SB-DVBE_Option_Solicitation.pdf

Department of State Hospitals RFQ Number: 16-20002-000 Telephone Repair Services

09/30/14

REQUEST FOR QUOTE (RFQ)

Notice to Prospective Bidders

RFQ Number: 16-20002-000 “Telephone Repair Services”

April 12, 2016

You are invited to review and respond to this Department of State Hospitals (DSH) solicitation. The DSH is seeking quotes for a contractor to perform telephone repair services.

In submitting a quote, bidders agree that they have read, understood, and will comply with the instructions found herein. Failure to comply with any of the requirements may result in rejection of a bidder’s quote. By submitting a response, bidders agree to the terms and conditions stated in this solicitation and any resulting agreement.

All agreements entered into with the State of California will include by reference the state’s General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at: http://www.dgs.ca.gov/ols/Resources/StandardContractLanguage.aspx.

Department of State Hospitals RFQ Number: 16-20002-000

TABLE OF CONTENTS

I. DESCRIPTION OF SERVICES

A. Description of Services/Background:

B. Agreement Term and Security Provisions:

II. MINIMUM QUALIFICATIONS (MQ)

A. Proof of Legal Right To Do Business:

B. References:

C. Agreement to Sign:

D. License Requirement:

E. SB/DVBE Certification:

III. QUOTE REQUIREMENTS AND INFORMATION

A. Key Action Dates:

B. Bidder’s Questions:

C. Submission of Quotes:

IV. QUOTE EVALUATION AND AWARD

A. Responsiveness and Responsibility Determination:

B. False Statements Disclaimer:

C. Intention to Award:

D. Tie Breaker:

E. Letter of Award F. Disposition of Quotes:

G. Tax Delinquency Disclaimer:

V. PREFERENCE AND INCENTIVE PROGRAMS

A. Disabled Veteran Business Enterprise Program and Incentive:

B. Calculation of Multiple Preferences C. Other Preference Programs:

D. Additional Small Business and Disabled Veteran Enterprise Information:

VI. REQUIRED ATTACHMENTS

A. Listing of Attachments:

i. Attachment 1 – Bid Submission Checklist

ii. Attachment 2 – Bidder’s Certification

iii. Attachment 3 – Minimum Qualification Response

iv. Attachment 4 – Bidder’s References

v. Attachment 5 – Bidder's Rate Sheet

vi. Attachment 6 – Bidder Declaration Form (GSPD-05-105) ......................................... (web) 19

vii. Attachment 7 – Payee Data Record (Std. 204) ......................................................... (web) 19

viii. Attachment 8 – Contractor Certification Clauses ............................................. (CCC - 307) 21

ix. Attachment 9 – Insurance Certifications

x. Attachment 10 – Darfur Contracting Act Certification

xi. Attachment 11 – DVBE Declarations Form (Std. 843) ............................................... (web) 30

xii. Attachment 12 – Sample Agreement (Std. 213 and Exhibits)

Department of State Hospitals RFQ Number: 16-20002-000

I. DESCRIPTION OF SERVICES

A. Description of Services/Background:

1. Contractor shall provide all personnel, labor, tools, equipment, insurance, incidentals, permits and license necessary to: provide the DSH with telephone repair and modification services.

2. Please carefully review and consider the minimum qualifications, and the detailed Scope of

Work located in Attachment 12, Sample Agreement, Exhibit A, Scope of Work, in order to complete your bid.

B. Agreement Term and Security Provisions:

1. The term of any agreement resulting from this IFB is anticipated to be July 1, 2016, through

June 30, 2018. Any agreement resulting from this IFB shall have no force or effect until it is signed by both parties and approved by the Department of General Services (DGS), if such approval is required. Performance shall start no later than on the expressed date set by the awarding agency and after all approvals have been obtained and the agreement is fully executed.

2. All performance, under the agreement, shall be completed on or before the termination date of the agreement.

3. Should the Contractor fail to commence work at the agreed upon time, the DSH reserves the right to terminate the agreement upon five (5) days written notice to the Contractor.

4. Bidder shall agree to all security provisions where the performance of work takes place on any state hospital grounds.

II. MINIMUM QUALIFICATIONS (MQ)

A. Proof of Legal Right To Do Business:

Bidders must submit proof of their legal right to do business in the State of California:

1. Bidders must submit a copy of their license to do business in the State of California, where applicable.

2. Bidders must certify that they are and will continue to meet all terms and conditions for operating a business in the city/county in which the business is headquartered.

3. Bidders which are corporations, regardless of where they are incorporated, shall submit a print-out from the California Secretary of State website (http://kepler.sos.ca.gov) which shows that their corporation is registered and is currently in good standing.

B. References:

Bidder must submit applicable references:

1. Bidder must provide a list of three (3) references from customers for whom the bidder has provided services of the same nature and type as those outlined in this solicitation.

References submitted must be for services provided in the past two (2) years (from the date of this solicitation). Each reference must be able to address each of the following:

Department of State Hospitals RFQ Number: 16-20002-000

i. The bidder’s responsiveness to requests for service

ii. The bidder’s ability to provide services as compared to his or her agreed upon contract

iii. The customer’s overall assessment of the bidder’s performance

The list of references shall include the following:

i. Company

ii. Name and title

iii. Address

iv. Phone number

The DSH reserves the right to utilize these references in determining whether a bidder is responsible.

C. Agreement to Sign:

1. The bidder shall certify that, if awarded an agreement, they shall sign and return two (2) originals of the Standard Agreement signature pages (Std. 213), to be received by the DSH no later than seven (7) calendar days from the date that DSH e-mails the agreement to the email address provided by bidder on the Minimum Qualifications Response Form (Attachment 3).

This requirement shall be ten (10) calendar days if the DSH elects to mail the agreement. The DSH reserves the right, at its sole discretion, to require documentation to be submitted in addition to the Std. 213. If the DSH exercises that right, the contractor must submit all required documentation within the timeframes noted here.

The bidder shall further certify that they understand the insurance requirements in Attachment 12, Sample Agreement, Exhibit F, Insurance Requirements, and if awarded an agreement, shall provide the DSH with all required insurance documents as may be applicable, in a timely manner.

The DSH reserves the right, at its sole discretion, to cancel a proposed award to a bidder who does not submit the required documentation described herein. Should the DSH cancel a proposed award for this reason, the DSH reserves the right, at its sole discretion, to award the contract to the next lowest, responsive and responsible bidder.

D. License Requirement:

1. Bidders must provide with their quote package a current and valid active C-7 Low Voltage Systems Contractor License as issued by the State of California Contractors State Licensing Board.

E. Small Business Certification:

1. Bidders must submit proof of California Small Business Certification issued by the California Department of General Services, Office of Small Business and DVBE Services (OSDS).

III. QUOTE REQUIREMENTS AND INFORMATION

A. Key Action Dates:

Department of State Hospitals RFQ Number: 16-20002-000

Event Date Time

RFQ available to prospective bidders 4/12/16 N/A

Deadline for Submission of Questions 4/22/16 12:00PM

Final Date for Quote Submission 5/3/16 3:00PM

Anticipated Start Date 7/1/16 N/A

B. Bidder’s Questions:

1. If there are questions or concerns regarding this solicitation, Bidders shall notify the DSH immediately via e-mail to Margo.Liner@dsh.ca.gov and Chris.Tomei@dsh.ca.gov. The level of detail that shall be provided in response is subject to the availability of the DSH resources.

DSH shall respond to all questions via an addendum with all questions and answers posted on California e-Procure (www.caleprocure.ca.gov). Note: It is the responsibility of the bidder to check California e-Procure for changes within the IFB as all questions, answers, and addendums will be posted. The DSH will not be held responsible for inaccurate bids due to bidder’s oversight in reviewing any and all information via Cal e- Procure.

Departmental Contact:

Margo Liner, Contract Analyst Department of State Hospitals

11401 S. Bloomfield Ave.

Norwalk, CA 90650

Email: Margo.Liner@dsh.ca.gov Phone: (562) 651-2280

Fax: (562) 863-7332

2. Verbal comments regarding this RFQ are unofficial and are not binding on the DSH unless later confirmed in writing as an official addendum.

3. Bidders that fail to report a known or suspected problem with the RFQ or fail to seek clarification and/or correction of the RFQ, submit a quote at their own risk.

C. Submission of Quotes:

1. Quotes may be received by any of the methods checked below:

E-Mail: Fax: Delivered (Mail, Hand, or Overnight):

2. All submissions must be sent to the contact person listed above.

3. If submitting by mail, quotes must be submitted under a sealed cover and received by the

DSH by the date and time shown in Section III, A – Key Action Dates. The sealed cover must be plainly marked with the RFQ number and title, and must be marked “DO NOT OPEN,” as shown in the following example:

RFQ # 16-20002-000

ATTN: Margo Liner

Department of State Hospitals

Department of State Hospitals RFQ Number: 16-20002-000

11401 S. Bloomfield Ave.

Norwalk, CA 90650

DO NOT OPEN

i. All quotes submitted under a sealed cover must clearly and legibly show the bidder’s firm name and address.

ii. All quotes submitted under a sealed cover must be packaged with a minimum of one (1) original and one (1) copy of the quote, and be clearly marked.

4. The quote package should be prepared in the least complicated method. Originals and copies should be bound with binder-clips or staples (no covers, no spiral bindings, etc.). All pages in the quote must be standard 8.5" x 11" paper, except charts, diagrams, etc., which may be foldouts. If foldouts are used, the folded size must fit within the 8.5" x 11" format. Double-sided printing is preferred except for required attachments numbers 1 through 11, located in page 13 through page 30 of this RFQ, which must be printed single-sided. It is the bidder’s responsibility to ensure that his or her quote is submitted in a manner that enables the DSH to easily locate all response descriptions and exhibits for each requirement of this RFQ. Page numbers must be located in the same page position throughout the quote. Note: Attachment 12 should not be returned with the quote.

5. Mail Delivery, Hand Delivery, or Overnight Delivery of quotes should be addressed as in Item

1.i. above.

6. Signature Requirements:

i. All documents requiring a signature must be signed by a person authorized to bind the bidder contractually. Unsigned forms may be cause for rejection.

ii. When signing the Bidder Certification Sheet, the signatory must indicate the title or position that they hold in the firm.

7. General Contents:

i. All quotes shall include all of the documents identified in Section VI, Required Attachments, Attachment 1, Quote Submission Checklist (Page 13).

ii. Quotes should provide straightforward and concise descriptions of the bidder's ability to satisfy the requirements of this RFQ. The quote must be complete and accurate.

Omissions, inaccuracies or misstatements will be sufficient cause for rejection of a quote.

iii. Quotes must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and shall cause a quote to be rejected.

iv. A quote shall 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 defect shall in no way modify the RFQ document or excuse the bidder from full compliance with all requirements if awarded the agreement.

Department of State Hospitals RFQ Number: 16-20002-000

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

vi. Where applicable, bidders must carefully examine work sites and specifications. Bidders shall 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.

8. General Considerations:

i. No oral understanding or agreement shall be binding on either party.

ii. Costs for developing quotes and anticipation of award of the agreement are entirely the responsibilities of the bidder and shall not be charged to the State of California.

9. Withdrawing and Resubmitting:

i. A bidder may modify a quote, after its submission, by withdrawing their original quote package and resubmitting a new quote package prior to the quote submission deadline.

Bidders modifications offered in any other manner, oral or written, will not be considered.

ii. A bidder may withdraw their quote by submitting a written withdrawal request to the DSH

– Contracts Office, signed by the bidder or an authorized agent. A bidder may thereafter submit a new quote package prior to the quote submission deadline. Quotes may not be withdrawn without cause, subsequent to the quote submission deadline. The DSH Contracts Office is located at:

Department of State Hospitals – Metropolitan Contracts Office

10. Modification and Rejections:

i. The DSH may modify the RFQ, prior to the solicitation due date and time, by the issuance of an addendum to all parties who received a solicitation package.

ii. The DSH reserves the right to reject all quotes. The DSH is not required to award an agreement.

iii. The DSH does not accept alternate contract language from a prospective contractor, unless offered through the Question and Answer period. A quote with alternate contract language will be considered a counter proposal and will be rejected. The State’s General Terms and Conditions (GTC) are not negotiable. Bidders are hereby advised that proposals of alternate contract language or attempts to negotiate the state’s Terms and Conditions after the selection of a proposed awardee shall be considered a counter proposal for the purposes of this solicitation. In such a situation, the DSH shall notify the proposed awardee that they must accept the state’s language and terms as offered or be disqualified from being awarded a contract. Should a contractor fail to accept the language and terms offered, the DSH shall disqualify that vendor and award the contract to the next lowest bidder and issue a revised Letter of Intent if applicable.

Department of State Hospitals RFQ Number: 16-20002-000

IV. QUOTE EVALUATION AND AWARD

A. Responsiveness and Responsibility Determination:

1. After the due date and time, each quote will be opened and the DSH will evaluate each quote to determine its responsiveness and each bidder’s responsibility to the published requirements of this RFQ.

2. A responsive bidder is one who submits a quote that meets all of the submission requirements and minimum qualification requirements stated in the RFQ. A responsible bidder is one that is trustworthy and possesses the necessary quality, fitness and capacity to satisfactorily perform the proposed work. Bidders who are determined to not be responsible or who submit non-responsive quotes shall have their quotes rejected.

3. Responsive quotes shall be considered evidence of the proposer’s responsibility. The DSH reserves the right to reevaluate a bidder’s responsibility prior to award and is in no way limited to submitted quote packages in making a determination as to a bidder’s responsibility. In determining whether a bidder is responsible, the DSH may require bidders to submit evidence of their qualifications at such times, and under such conditions, as it may require.

B. False Statements Disclaimer:

1. 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.

C. Intention to Award:

1. The DSH intends, if an award is made, to award to the lowest responsive responsible bidder in accordance with Section V, Preference and Incentive Programs.

D. Tie Breaker:

1. Should two or more bidders submit quotes that, after the calculation of preferences as described in Section V, Preference and Incentive Programs, result in a tie, the DSH shall resolve the tie as follows:

i. In accordance with Government Code section 14838, subdivision (f), in the event of a precise tie between a small business or microbusiness, and a disabled veteran-owned small business or microbusiness, the agreement shall be awarded to the disabled veteran-owned small business or microbusiness.

ii. In all other circumstances a coin toss witnessed by two DSH admin staff shall determine the proposed awardee.

E. Letter of Award:

1. Whenever an agreement is awarded under a procedure which provides for competitive bidding, but the agreement is not to be awarded to the low bidder, the low bidder shall be notified by telegram, electronic facsimile transmission, overnight courier, electronic mail, or personal delivery five (5) working days prior to the award of the agreement.

Department of State Hospitals RFQ Number: 16-20002-000

2. Upon written request by any bidder, notice of the proposed award shall be posted in a public place in the office of the awarding agency at least five (5) working days prior to awarding the

F. Disposition of Quotes:

1. Upon quote opening, 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. Should a bidder desire to keep any or all components of their response to this RFQ confidential, the bidder would need to obtain a protective order from a court of competent jurisdiction.

G. Tax Delinquency Disclaimer:

1. Pursuant to the Public Contract Code section 10295.4, persons or companies identified as the largest tax delinquents by the Franchise Tax Board (FTB) or the Board of Equalization (BOE) are ineligible to enter into any agreement with the state for non-IT goods or services. Any agreement entered into in violation of section 10295.4 is void and unenforceable.

Prior to executing any state agreement or renewal for non-IT goods or services, the DSH shall verify that the proposed awardee(s) is not on a prohibited list by checking both the FTB and BOE websites. The established lists can be found at:

i. FTB: https://www.ftb.ca.gov/aboutFTB/Delinquent_Taxpayers.shtml

ii. BOE: http://www.boe.ca.gov/cgi-bin/deliq.cgi

V. PREFERENCE AND INCENTIVE PROGRAMS

A. Disabled Veteran Business Enterprise Program and Incentive:

1. An incentive for bidders who include DVBE participation is available and encouraged for this

RFQ. For evaluation purposes only, DSH shall apply an incentive to bids that include California certified DVBE participation and confirmed by the DSH. The incentive amount will vary in conjunction with the percentage of DVBE participation in accordance with the following formula:

DVBE Incentive Participation DVBE Incentive

5% or Over 5% 4% to 4.99% Inclusive 4% 3% to 3.99% Inclusive 3% 2% to 2.99% Inclusive 2% 1% to 1.99% Inclusive 1%

2. The net bid price of responsive bids with DVBE participation will be reduced (for evaluation purposes only) by the amount of DVBE incentive as applied to the lowest responsive net bid price. If the #1 ranked, responsive, responsible bid is a California certified small business, the only bidders eligible for the incentive will be other California certified small businesses. The incentive adjustment for awards based on low price cannot exceed 5% or $50,000.00, whichever is less, of the #1 ranked net bid price.

Department of State Hospitals RFQ Number: 16-20002-000

3. Information submitted by the bidder to claim the DVBE incentive will be verified by the DSH.

Only the DVBEs who shall perform a commercially useful function relevant to the Scope of Work included in this RFQ may be used to qualify the bidder for a DVBE incentive. All DVBE bidders and their proposed subcontractors must submit a copy of the DVBE Declarations Form (Std. 843). See Attachment 11.

4. Disabled Veteran Business Enterprise Incentive Example (Single Award):

Bidder A Bidder B

Bidder Status SB w/3% SB

Incentive Applicable? X

Original Bid Amount $105,000 $102,500

Apparent Low Bid

X

Incentive Qualified 3% 0%

Incent. Amount (% of Low Bidder) $3,075 $0.00

Revised Bid $101,925 $102,500

Revised Lowest Bidder X

5. Explanation of Example:

The lowest bidder at the time of bid opening is Bidder B, which is a SB not claiming a DVBE subcontracting incentive. Bidder A claims (and qualifies for) a DVBE incentive of three (3) percent. To apply the incentive, three (3) percent of Bidder B’s bid is subtracted from Bidder A’s bid, resulting in a revised bid of $101,925. After applying the incentive, Bidder A’s revised bid ($101,925) is less than the other bid, making them the revised apparent low bidder.

Note: since the preferences are used only for computation purposes to determine the successful bidder, if an agreement was awarded to Bidder A, it would be at the original $105,000 amount.

B. Calculation of Multiple Preferences:

1. In the event that bidders qualify for the SB preference and/or the DVBE incentive, the SB preference shall be calculated first. In circumstances where the DSH will award a single agreement as a result of this solicitation, in accordance with Government Code section 14838, subdivision (f), the DVBE incentive will not be calculated if, after the application of the SB preference, an SB bidder is the apparent low bidder unless another SB bidder is also a DVBE or has subcontracted with DVBE firms.

Note: in accordance with Government Code section 14838, subdivision (f), in the event of a precise tie between a small business or microbusiness, and a disabled veteran-owned small business or microbusiness, the agreement shall be awarded to the disabled veteran-owned small business or microbusiness.

C. Other Preference Programs:

1. Additional preference programs exist and may be applicable. Specifically the Target Area

Contract Preference Act (TACPA). For information regarding these programs please see the following website: http://www.dgs.ca.gov/pd/Programs/DisputeResolution.aspx

Department of State Hospitals RFQ Number: 16-20002-000

D. Additional Small Business and Disabled Veteran Enterprise Information:

1. Adherence to the DVBE Requirements:

i. Failure of Contractor to seek substitution and adhere to the DVBE participation level identified in the quote or offer may be cause for agreement termination, recovery of damages under rights and remedies due to the State, and penalties as outlined in Military & Veterans Code section 999.9; Public Contract Code section 10115.10 or Public Contract Code section 4110 (applies to public works only). Contractor must immediately notify the DSH’s SB/DVBE Advocate that the substitution of a DVBE subcontractor is requested.

ii. Failure of Contractor to adhere to the certification requirements of Military and Veterans Code section 999.5, subdivision (d) may be used as evidence of the bidder’s non-responsibility in future solicitations.

2. Commercially Useful Function (CUF) Disclaimer

Each certified SB/MB or DVBE must perform a commercially useful function. Bidders who are found to not be performing a CUF will have their quotes deemed non-responsive. A SB/MB or DVBE is deemed to perform a commercially useful function when the business does all of the following:

i. Is responsible for the execution of a distinct element of the work of the agreement.

ii. Carries out its obligation by actually performing, managing, or supervising the work involved.

iii. Performs work that is normal for its business services and functions.

iv. Is responsible, with respect to products, inventories, materials, and supplies required for the agreement, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment.

v. Is not further subcontracting a portion of the work that is greater than that expected to be subcontracted by normal industry practices.

Agreements resulting from this solicitation shall afterwards be monitored for compliance with CUF for the duration of the agreement.

VI. REQUIRED ATTACHMENTS

A. Listing of Attachments:

i. Attachment 1 Bid Submission Checklist

ii. Attachment 2 Bidder’s Certification

iii. Attachment 3 Minimum Qualifications Response

iv. Attachment 4 Bidder’s References

v. Attachment 5 Bidder’s Rate Sheet(s)

vi. Attachment 6 Bidder Declaration Form (GSPD-05-105)

vii. Attachment 7 Payee Data Record (Std. 204)

viii. Attachment 8 Contractor Certification Clauses (CCC-307). The CCC-307 can

Department of State Hospitals RFQ Number: 16-20002-000 also be found on the Internet at www.ols.dgs.ca.gov/Standard+Language.

ix. Attachment 9 Insurance Certifications

x. Attachment 10 Darfur Contracting Act Certification (Only if applicable)

xi. Attachment 11 DVBE Declarations Form (Std. 843)

xii. Attachment 12 Sample Standard Agreement (Std. 213 and Exhibits)

Note: attachment 12 is included for reference only. Only the successful bidder will submit these documents, when requested by DSH.

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 1

Quote Submission Checklist

Complete this checklist to confirm the items in your quote. For your quote to be considered responsive, Attachments 1 through 11 in this checklist must be submitted by the Quote Submittal Deadline indicated in this RFQ. Include this checklist with your quote package.

Contractor Name: ____________________________________________________________________

Attachment Name of Attachment

______ Attachment 1 Bid Submission Checklist

______ Attachment 2 Bidder’s Certification

______ Attachment 3 Minimum Qualifications Response

______ Attachment 4 Bidder’s References

______ Attachment 5 Bidder’s Rate Sheet

______ Attachment 6 Bidder Declaration Form (GSPD 05-105)

This form is not included in this IFB. Please obtain from the following web site:

http://www.documents.dgs.ca.gov/pd/delegations/GSPD105.pdf

______ Attachment 7 Payee Data Record (Std. 204)

This form is not included in this IFB. Please obtain from the following http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

______ Attachment 8 Contractor Certification Clauses (CCC – 307)

______ Attachment 9 Insurance Certification

______ Attachment 10 Darfur Contracting Act Certification (only if applicable)

______ Attachment 11 DVBE Declarations Form (Std. 843)

This form is not included in this IFB. Please obtain from the following http://www.documents.dgs.ca.gov/pd/poliproc/STD-843.pdf

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 2

Bidder’s Certification

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

By signing below, the bidder represents and warrants that statements and representations contained in the documents and data submitted in connection with this quote are true and correct. In the event the bidder’s submittal in connection with this quote contains false statements or misrepresentations of fact, the quote may be rejected or any succeeding contract terminated for cause and the bidder deemed to be a non-responsible bidder which may adversely affect future quotes submitted by the bidder. In addition, any misrepresentation of fact or fraud in connection with an attempt to secure a state contract, could result in legal action being taken against the bidder.

An Unsigned Bidder’s Certification May Be Cause for Rejection

Company Name Telephone Number Fax Number

Address Email

Name Title

Original Signature Date

California Certified Small Business or Disabled Veteran Business Enterprise Number

California Certified Disabled Veteran Business Enterprise Number:

California Certified Small Business Number:

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 3

Minimum Qualification Response

Bidder’s Name: _________________________________________________________________

Minimum Qualification Bidder's Response Bidder must submit a copy of their license to do business in the State of California as applicable.

Business License(s) Included?

Yes No N/A

Bidders must certify that they are and will continue to meet all terms and conditions for operating a business in the city/county in which the business is headquartered.

Do you so certify?

Yes No

Bidders which are corporations shall submit a printout from the California Secretary of State website which shows that their corporation is currently in good standing.

Printout included?

Yes No N/A

Bidder must provide three (3) references from customers as described in II. Minimum Qualifications (MQ), Section C., References.

References included?

The bidder certifies that they understand the insurance requirements and, if awarded an agreement, shall sign and return two (2) originals of the Standard Agreement signature pages (Std. 213) and any required insurance documents as directed.

Email: _____________________________________________________________

Do you so certify?

Bidders must provide with their quote package a current and valid active C-7 Low Voltage Systems Contractor License as issued by the State of California Contractors State Licensing Board.

License included?

Bidders must submit proof of California Small Business Certification issued by the California Department of General Services, Office of Small Business and DVBE Services (OSDS).

Proof included?

I, the undersigned, declare that the certifications required above are true and that I am authorized to make such certifications and bind the bidder contractually

Signature of Declarer Print First and Last Name Date Signed

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 4

Bidder’s References

Bidder must provide a list of three (3) references from customers for whom the bidder has provided services of the same nature and type as those outlined in this solicitation. References submitted must be for services provided in the past two (2) years (from the date of this solicitation).

References Name of Company

Address

Contact Name

Telephone

Email Address

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 5

Bidder's Rate Sheet

Important Considerations:

1. The bidder shall set forth the bid rates in clear, legible figures in the space provided.

2. By submitting a bid, the bidder agrees that his or her final bid constitutes an irrevocable offer which shall be valid for 180 calendar days from the bid submission date.

3. The DSH does not expressly or by implication agree that the actual amount of work will correspond therewith and reserves the right to omit portions of the work as may be deemed necessary or advisable by the DSH. The estimates listed below are a good faith estimate and are not a guarantee of business and is subject to change depending on services needed. The amounts indicated below will be used solely for comparison of bids. The DSH makes no guarantee, expressed or implied for actual number of hours to be used. However, the actual rates quoted by the bidder shall be binding for the term of the

4. Telephone Repair Services Rates:

Fiscal Year 2016/2017 (July 1, 2016 – June 30, 2018)

Type of

Service

Rate per hour

Estimated # of Hours per

Week

Estimated

Weekly Cost

# of Weeks per Annum

Total Annual

Cost

Repair per hour

X 25 Hours =

$ X 52 Weeks =

Rate per hour

Estimated # of Instances per Year

Minimum

Number of

Hours

Projected

Overtime

X 10 X 2 Hours

Fiscal Year 16/17 Total Cost

Department of State Hospitals RFQ Number: 16-20002-000

Fiscal Year 2017/2018 (July 1, 2017 – June 30, 2018)

Service

Rate per hour

Estimated # of Hours per

Week

Estimated

Weekly Cost

# of Weeks per Annum

Total

Annual Cost

X 20 Hours = per hour

Estimated # of Instances per Year

Minimum

Number of

Hours

Fiscal Year 17/18 Total Cost

Total Cost FY 2016-2017 =

Total Cost FY 2017-2018 =

GRAND TOTAL (July 1, 2016 – June 30, 2018)

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 6

Bidder Declaration Form (GSPD-05-105)

Form is located at the following web address:

http://www.documents.dgs.ca.gov/pd/delegations/GSPD105.pdf

ATTACHMENT 7

Payee Data Record (Std. 204) http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf

PLEASE SEE NEXT PAGE FOR CLARIFICATIONS REGARDING COMPLETING THE FORM

Department of State Hospitals RFQ Number: 16-20002-000

PAYEE’S LEGAL BUSINESS NAME

For Bidders with a Fictitious Name Permit (FNP) or a “Doing Business As” (DBA) name, enter your full legal name followed by your operational name.

Example: John Doe Plumbing, DBA Acme Plumbing Company.

BUSINESS ADDRESS

Enter the Remit to Address here.

MAILING ADDRESS

Enter the address used for correspondence. Do NOT enter the Remit to Address.

INDIVIDUAL OR SOLE PROPRIETOR

If the bidder is a sole proprietor, even if that bidder has a federal tax ID number, it is required that the bidder enter their social security number in the box provided.

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 8

Contractor Certification Clauses, CCC 307

CERTIFICATION

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

Contractor/Bidder Firm Name (Printed)

Federal ID Number

By (Authorized Signature)

Printed Name and Title of Person Signing

Date Executed Executed in the County of

1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 8103) (Not applicable to public entities.)

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

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

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

1) the dangers of drug abuse in the workplace;

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

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

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

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

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

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

Department of State Hospitals RFQ Number: 16-20002-000

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

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

4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003.

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

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

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

6. SWEATFREE CODE OF CONDUCT:

a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.

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

7. DOMESTIC PARTNERS: For contracts over $100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code section 10295.3.

Department of State Hospitals RFQ Number: 16-20002-000

DOING BUSINESS WITH THE STATE OF CALIFORNIA

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

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

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

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

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

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

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

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

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

Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem.

(Pub. Contract Code §10430 (e))

2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700)

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

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

Department of State Hospitals RFQ Number: 16-20002-000

5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:

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

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

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

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

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

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

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 9

Insurance Certification

This form reminds bidders of the insurance requirements that may be imposed by this solicitation and provides samples of some of the forms that they may be required to produce prior to being awarded an agreement.

Initial Certification

Bidder acknowledges that they have reviewed and understands the insurance requirements for this solicitation as described in Attachment 12, Sample Contract, Exhibit F, Insurance Requirements.

Bidder acknowledges that they have reviewed and understands the sample insurance forms provided with this attachment.

Bidder certifies that, if awarded an agreement, the bidder shall provide the DSH with all required insurance documents as may be applicable, in a timely manner. This includes, but may not be limited to:

Certificates of insurance showing the bidder’s insurance coverage types and limitations, Proof that the bidder has insured the State of California, its officers, employees, and agents. Bidder further understands that this proof shall come in the form of either:

� An endorsement to the bidder’s insurance policy (Form CG 20 37 10 01 or similar), � A copy of the bidder’s current insurance policy that shows that the policy already insures all parties required to be insured by this Agreement.

Bidder certifies that, should Commercial General Liability insurance be required, and should the bidder use a subcontractor to complete a portion of this Agreement, the bidder shall either:

� Include the subcontractor as an additional named insured under the bidder’s policy, � Ensure that each subcontractor is insured under their own Commercial General Liability policy.

Bidder acknowledges that they understand that the DSH reserves the right, at its sole discretion, to cancel a proposed award to a bidder who does not submit the required documentation described herein.

Bidders are reminded that there is no requirement to submit proof of insurance with their bid. Proof of insurance shall only be required of those firms awarded a contract.

Department of State Hospitals RFQ Number: 16-20002-000

ACORD CERTIFICATE

This is a sample insurance certificate.

ENDORSEMENT

Language on this certificate indicating that the State is an additional insured is not sufficient to meet the requirements of Exhibit F.

INSURED

The name in this box MUST match the name listed in the PAYEE’S LEGAL BUSINESS NAME field on the Std. 204.

TYPE OF INSURANCE and LIMITS Each required insurance type, with the exception of Worker’s Compensation and Professional Liability, must be listed on the certificate.

CERTIFICATE HOLDER

This box must be completed as indicated in Exhibit F, section 4.

POLICY EXP.

All required insurance types must be active (not expired). If an insurance policy expiration date is impending, awarded firms are advised to be ready to submit an updated certificate with the renewal dates.

Department of State Hospitals RFQ Number: 16-20002-000

“BLANKET ENDORSEMENT”

Section g. is an example of an existing insurance policy that contains a provision naming a contracted party an additional insured.

POLICY OR FORM NUMBER

A blanket endorsement such as this MUST be reconcilable to the insurance certificate. To ensure that they are reconcilable, ensure that the blanket endorsement contains either the policy number or a form number that is also clearly referenced on the insurance certificate.

Department of State Hospitals RFQ Number: 16-20002-000

TRADITIONAL ENDORSEMENT

This is an example of an endorsement amending an insurance policy to add the state as an additional insured.

POLICY OR FORM NUMBER

Like a blanket endorsement, this traditional endorsement must be reconcilable to the insurance certificate.

A policy or form number that is also referenced on the insurance certificate must be present on the endorsement.

ADDITIONAL INSURED LANGUAGE

As required in Exhibit F, the “State of California, its officers, employees, and agents” must be listed as the additional insured parties. However, this endorsement may be limited to just the operations under the Agreement.

Department of State Hospitals RFQ Number: 16-20002-000

ATTACHMENT 10

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 or bid.

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 section 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 #2 – WRITTEN PERMISSION FROM DGS

Pursuant to Public Contract Code section 10477, subsection (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.