STD_816_-_DVBE_Exemption_Request.pdf
PDF 120 KB Posted
- Attached to
- NCR-HQ-RFQ-25-E0023 Interpretive Panels
- Solicitation number
- 0000037948
- Issued by
- California
About this file
This is a Disabled Veteran Business Enterprise (DVBE) Exemption Request form (STD 816) issued by the California Department of General Services for the state and local contract opportunity NCR-HQ-RFQ-25-E0023 for Interpretive Panels and Posts. The form permits state departments to request approval to exempt procurement activities from DVBE Program Requirements and/or DVBE Incentive provisions. Departments must select one of three exemption options: exempt DVBE Program Requirements while including the DVBE Incentive, exempt the DVBE Incentive while including Program Requirements, or exempt both the DVBE Program Requirements and Incentive. The requesting department must provide the procurement identifier, contact information, and detailed justification for the exemption in the designated section. The form requires signatures and approval from both the department designee completing the request and the highest-ranking executive or designee.
The exemption request form is a standard administrative document used to establish exceptions to California's DVBE participation mandates for specific solicitations. Departments must submit one form per solicitation without bundling multiple procurements together. The form serves as the official request mechanism for departments seeking relief from DVBE requirements when circumstances warrant exemption, with the justification section functioning as the critical element supporting the exemption decision. All submitted forms require dual-level approval to ensure appropriate authorization and oversight of DVBE requirement deviations.
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Text version
STATE OF CALIFORNIA
DVBE EXEMPTION REQUEST
STD 8 16 (Rev. 09/20)
INSTRUCTIONS
Department of General Services
DEPARTMENT INFORMATION
DEPARTMENT (includes Boards, Commissions, and Associations)
PROCUREMENT IDENTIFIER(S) (include requisition number a nd estimated amount of purchase if applicable)
CONTACT NAME
BUSINESS STREET ADDRESS
BUSINESS MAILING ADDRESS (if different from Street Address)
BUSINESS PHONE BUSINESS EMAIL
THE DEPARTMENT REQUESTS TO:
EXEMPT the DVBE Program Requirements and INCLUDE the DVBE Incentive. Please ensure that:
• The reason for exempting the DVBE Program Requirements is provided in the Exemption Justification section below.
• The purchase indicates the DVBE Program Requirements have been exempted, but the DVBE incentive applies.
EXEMPT the DVBE Incentive and INCLUDE the DVBE Program Requirements. Please ensure that:
• The reason for e xempting the DVBE Incentive is provided in the Exemption Justification section below.
• The purchase indicates the DVBE Incentive has been exempted, but the DVBE Program Requirements apply.
EXEMPT the DVBE Program Requirements and the DVBE Incentive. Please ensure that:
• The reason for exempting the DVBE Program Requirements and the DVBE Incentive is provided in the Exemption Justification section below.
EXEMPTION JUSTIFICATION
Reason(s) f or excluding the DVBE Program Requirements and/or D VBE Incentive for this purchase:
SIGNATURE APPROVAL (Department designee completing the Std. 816)
PRINTED
NAME
TITLE
SIGNATURE
(Please click here to sign with a Digital ID) DATE
Use this form to request approval to exempt the Disabled Veteran Business Enterprise (DVBE) Program Requirements and/or DVBE Incentive. Submit one form per solicitation. Do not bundle multiple solicitations together. For additional information, see the State Contracting Manual.
SIGNATURE APPROVAL (Highest ranking executive or designee only)
PRINTED NAME TITLE
SIGNATURE (Please click here to sign with a Digital ID) DATE
Accessibility Report
Filename:
STD 816 Draft 5.pdf
Report created by:
Kevin Vang, IT Person, Kevin.Vang@dgs.ca.gov
Organization:
DGS, DGS
[Personal and organization information from the Preferences > Identity dialog.]
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| CONTACT NAME: |
| BUSINESS STREET ADDRESS: |
| BUSINESS MAILING ADDRESS if different from Street Address: |
| BUSINESS PHONE: |
| BUSINESS EMAIL: |
| PROCUREMENT IDENTIFIERS include requisition number and estimated amount of purchase if applicable: |
| Department: |
| Text1: |
| Exempt: Off |
| DATE: |
| TITLE: |
| PRINTED NAME: |
| PRINTED NAME1: |
| TITLE1: |
| DATE1: |
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