requirements, Item J. Key Action Dates above.

2. Any quote received after the quote submission date and time will NOT be considered.

It is the State's policy to make every effort to ensure that all quotes have been received and properly time stamped; however, bidders are ultimately responsible for ensuring timely receipt of their quote.

3. All quotes must include the documents identified in Section 4, Submittal Check List (Attachment 1). Required attachments must be fully completed and not contain alternate versions or alterations. If an attachment does not apply, the form must be marked “N/A” and included in the quote. Do not mark the checklist item as “N/A” and omit the form from the quote. Quotes not including all documents identified in Attachment 1 will be deemed non-responsive and may be rejected. A non-responsive quote is one that does not meet the basic requirements.

4. All documents requiring a signature must be signed by a person authorized to bind the bidding firm. E-signatures are acceptable.

5. Email quotes to the RFQ Contact: Elbertlyn Cantey at Elbertlyn.Cantey@wildlife.ca.gov

6. Reference the RFQ number and name in subject line: RFQ P2540001, Kern National Wildlife Refuge Portable Toilets

7. Quotes must be submitted for the performance of all the services described herein.

Any deviation from the work specifications will not be considered and will cause a quote to be rejected.

8. A quote may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all quotes and may waive an immaterial deviation in a quote. The State's waiver of an immaterial deviation will in no way modify the RFQ document or excuse the bidder from full compliance with all requirements if awarded the agreement.

9. The Bidder is required to complete all items on the bid cost sheet. Any items left blank will be interpreted by the State to represent a bid of zero dollars ($0.00) for that item.

Items indicating anything other than a numerical dollar amount (e.g. N/A) may be deemed nonresponsive and may be rejected.

10. All costs incurred for developing quote and in anticipation of award of the agreement are the responsibility of the bidder and will not be charged to the State of California.

11. The Bid/Bidder Certification Sheet (Attachment 2) must be signed by an individual authorized to bind the bidder. The signature must indicate the title or position that the individual holds in the firm. An unsigned quote may be rejected.

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

13. The CDFW may modify the RFQ prior to the date fixed for submission of quotes by the issuance of an addendum to all parties who received an RFQ package.

14. The CDFW reserves the right to reject all quotes. CDFW is not required to award an agreement.

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

16. Where applicable, bidder should carefully examine specifications. Bidder must investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered. No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications.

17. The State does not accept alternate contract language from a prospective contractor. A quote with such language will be considered a counter proposal and will be rejected as non-responsive. The State’s General Terms and Conditions are not negotiable.

18. No oral understanding or agreement will be binding on either party.

M. Commercially Useful Function Definition

1. All California-certified Small Businesses (SB) and Disabled Veteran Business Enterprise (DVBEs) doing business with the state must perform a Commercially Useful Function (CUF). Performing CUF is a critical requirement for all California-certified firms - SB and DVBE - that do business with the state (Government Code Section 14837 and Military and Veterans Code Section 999).

2. CUF definition and resources can be found at:

https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division- Resources-List-Folder/Commercially-Useful-Function-for-Certified-Firms

3. A Contractor, subcontractor, or supplier will not be considered to perform a commercially useful function if the Contractor's, subcontractor's, or supplier's role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of disabled veteran business enterprise participation.

Section 3: Evaluation and Award Process

N. Evaluation and Selection

At the time of evaluation, each quote will be checked for the presence or absence of required information in conformance with the submission requirements of this RFQ.

The CDFW will evaluate each quote to determine its responsiveness to the RFQ’s requirements.

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

O. Basis of Award

Quotes must comply with all RFQ requirements; failure to do so will disqualify the bidder. If it is determined not to be in the best interest of the State, the State reserves the right to not award a contract to the lowest bidder in response to this RFQ.

P. Disposition of Bid

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

Q. Agreement Execution and Performance

This RFQ includes a Sample Standard Agreement (STD 213) for review as a separate document. The Sample Standard Agreement contains language that CDFW expects to utilize for this contract.

Work will start no later than ten (10) days, or on the express date set by the CDFW Contract Manager and the Contractor, after all approvals have been obtained and the agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, the CDFW, upon five (5) days written notice to the Contractor, reserves the right to terminate the Agreement. In addition, the Contractor will be liable to the State for the difference between Contractor's quoted price and the actual cost of performing work by the second lowest bidder or by another Contractor.

All performance under the Agreement must be completed on or before the termination date of the Agreement.

Section 4: Submittal Checklist and Required Attachments

ATTACHMENT 1 - SUBMITTAL CHECK LIST

A complete quote must include all of the items identified below.

Complete this checklist to confirm the items in your quote. Place a check mark or “X” next to each item that you are submitting to the State (do not mark as N/A). For your quote to be responsive, this checklist and all required attachments must be included.

Attachment Attachment Name/Description

Attachment 1 Required Attachment Check List

Attachment 2 Bid/Bidder Certification Sheet

Attachment 3 Payee Data Record (STD 204)

Attachment 4 Bid Cost Sheet

Attachment 5 Darfur Contracting Act Certification

Attachment 6 Signed Contractor’s Certification Clauses (CCC 04/2017)

Attachment 7 Commercially Useful Function (CUF) Certification

Other Required Documents:

Copy of California Business License or articles of incorporation (per “Eligible Bidders”

Section)

Proof of Active Small Business status with the Department of General Services

Email Quote Submission to: elbertlyn.cantey@wildlife.ca.gov

ATTACHMENT 2 - BID/BIDDER CERTIFICATION SHEET

This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as directed in Submission of Bid.

A. Our all-inclusive quote is submitted as detailed in Attachment 4, Bid Cost Sheet.

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

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

An unsigned Bid/Bidder Certification Sheet may be cause for rejection

1. Company Name 2. Telephone Number 2a. 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. Bidder’s Name (Print) 11. Title

12. Signature 13. Date

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

a. California Small Business Yes No

If yes, enter certification number:

b. Disabled Veteran Business Enterprise Yes No

If yes, enter certification number:

c. Non-Small Business Subcontractor Preference: Yes No

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

Date application submitted to OSDS (if application is pending):

ATTACHMENT 2

BID/BIDDER CERTIFICATION SHEET INSTRUCTIONS

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

Item Numbers

Instructions

1, 2, 2a, 3

Must be completed. Items are self-explanatory.

Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one (1) person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business.

Check if your firm is a partnership. A partnership is a voluntary agreement between two (2) 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 must be a proportional sharing of the profits and losses between them. An association of two (2) 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/her successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals.

Enter your Federal Employee Tax Identification Number.

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

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

10, 11, 12, 13

Must be completed. These items are self-explanatory.

If certified as a California Small Business, place a check in the "Yes" box, and enter your certification number on the line.

If certified as a Disabled Veterans Business Enterprise, place a check in the "Yes" box and enter certification number on the line.

If you are not certified to one (1) or both, place a check in the "No" box. If your certification is pending, enter the date your application was submitted to OSDS.

ATTACHMENT 3 - PAYEE DATA RECORD (STD 204/205)

A completed Payee Data Record 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.

STD 204 Payee Data Record

This form is available at: https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

The STD 205 is optional. It 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 Payee Data Record Supplement

This form is available at: https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std205.pdf

ATTACHMENT 4 - BID COST SHEET

The Bidder proposes to provide CDFW with portable to in accordance with the specifications, terms and conditions contained herein, at the unit rates noted below. Rates include all Contractor costs including but not limited to labor, transportation, travel, parking, and all other expenses necessary under the performance of this contract. The awarded Contractor will be reimbursed for actual services rendered as requested and approved by the CDFW Contract Manager.

If a field within the Bid Cost Sheet is left blank, it will be construed as a bid of $0.00. If a field within the Bid Cost Sheet is marked with anything other than a number (i.e. N/A) the bid may be deemed nonresponsive.

Fiscal Year 25/26 (October 2025-February 2026):

Item Number of

Units

Monthly Cost Per Unit*

# of

Months Subtotal

ADA Portable Toilet Rental and Weekly Service

1 X $ X 4 = $

Standard Portable Toilet Rental and Weekly Service

2 X $ X 4 = $

Total Amount for FY 25/26 $

Fiscal Year 26/27 (October 2026 – February 2027):

Monthly Cost Per

Unit*

Total

ADA Portable Toilet Rental and Weekly Service

1 X $ X 4 = $

Standard Portable Toilet Rental and Weekly Service

2 X $ X 4 =

Total Amount for FY 26/27 $

Fiscal Year 27/28 (October 2027 – February 2028):

Monthly Cost Per

Unit*

Total

ADA Portable Toilet Rental and Weekly Service

1 X $ X 4 = $

Standard Portable Toilet Rental and Weekly Service

2 X $ X 4 = $

Total Amount for FY 27/28 $

Total Amount for FY 25/26 $

Total Amount for FY 26/27 $

Total Amount for FY 27/28 $

Total Amount for Fiscal Years 25/26, 26/27, and 27/28 must not exceed $

*If required, additional servicing is to be scheduled based on specifications in Exhibit A.

ATTACHMENT 5 - DARFUR CONTRACTING ACT CERTIFICATION

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

OPTION #1 – NOT APPLICABLE

Check here if your company has not, within the previous three years, had any business activities or other operations outside of the United States.

Company/Vendor Name (Printed) Federal ID Number

Printed Name and Title of Person Signing By (Authorized Signature)

OPTION #2 - CERTIFICATION

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

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

Company/Vendor Name (Printed) Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County and State of

OPTION #3 – WRITTEN PERMISSION FROM DGS

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

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

Company/Vendor Name (Printed) Federal ID Number

Initials of Submitter

Printed Name and Title of Person Initialing

ATTACHMENT 6 - CONTRACTOR CERTIFICATION CLAUSES (CCC 04/2017)

A completed Contractor Certification Clauses is required with your quote. Download, print, sign first page and attach form to your quote.

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

Under the General Terms and Conditions heading, select CCC 04/2017 – Contractor Certification Clauses. Effective 4/4/2017.

ATTACHMENT 7 - COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION

Complete one (1) CUF Certification for the portion of the contract that each certified Small Business (SB) and/or Disabled Veteran Business Enterprise (DVBE) identified on the Bidder Declaration will be performing. If no SBs or DVBEs will participate in the contract work, mark ‘N/A’ on this form when submitting it with your bid.

CUF statute (Government Code 14837 and Military and Veterans Code 999) requires that the contractor and subcontractor provide goods/services described in the scope of work and/or considered to be distinct element of the contract work.

Supplier Name:

Certification Type (SB or DVBE):

Certification number:

Prime or Subcontractor?

1. List the specific services the supplier will provide in relation to the Scope of Work:

2. List reasons why the services are a normal and consistent function of the supplier; provide support (e.g.

UNSPSC, certification, resumes, licenses, educational degrees, website, past performance, etc.):

3. Will the supplier provide products, inventories, materials, and supplies as well as perform ALL the following duties?

(If supplier is not providing any goods, mark “N/A”)

1. Negotiating Price

2. Determining quality and quantity

3. Ordering

4. Making payment

5. Installing

N/A Yes No