STD1000_-_Generative_AI_Form_(rev._07-2024).pdf
PDF 301 KB Posted
- Attached to
- RFQ-2024-IDR6-007, Pheasants
- Solicitation number
- 0000032370
- Issued by
- San Bernardino County, California
About this file
The document is a Generative Artificial Intelligence (GenAI) Reporting and Factsheet from the California Department of General Services Procurement Division. The form requires bidders or offerors to provide details about any GenAI technology, model, service, or system they or their subcontractors will be using in performing the contract. Information required includes the GenAI model name, version, and owner, a product description, use cases, intended information domain, and an explanation of how the GenAI system will not adversely impact decisions related to housing, education, employment, credit, healthcare, and criminal justice. Bidders must complete and submit this form with their response to the solicitation.
The related state and local contract opportunity is an RFQ-2024-IDR6-007 for live, healthy, male-only ring-neck pheasants needed for hunt events hosted by the state of California between November 2024 and January 2025.
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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: Reporting 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) All Model Names/ Owners for The Solution or Offering
STD 1000 (REV. 07/2024)
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.
2. Applications / Product Owner
(GenAI powered or driven)
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) and 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. Applications/Product Owner (GenAI powered or driven):
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
| 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: |
| Solicitation Contract Number: |
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