Solicitation___25AG0024.pdf

STATE OF CALIFORNIA — DEPARTMENT OF STATE HOSPITALS Gavin Newsom, Governor

DEPARTMENT OF STATE HOSPITALS

Solicitation Number:

DSH 2010 - Revised 08/22/23

Except as outlined in PCC 12156 (b), it is unlawful to prohibit a printer or duplication cartridge that is sold to the State from being remanufactured or recycled.

5/17/2026 to file a full and complete written statement specifying in detail the ground of the protest and the facts in support thereof

5% 4% to 4.99% inclusive 4% 3% to 3.99% inclusive 3%

5% or Over

Small-Business Pref.: DGS.ca.gov - Small Business Preference

4/30/2026 to submit a written request to have notice of proposed award publicly posted

Post-Award Protests In accordance with PCC 10306, the following are the key action dates related to Post-Award Protests. All dates are Close of Business (COB).

5/7/2026 to submit a protest to the awarding department/buyer concerning the proposed contract award

DVBE Waiver Notification:

The DVBE Program requirement is either not applicable or is waived for this solicitation and resulting contract.

Tie Breaking Ties between bidders will be resolved in accordance with GC 14838 and CCR, Title 2,

1896.6. If a tie remains, a witnessed coin toss will determine the winner.

DVBE Incentive An incentive will be given to bidders who provide DVBE participation either as DVBEs or through subcontracting. The following percentages will apply:

DVBE Participation Incentive

GENAI Disclosure & Factsheet

The State of California seeks to realize the potential benefits of GenAI, through the development and deployment of GenAI tools, while balancing the risks of these new technologies. Bidder / Offeror 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

Bidder Declaration Form Requirements: DGS.ca.gov - Bidder Declaration Use and Evaluation Procedure

Bidder Instructions: DGS.ca.gov - Bidder Instructions

10333 El Camino Real Atascadero, CA 93422

805-468-2651 amy.goodman@dsh.ca.gov

25AG0024

The Department of State Hospitals (DSH) would like to request a quote from your company, which will be awarded to the lowest cost vendor. If your company/firm is interested in bidding, please note that the following provisions and instructions are in force for this solicitation. Bidders are advised to read each document.

Classification: Non-Information Technology (Non-IT)

Recycled Products Requirement

Recycled products shall be offered and/or used to the maximum extent economically feasible.

Solicitation Method: Competitive (Advertised)

General Provisions: DGS.ca.gov - General Provisions

DEPT. OF STATE HOSPITALS - ATASCADERO

10333 El Camino Real Atascadero, CA 93422

Amy GoodmanApril 29, 2026 https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts https://www.dgs.ca.gov/PD/Resources/Page-Content/Procurement-Division-Resources-List-Folder/Required-Language-for-Solicitations-and-Contracts 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DEPT. OF STATE HOSPITALS - ATASCADERO

Cert. #:

1.

2.

3.

4.

X

Non-Competitive Bid05/18/2605/15/2625AG0024

REQUEST FOR QUOTATION

ATTACHMENT A - BIDDER'S INFORMATION AND CERTIFICATIONS

SOLICITATION SPECIFICS:

Solicitation Number: Solicitation Due Date: Solicitation Eval Date: Evaluation Method:

Delivery Location:

Receiving Dock: 10333 El camino Real, Atascadero, CA 93422 Specific Instructions/Requirements (if any):

Receiving Dock Hours: Monday through Friday, 0700am-0300pm, excluding holidays

BIDDER'S INFORMATION

Firm's Legal Name: Seller's Permit / Cert. of Registration #:

Firm's Address: City, State, and Zip:

Bidder's FEIN Number: Claiming SB/MB or Non-SB Pref.? Certified DVBE? Cert. #:

Approximate Lead Time: Product Warranty Period: Date Quote Expires DVBE Participation %:

That I am duly authorized to legally bind the prospective Contractor to the specifications, clauses, and requirements of this solicitation and its attachments;

BIDDER'S REPRESENTATIVE

Designated Contact Person: Phone Number: E-Mail:

BIDDER'S CERTIFICATIONS

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY, and under the laws of the State of California, the following:

That the information provided is accurate to the best of my knowledge;

That the products I have identified in Attachment B meet the specifications as they are written in this solicitation and its attachments; AND

That I have understood and shall comply with the terms, conditions, and requirements as outlined in this solicitation and its attachments, including but not limited to, the General Provisions and Bidder's Instructions as referenced herein.

Printed Name and Title of Signatory:

Signature: Date Executed:

YES NO YES NO

DEPT. OF STATE HOSPITALS - ATASCADERO

Solicitation #: 25AG0024 Vendor Name:

Quotation Award

# DESCRIPTION OF GOODS / SERVICES QTY UOM UNIT PRICE EXTENSION

1 FastPak Elite Ribbon Item # 51022490A 40 CS $ - 2 FastPak Elite Narrow Non-Humid Paper, Item # 29132000 60 CS $ - 3 $ - 4 $ - 5 ***Delivery Schedule to be Provided when Awarded*** $ - 6 $ - 7 $ -

SHIPPING OPTIONS Initial Date

1 No shipping Fee is associated with this quote

2 ADD Shipping (Non Taxable)

3 ADD Shipping and Handling (Taxable)

SUBTOTAL:

OTHER, NON-SHIPPING * CHARGES:

TOTAL:

*: Do NOT include tax in your pricing. Tax will be added later.

REQUEST FOR QUOTATION

ATTACHMENT B - GOODS AND SERVICES PRICING PAGE

Response Disclaimer:

Solicitations sent to any other email will not be considered. To be considered, all pages of the emailed solicitation that are received prior to the bid solicitation deadline specified in the solicitation will be considered "the complete solicitation". Supplier shall carefully review all documents referenced and made a part of this solicitation to ensure that all information required to properly respond to the solicitation has been received or made available and all requirements are priced in the solicitation. Failure to examine any document, drawing, specification, or instruction will be at the supplier's sole risk.

Soliciting Office: Return E-Mail Address:

DSH-Procurement amy.goodman@dsh.ca.gov

Amount mailto:amy.goodman@dsh.ca.gov mailto:amy.goodman@dsh.ca.gov mailto:amy.goodman@dsh.ca.gov

DEPT. OF STATE HOSPITALS - ATASCADERO

Solicitation #: 25AG0024 Vendor Name:

Form Name Form Form Description Darfur Contracting Act Certification Darfur Public Contract Code section 10475, et. seq. prohibits state agencies from doing business with vendors which have certain business dealings with the Sudan. This form documents that the bidder has no such relationships and is therefore eligible to bid.

Payee Data Record STD204 This form provides the awarding department the bidder's legal name and address, corporate status, and tax identification number.

Bidders Declaration Form GSPD-05-106 This form is used to capture subcontractor information and is used to determine whether a bidder is performing a commercially useful function, as required by statute.

DVBE Declarations Form STD843 This form documents the ownership and broker-status of a disabled veteran business enterprise.

Recycled Content Certification Form CalRecycle074 Effective 1/1/23 PCC 12201.c.2. During bid evaluation, DSH reserves the right to award to the vendor who meets recycled products content in lieu of lowest bid. Not in excess of 10% greater total cost than nonrecycled products.

Contractor Certification Form CCC Only required if the vendor will be performing services within the PO or if your request is for a Short Form Contract.

Insurance Requirements Exhibit G See

Attached (If Applicable)

The attached exhibit is hereby incorporated into this solicitation. By signing this solicitation, the bidder represents that they have read and agree to the contents of the exhibit.

Voluntary Statistical Data Sheet VSDS Utilized to track reporting data.

The Department of State Hospitals shall make available to each bidder the forms checked below by double clicking the form name under the "Form" header. However, failure on the part of the DSH to provide each form does not excuse the bidder from their responsibility to submit the required forms with their bids. Bidders are hereby advised that they may locate copies of each of the forms below at the Department of General Services' website, at www.pd.dgs.ca.gov. Bidders may also contact the Buyer for this solicitation and request a copy of some or all of these forms prior to the due date for the solicitation, and if the forms were not provided with the solicitation itself.

Required Forms Disclaimer:

If a box is checked below, the corresponding form must be submitted with a bidder's bid before the solicitation due date. Other forms not check may be required after the close of the solicitation and prior to award. Failure on the part of the bidder to submit those forms may be grounds for disqualification.

REQUEST FOR QUOTATION

ATTACHMENT C - REQUIRED FORMS

Provision of Required Forms Disclaimer: