STD1000_GenArtificial_Intelligence_Disclosure.pdf

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Attached to
Addendum 1: Wheelchair mobility device
Solicitation number
118-276600
Issued by
California

About this file

This document is the Generative Artificial Intelligence (GenAI) Reporting and Factsheet from the State of California Department of General Services. It requires bidders or offerors to disclose if they or their subcontractors will be using GenAI technology, models, services, or systems as part of a state contract. If yes, the bidder must provide details about the GenAI system, including the model name, version, applications, product description, use cases, and intended information domain. The bidder must also explain how the GenAI system will not adversely impact decisions related to housing, education, employment, credit, healthcare, and criminal justice.

The form requires the bidder's signature to certify the information provided. If any new or previously unreported GenAI use is identified in the future, the bidder must submit an updated form to the awarding department. This reporting requirement is intended to ensure transparency and responsible use of GenAI technology in state contracting.

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STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES

GENAI REPORTING AND FACTSHEET PROCUREMENT DIVISION

STD 1000 (REV. 07/2024)

Generative Artificial Intelligence (GenAI) Reporting and Factsheet

Section 1: Bidder / Offeror / Contractor Information

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

Business Name Business Telephone Number

Business Address City State Zip Code

Contract / Description of Purchase

Section 2: Disclosure and Factsheet

Will you and/or your subcontractor(s) be using or offering GenAI technology, model, service, or system (collectively, “product”)? Yes No (If no, skip to Signature section of this form.)

If yes, provide details regarding the GenAI system. See GenAI Reporting and Factsheet Instructions at the end of this form for more information.

Failure to provide information requested on this form may result in disqualification or may void any resulting contract.

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

STD 1000 (REV. 07/2024)

2. (GenAI powered, or driven), applications / product owner

3. Product Description

4. Use Case(s)

5. Intended Information Domain

6. Explain how the GenAI system is not adversely affecting decisions that materially impact access to, or approval for, housing or accommodations, education, employment, credit, health care, and criminal justice.

Signature

By signing this document, I have identified and reported any GenAI use in the performance of this contract. If any new or previously unreported GenAI use is identified in the future in the performance of this contract, we will complete and submit to the State an updated STD 1000.

Signature Date

Submit completed form to the awarding department

STD 1000 (REV. 07/2024)

GenAI Reporting and Factsheet Instructions

Please use the following definitions and instructions to complete the GenAI Reporting and Factsheet:

1. GenAI Model Name, LLM Version (including number of parameters) & list ALL model names/owners for the solution or offering

a. Definition: The unique identifier or name assigned to the specific GenAI model or service.

b. Purpose: Allows users to refer to and distinguish between different GenAI models.

2. (GenAI powered, or driven), applications/product owner:

a. Definition: The name of the organization or entity responsible for creating or deploying the GenAI model or service.

b. Purpose: Helps identify the source and accountability for the GenAI system.

3. Product Description:

a. Definition: A concise summary of the GenAI model’s purpose, functionality, and key characteristics.

b. Purpose: Provides a high-level understanding for users and stakeholders.

4. Use Case(s):

a. Definition: The intended use or goal of the GenAI model (e.g., image recognition, natural language processing, text summarization).

b. Purpose: Helps users assess whether the GenAI model aligns with their needs.

5. Intended Information Domain:

a. Definition: The context, subject matter, or domain for which the GenAI model is designed to operate effectively.

b. Purpose: Helps users determine if the GenAI model is suitable for their specific use case.

6. Adverse Impact:

a. Explain below how you are ensuring the GenAI system is not adversely affecting decisions that materially impact access to, or approval for, housing or accommodations, education, employment, credit, health care, and criminal justice.

7. Signature:

a. The signatory for the Contract shall also sign the STD 1000

Solicitation Contract:
Number Bidder ID Vendor ID optional:
Business Name:
Business Telephone Number:
Business Address:
City:
State:
Zip Code:
Yes: Off
No If no skip to Signature section of this form: Off
1 GenAI Model Name LLM Version including number of parameters list ALL model namesowners for the solution or offering:
2 GenAI powered or driven applications product owner:
3 Product Description:
4 Use Cases:
5 Intended Information Domain:
6 Explain how the GenAI system is not adversely affecting decisions that materially impact access to or approval for housing or accommodations education employment credit health care and criminal justice:
Date:
Contract / Description of Purchase:

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