Edmund G. Brown Jr., Governor
State of California
Health and Human Services Agency
Department of Rehabilitation
721 Capitol Mall
Sacramento, CA 95814
May 17, 2012
Short Form Bid
Contract #12-04-07
Los Angeles and Kern Counties
Lock and Safe Installation Service and Repair
The department is soliciting short form bids for Lock and Safe Installation Service and Repair. The
term of this agreement will be July 1, 2012 through June 30, 2014.
Small Business and DVBE are encouraged to participate.
Services shall be provided in accordance with all terms and conditions contained in the attached
Scope of Work. The State does not accept alternate contract language from a prospective contractor.
A bid with such language will be considered a counter proposal and will be rejected. The State’s
General Terms and Conditions (GTC 610)
(http://www.ols.dgs.ca.gov/Standard+Language/default.htm) are not negotiable.
The deadline for submission of the completed Attachment 2 – Bid/Bidder Certification Worksheet is:
May 23, 2012, at 2:00 PM
Bids must be in written form and may be submitted via fax, hand delivery or U.S. mail.
For more details, download sample SFC contract.
Any questions regarding services to be performed should be directed to: Julie Sanchez
Request Submittal
Fax to or Email:
(916) 558-5681 or Julie.E.Sanchez@dor.ca.gov
Mail to/Hand Carry:
Julie Sanchez, Contract Analyst
721 Capitol Mall, 6th Floor
Sacramento, CA 95814
1
DOR Short Form BEP Bid Packet (Rev 05/10/12)
A) Work to be Performed
Type of Service
1) The Department of Rehabilitation's Business Enterprise Program (BEP) equipment is
located in State, Federal, County office buildings, privately owned building cafeterias, snack
bars and Refrigeration facilities.
2) The Contractor shall provide Lock and Safe Installation, Service, and Repair, including
replacement parts. The Contractor shall provide installation, preventive maintenance, service
and repair on electronic locks, combination locks, and key locks. Installation of key locks
may include, but is not limited to the following: door handles, dead bolts, padlocks, cabinet
locks security gates, refrigeration locks, and safes. Contractor will be required to change
combination locks on safes, when applicable. At the request of the Contract
Administrator/designee the contractor shall evaluate the equipment in need of repair and
provide a service recommendation should equipment need duplicate repairs in less than a
three (3) month time frame. This can include photos or written descriptions justifying
repeated service.
3) Timely services must be provided to ensure the BEP vendor has limited interruption of
business operations, the Contractor headquarters and/or off-site location must be within
100 mile radius of the requested location area. Locations listed on page(s) 8-9.
4) Services shall be provided at the facility location unless it absolutely necessary to remove the
item(s) for servicing at the Contractor’s shop. If any equipment must be removed for servicing
at the Contractor’s shop, the Contractor shall provide, at no cost to the State, a suitable
replacement until the unit has been repaired and installed.
5) Equipment is not to be removed for the location without the written approval of a Business
Enterprise Consultant (BEC) or a Supervisor BEC; No exceptions. Only when approval has
been received in writing granting authorization to remove equipment, shall the contractor
complete the "Equipment sign out control log" DR287.
6) The Contractor shall instruct the blind/visually impaired vendor on the repairs and operation
of the equipment and evaluate any problems. Contractor must be available for consultation
by phone, and the training of vendor on proper preventative maintenance.
7) Contractor may be used in an emergency, when the primary contractor is not available.
8) The contractor shall provide service listed on the Authorization for Repairs and Service (DR
1308) only. If additional work is required the contractor shall obtain approval from the
Contract Administrator/designee prior to additional work commencing.
9) All machines are to be serviced at the facility.
B) Locations
Los Angeles and Kern Counties. Locations and equipment are subject to change. See page(s)
8-9 for details.
C) Service Hours
All Services shall be provided six (6) days a week, excluding holidays, between the hours of
7:00 a.m. to 5:00 p.m. For work which needs to be accomplished before or after normal
working hours, a charge of one-and-one-half (1-1/2) times the bid rate will be granted. For
work which needs to be accomplished on a Sunday or official State holiday, an amount of
twice the bid rate will be granted. Prior authorization must be obtained, in writing, from the
Department of Rehabilitation's Contract Administrator and/or designee for time requested other
than normal working hours, Saturdays, Sundays, and official State holidays. A list of official
State holidays is available from the Department of Rehabilitation.
The Department of Rehabilitation may pay any applicable sales and use tax imposed by
another State.
2
DOR Short Form BEP Bid Packet (Rev 05/10/12)
D) Estimates
The Department of Rehabilitation’s Contract Administrator and/or designee has the authority to
request the Contractor to provide an estimate prior to authorizing any services.
E) Response Time
From the time the Department of Rehabilitation initiates a service request to the time the
service commences shall not exceed four (4) hours, unless an extension of time is approved
by the Department of Rehabilitation’s Contract Administrator and/or designee. Occasionally,
the State will inform the Contractor that an emergency condition exists and the Contractor shall
complete the required service within a six (6) hour period to the satisfaction of the State. In
general, service shall be completed within a reasonable and acceptable time period to the
State taking into consideration the nature and degree of the difficulty of the work involved.
Emergency shall be defined as a health and safety or hazardous working environment
situation. In general, service shall be completed within a reasonable and acceptable time
period to the State taking into consideration the nature and degree of the difficulty of the work
involved. In general, service shall be completed within a reasonable and acceptable time
period to the State taking into consideration the nature and degree of the difficulty of the work
involved.
F) Call Back Services
Should the Contractor fail to provide any of the specified services in the prescribed manner,
the State may call the Contractor to provide services within four (4) hours, unless otherwise
specified, at no additional cost to the State. All work shall be under warranty for thirty (30)
days from date of completed repair. Time and costs for call backs to previous repairs under
warranty shall be borne by the Contractor.
G) Notification
The Contract Administrator will notify the Contractor, via a Authorization for Repairs and
Service - DR 1308, of location(s) requiring service and location contact person. The
Contractor shall schedule service date(s) and time(s) with the BEP vendor and notify the DOR,
via email or phone, of service schedule, prior to work commencement. If the BEP vendor or
designee is not on site at the scheduled time and date, the Contractor is to leave the site
without doing any work and will charge the DOR one (1) hour at the contract labor rate. The
Contractor shall obtain the BEP vendor or designee’s signature on the Authorization for
Repairs and Service - DR 1308 upon work completion and verification that equipment is in
working order and submit signed Authorization for Repairs and Service - DR 1308 for
payment.
H) Verification of Arrival
The Contractor/service technician is required to have the location staff verify time of arrival on
the job site, as well as the time of departure. Location staff must be on site while the service is
being performed. Contractor shall not accept the Refrigeration keys from the operator.
Location staff has the authority to determine whether the service performed requires the
services of more than one (1) service technician. The Contractor shall leave a copy of the
work order signed by the location staff indicating: 1) minimum time of arrival; 2) time of
departure; and 3) general description of work performed at the location.
I) Parts and Materials
The charges for parts and materials shall not exceed twenty percent (20%) of the Contractor's
wholesale costs; excluding tax, i.e.; $100.00 parts cost x 20% x 7.75 (City Sales) Tax =
$129.30. Only original manufacturer parts and materials shall be used. Removed parts shall
be left at the location for State inspection. The maximum amount that may be charged per job
shall be $2,000.00. The maximum amount that may be charged per job may be increased with
the approval of the Supervising Business Enterprise Consultant/Contract Administrator or the
Business Enterprise Program Manager. See Sample Contract Exhibit B Invoicing and
3
DOR Short Form BEP Bid Packet (Rev 05/10/12)
Payments for parts and material cost reimbursements. Refurbished or rebuilt parts are not
allowed.
J) Freight Charges
Contractor will be allowed to recover freight or shipping costs for parts, with no allowance for
mark-up, by:
1) Itemizing the cost of freight or shipping on the invoice.
2) Attaching a copy of the freight or shipping invoice (original whenever possible) to the
invoice.
3) When the freight or shipping invoice includes costs not specifically associated with the
billing, the Contractor will only charge for the costs associated with the billing and note the
freight or shipping invoice accordingly.
K) Work Area
Contractor will ensure that the work area is kept clean and free of debris, as necessary, to
maintain a safe working environment for staff and, if performing services for the California
Department of Corrections and Rehabilitation, for inmates. While working on equipment,
contractor agrees to perform services with as little disruption to the State’s operations as
possible. All tools, equipment and other work materials belonging to the contractor will be
removed from the work location at the end of each working day. The State shall not be
responsible for storage of any contractor property.
L) State Property
1) It shall be the Contractor's responsibility to make all necessary arrangements with
office/building manager and local traffic authorities for use of elevators, loading docks,
adjacent streets, sidewalks, and/or malls.
2) Any damages by the Contractor to portions of buildings, premises, equipment, furniture,
material or other property for which the State is responsible will be repaired or items will be
replaced by Contractor to the satisfaction of the State with no expense to the State.
Contractor shall patch, replace and/or finish in kind all surfaces of features displaced, or
damaged in performance of work, such as but not limited to acoustical tile, floor covering,
and wall areas.
3) Contractor shall provide dust covers, temporary dust barriers, pads, etc., as required to
protect building occupants and contents during its operation. upon completion of the work,
there shall be no discrepancy between the new and existing work. Where existing surfaces
are painted, under the provisions of this paragraph, paint shall extend to the nearest natural
break.
4) Contractor shall paint or finish all new work, except factory-finished items, a minimum two
(2) coats to match existing adjacent area. Any items lost or stolen while in the Contractor's
custody will be replaced by the Contractor at no expense to the State/Federal government.
Contractor must receive approval from the State/Federal government to remove equipment
from a location.
5) Floors, walls, and ceilings of buildings, including elevators, will be adequately protected by
Contractor to prevent marring and scratching or other damages. The State may, itself, at its
option, repair any damage or replace any lost or stolen items and deduct the cost thereof
from Contractor's invoice.
6) Contractor shall keep site clean as work progresses. Upon completion of the work, all
surfaces involved in this project shall be clean of any foreign material. Contractor shall
remove all waste materials from the work site and dispose of same daily.
B) Insurance Requirements
Upon award of contract, the Contractor must furnish to the State a certificate of insurance stating
the following:
Basic Insurance Requirements
1. General Provisions Applying to All Policies
4
DOR Short Form BEP Bid Packet (Rev 05/10/12)
2.
1) Coverage Term – Coverage needs be in force for the complete term of the Agreement.
If insurance expires during the term of the Agreement, a new certificate must be
received by the State at least ten (10) days prior to the expiration of the insurance. Any
new insurance must still comply with the terms of the Agreement.
2) Policy Cancellation of Termination & Notice of Non-Renewal – Contractor shall
provide to the State within five (5) business days following receipt by contractor a copy
of any cancellation or non-renewal of insurance required by this agreement. In the event
contractor fails to keep in effect at all times the specified insurance coverage, the State
may, in addition to any other remedies it may have, terminate this agreement upon the
occurrence of such event, subject to the provisions of this Agreement.
3) Deductible – Contractor is responsible for any deductible or self-insured retention
contained within their insurance program.
4) Primary Clause – Any required insurance contained in this Agreement shall be primary,
and not excess or contributory, to any other insurance carried by the State.
5) Insurance Carrier Required Rating – All insurance companies must carry a rating
acceptable to the Department of General Services, Office of Risk and Insurance
Management. If the Contractor is self insured for a portion or all of its insurance, review
of financial information including a letter of credit may be required.
6) Endorsements – Any required endorsements must be physically attached to all
requested certificates of insurance and not substituted by referring to such coverage on
the certificate of insurance.
7) Inadequate Insurance – Inadequate or lack of insurance does not negate the
Contractor’s obligations under the Agreement.
Insurance Coverage
1) Commercial General Liability – Contractor shall maintain general liability on an
occurrence form with limits not less than $1,000,000 and $2,000,000 aggregate for
bodily injury and property damage liability. The policy must include coverage for
liabilities arising out of premises operations, independent contractors,
products/completed operations, personal & advertising injury, and liability assumed
under an insured agreement. This insurance shall apply separately to each insured
against whom claim is made or suit is brought subject to the Contractor’s limit of liability.
The policy must include this wording exactly:
“Department of Rehabilitation, State of California, its officers, agents,
employees and servants are included as additional insureds, but only with
respect to work performed under the Agreement.”
This endorsement must be supplied under form acceptable to the Department of
General Services, Office of Risk and Insurance Management.
In the case of Contractor's utilization of subcontractors to complete the contracted
scope of work, contractors shall include all subcontractors as insureds under
Contractor's insurance or supply evidence of insurance to the State equal to policies,
coverages and limits required of Contractor.
2) Automobile Liability – Contractor shall maintain motor vehicle liability with limits not
less than $1,000,000 combined single limit per accident. Such insurance shall cover
liability arising out of a motor vehicle including owned, hired and non-owned motor
vehicles.
5
DOR Short Form BEP Bid Packet (Rev 05/10/12)
The same additional insured designation and endorsement required for general
liability is to be provided for this coverage.
3) Workers Compensation and Employers Liability – Contractor shall maintain
statutory worker’s compensation and employer’s liability coverage for all its employees
who will be engaged in the performance of the Agreement. Employer’s liability limits of
$1,000,000 are required.
When is performed on State-owned or controlled property the workers'
compensation policy shall contain a waiver of subrogation in favor of the State.
The waiver of subrogation endorsement shall be provided.
4) If your business is a Sole Proprietorship and does not employ any other individual(s), a
signed statement on business letterhead stating, “I certify under penalty of perjury
under the laws of the State of California that I do not employ any person in any
manner as to become subject to the Workers’ Compensation laws of California. I
further certify that the Department of Rehabilitation will be notified within ninety
(90) days of any changes which results in the business becoming subject to the
Workers’ Compensation laws of the State of California" must be on file for this
agreement
C) BIDDER MINIMUM QUALIFICATIONS
1) Licenses and Permits
The Contractor shall be an individual or firm licensed to do business in California and shall
obtain at his/her expense all license(s) and permit(s) required by law for accomplishing any
work required in connection with this contract. A copy of your current license is required at
bid opening.
Contractor must provide a business license or business tax certificate from the city/county in
which you are headquarter is necessary, however, if you are a corporation, a copy of your
incorporation documents/letter from the Secretary of State’s Office can be submitted. A copy
of your current license will be required if an award is made.
In the event, any license(s) and/or permit(s) expire at any time during the term of this contract;
Contractor agrees to provide agency a copy of the renewed license(s) and/or permit(s) within
30 days following the expiration date. In the event the Contractor fails to keep in effect at all
times all required license(s) and permit(s), the State may, in addition to any other remedies it
may have, terminate this contract upon occurrence of such event.
2) Must be able to demonstrate at least 3 yrs experience providing similar equipment
supplies and installation. Contractor must be headquartered in one of the counties being
served under this agreement.
3) Special Licenses and Certificates: N/A
6
DOR Short Form BEP Bid Packet (Rev 05/10/12)
C) BID REQUIREMENTS AND INFORMATION
1) Key Action Dates
EVENT
DATE
SFC available to prospective bidders
Final Bid Submission Date & Opening
Anticipated Award Date
Contract Period
May 17, 2012
May 23, 2012 by 2:00pm
May 25, 2012
July 01, 2012 through June 30, 2014*
*This agreement is for two (2) years, but may be extended for time only at the State’s
discretion under the same terms and conditions.
2) Evaluation and Selection
a) At the time of bid opening, each bid will be checked for the presence of the required
information in conformance with the submission requirements of this SFC.
b) The State will evaluate each bid to determine its responsiveness to the published
requirements.
c) Bids 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.
d) Award if made, will be to the lowest responsive responsible bidder.
7
DOR Short Form BEP Bid Packet (Rev 05/10/12)
LA Kern
Lock and Safe
Location
#
111
245
245
246
247
248
256
256
275
304
304
337
394
394
418
428
428
473
473
473
494
515
555
570
616
622
622
629
629
635
712
819
827
827
832
832
832
844
844
844
Building
US. Court House
Kern County Welfare Office
Kern County Court House
LA County Court House
LA County Court House
LA County Court House
Juvenile Hall
US. Post Office
LA County Hall of Administration
LA County Hall of Records
Address
312 N. Spring street , LA 90012
100 E. California, St. Bakersfield, 93307
1415 Truxtun Ave. Bakersfield 93301
110 N. Grand Ave., LA 90012
435 w. First ST. LA 90012
111 N. Hill LA 90012
1601 Eastlake AVE. LA 90033
7001 S. Central , LA 90001
500 w. Temple LA 90012
227 N. Broadway, LA 90012
6150 Van Nuys Blvd. ,Van Nuys 91401State Office Building
3377
New Federal Building
300 N. Los Angeles St. LA 90012
LA County Courts Building
825 Maple St. Torrance 90503
Municipal Courts Building
111 E. Regent St, Inglewood 90301
Federal Office Building
11000 Wilshire Blvd. LA 90024
Superior Courts Building
12720 Norwalk Blvd. Norwalk 90650
Metropolitan State Hospital
11401 Bloomfield Avenue, Norwalk 90650
Rancho Los Amigos Hospital
7601 E. Imperial Hwy, Downey 90242-3456
Downey Municipal Courts
7500 E Imperial Hwy, Downwy 90242
Los Padrinos Juvenile Hall
7285 E. Quill Dr., Downwy 90242
Municipal Traffic Courts
1945 S. Hill LA 90007
LA CO Criminal Courts
210 West Temple Street , LA 90012
401 Golden Shore Drive, Long Beach
CA State Univ HDQTS
90801
Hubert Humphrey Medical Center
5850 S. Main St, LA 90003
LA CO Courthouse -Compton
200 W. Compton Blvd. Compton 90220
Rio Hondo Courts Bldg.
11234 Valley Blvd. El Monte, 91731
LA County Court
1427 W. Covina 91790
Long Beach Court House
415 W. Ocean Blvd. Long Beach 90802
Long Beach City Hall
333 W. Ocena Blvd., Long Beach 90802
Hudson Comp Healt Center
2829 So. Grand Ave. LA 90007
Ronald Reagan Bldg.
3rd and Spring St. LA 90013
Button Willow North and South Bound 1-5 North Bound Kern County 93206
US Post Office
28201 Franklin Pkwy Santa Clarita 91383
US Post Office
15701 Sherman Way, Van Nuys 91409
Bulk Mail Center
5555 Bandini Blvd. Bell 90201-9997
Van Nuys Municipal Courts
14400 Erwin St Mall, Van Nuys 91401
LA County Superior Courts
6230 Sylmar, Van Nuys 91401
WorldWay Postal Service Facility
5800 W. Century Blvd.LA 90009
US Post Office
3019 Bellflower St.Long Beach 90808
USPO East Long Beach Station
2727 E. Anaheim, Long Beach 90804
8
DOR Short Form BEP Bid Packet (Rev 05/10/12)
844
844
844
844
844
844
844
844
857
872
877
1001
1001
1004
1004
1004
1028
1028
1028
1028
1028
1028
886
USPO Nortt Long Beach Station
USPO Carson Branch Station
US Post Office N. Long Beach
USPO Loma Branch Station
USPO Pacific Avenue Station
US Post Office Atlantic Avenue
US Post Ofice Long Beach District
Alhambra Municipal Courts
California State Prison LA County
New Junipero Serra Espresso Bar
California Correctional Institute
Federal Building
LAX (TSA)
CAL Trans District 7 HQ
Metropolitan Detention Center
Cal Trans L.A.R.T.M.C
Superior Courts -Shafter Branch
Superior Courts - Lamont Branch
Superior Courts -Delano Branch
Juvenile Justice Center
Homeland Security (ICE)
Boron Roadside Rest East and West
LA County Sanitation
5101 Long Beach Blvd. Long Beach 90805
21350 Avalon Blvd., Carson 90745
300 N. Long Beach, Long Beach 90802
3540 E. 4th St. Long Beach 90803
1920 Pacific Ave. Long Beach 90806
4580 Atlantic Ave. Long Beach 90807
2300 Redondo Ave. Long Beach 908099441
150 Commonwealth Ave. Alhambra, 91801
44750 60th Street West, Lancaster 93536
320 West 4th Street , LA 90013
202 Tehachapi, Tehachapi 93561
15000 Aviation Blvd, Lawndale 90261
5757 W. Century Blvd.LA 90045
100 S. Main Street, LA 90012
535 W. Alameda St., LA 90012
2901 W.Broadway LA 91204
325 Central Valley Hwy. Shafter 93263
12022 Main Street Lamont 93241
1122 Jefferson St.Delano 93215
2100 College Avenue, Bakersfield 93305
800 Truxton Avenue, Bakersfield 93301
Kern CO Mile Post 139 Boron, 93516
1955 Workman Mill, Whittier, 90601
9
DOR Short Form BEP Bid Packet (Rev 05/10/12)
ATTACHMENT 1 - REQUIRED ATTACHMENT CHECK LIST
A complete SFC bid will consist of the items identified below. Complete this checklist to confirm
the items in your bid. Place a check mark or “X” next to each item that you are submitting to the
State. For your bid to be responsive, all applicable required attachments must be returned.
This checklist should be returned with your bid package also.
Attachment
Attachment Name/Description
_____ Attachment 1
Required Attachment Check List
_____ Attachment 2
Bid/Bidder Certification Sheet
_____ Attachment 3
SFC Bid Worksheet
_____ Attachment 4
GSPD-05-106 Bidder Certification Participation Sheet
_____ SFC Requirement
Proof of Current Insurance Certificate(s)
Commercial General
Liability, Automobile Liability
Workers Compensation and Employers Liability (If applicable)
_____ SFC Requirement
Proof of Current Business License(s), Business Tax Certificate or
Secretary of State’s incorporation document/letter.
_____ SFC Requirement
Small Business/DVBE Participation Requirements (If applicable)
Small Business Certification
DVBE Certification
10
DOR Short Form BEP Bid Packet (Rev 05/10/12)
ATTACHMENT 2
BID/BIDDER CERTIFICATION SHEET
This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as an entire
package with original signatures.
A.
Our bid is submitted as____________ PER hour. Note: Upon contract award, for cost reimbursements of
parts/materials under $100, the Contractor may submit a common parts price list or the Contractor will be required
to submit original receipt(s). For cost reimbursement of parts/materials $100 or more, original receipt(s) will be
required.
B.
All required attachments are included with this certification sheet.
C.
I have read and understand the DVBE participation requirements and have included documentation if Contractor
elects to meet participation goals.
D.
The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The
signature below authorizes the verification of this certification.
An Unsigned Bid/Bidder Certification Sheet May Be Cause For Rejection
1. Company Name
2. Telephone Number
(
)
2a. Fax Number
(
)
3. Address and Email Address
Indicate your organization type:
4.
Sole Proprietorship
5.
Partnership
6.
Corporation
Indicate the applicable employee and/or corporation number:
8. California Corporation No.
7. Federal Employee ID No. (FEIN)
9. Indicate applicable license and/or certification information:
10. Bidder’s Name (Print)
11. Title
12. Signature
13. Date
14. Are you certified with the Department of General Services, Office of Small Business and Disabled Veteran
Business Enterprise Services (OSDS)
a. California Small Business
Yes
No
If yes, enter certification number:
b. Disabled Veteran Business Enterprise Yes
No
If yes, enter your service code below:
NOTE: A copy of your Certification is required to be included if either of the above items is checked “Yes”.
Date application was submitted to OSDS, if an application is pending:
11
DOR Short Form BEP Bid Packet (Rev 05/10/12)
Completion Instructions for Bid/Bidder Certification Sheet
Complete the numbered items on the
Bid/Bidder Certification Sheet by following the instructions below.
Item
Numbers
Instructions
1, 2, 2a, 3
Must be completed. These items are self-explanatory.
4
Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one
person owns all the assets of the business in contrast to a partnership and corporation. The sole
proprietor is solely liable for all the debts of the business.
5
Check if your firm is a partnership. A partnership is a voluntary agreement between two or more
competent persons to place their money, effects, labor, and skill, or some or all of them in lawful
commerce or business, with the understanding that there shall be a proportional sharing of the
profits and losses between them. An association of two or more persons to carry on, as coowners, a business for profit.
6
Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or
under the authority of the laws of a state or nation, composed, in some rare instances, of a single
person and his successors, being the incumbents of a particular office, but ordinarily consisting of
an association of numerous individuals.
7
Enter your federal employee tax identification number.
8
Enter your corporation number assigned by the California Secretary of State’s Office. This
information is used for checking if a corporation is in good standing and qualified to conduct
business in California.
9
10, 11,
12, 13
14
Complete, if applicable, by indicating the type of license and/or certification that your firm
possesses and that is required for the type of services being procured.
Must be completed. These items are self-explanatory.
If certified as a California Small Business, place a check in the "Yes" box, and enter your
certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a
check in the "Yes" box and enter your service code on the line. If you are not certified to one or
both, place a check in the "No" box. If your certification is pending, enter the date your application
was submitted to OSBCR.
12
DOR Short Form BEP Bid Packet (Rev 05/10/12)
ATTACHMENT 3
BIDDER DECLARATION - GSPD-05-105
1. Prime bidder information (Review attached Bidder Declaration Instructions prior to
completion of this form):
a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): ____________ or None
____ (If “None”, go to Item #2)
b. Will subcontractors be used for this contract? Yes ___ No ___ (If yes, indicate the distinct element
of work your firm will perform in this contract e.g., list the proposed products produced by your firm,
state if your firm owns the transportation vehicles that will deliver the products to the State, identify
which solicited services your firm will perform, etc.). Use additional sheets, as necessary.
________________________________________________________________________________
______________________________________________________________________________
c. If you are a California certified DVBE:
(1) Are you a broker or agent? Yes ___ No ___
(2) If the contract includes equipment rental, does your company own at least 51% of the equipment
provided in this contract (quantity and value)? Yes ___ No ___ N/A ___
2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for
this contract. (Attach additional pages if necessary):
Subcontractor
Name Contact
Person
Phone Number &
Fax Number
Subcontractor
Address&
Email Address
CA Certification
(MB, SB, DVBE
or None)
Work performed
or goods
provided for this
contract
Corresponding
% of bid price
Good
Standing?
51%
Rental?
3. CERTIFICATION: By signing this form, I certify under penalty of perjury that the information
provided is true and correct.
Printed Name: ____________________________ Signature: _____________________________
Date Signed: __________________
State of California—Department of General Services, Procurement Division
GSPD–05–105 (EST 8/05) Written Version
Page_____ of _____
13
DOR Short Form BEP Bid Packet (Rev 05/10/12)
BIDDER DECLARATION Instructions
All prime bidders (the firm submitting the bid) must complete the Bidder Declaration.
1.a. Identify all current certifications issued by the State of California. If the prime bidder has no
California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder
possesses one or more of the following certifications, enter the applicable certification(s) on the line:
• Microbusiness (MB)
• Small Business (SB)
• Small Business Nonprofit Veteran Service Agency (SB/NVSA)
• Disabled Veteran Business Enterprise (DVBE)
1.b. Mark either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the
response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work
contained in the contract to be performed or the goods to be provided by the prime bidder. Do not
include goods or services to be provided by subcontractors.
Bidders certified as MB, SB, SB/NVSA, and/or DVBE must provide a commercially useful function as
defined in Military and Veterans Code Section 999(e)(2)(A) for DVBEs and Government Code Section
14837(d)(4)(A) for small/micro businesses. For questions regarding commercially useful function
determinations made in conjunction with certification approval, contact the Department of General
Services, Procurement Division, Office of Small Business and DVBE Certification (OSDC), OSDC
Certification and Compliance Unit via email at: osdchelp@dgs.ca.gov.
Bids must propose that certified bidders provide a commercially useful function for the resulting
contract or the bid will be deemed non-responsive and rejected by the State. For questions regarding
the solicitation, contact the procurement official identified in the solicitation.
Note: A subcontractor is any person, firm, corporation, or organization contracting to perform part of
the prime’s contract.
1.c. This Item is only to be completed by businesses certified by California as a DVBE.
(1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or “No”. The Military
and Veterans Code Section 999.2 (b) defines “broker” or “agent” as a certified DVBE contractor or
subcontractor that does not have title, possession, control, and risk of loss of materials, supplies,
services, or equipment provided to an awarding department, unless one or more of the disabled
veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies,
services, and of each piece of equipment provided under the contract.
(2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least
51% of the equipment provided (quantity and value). If not bidding rental equipment, mark “N/A”
for”“not applicable.”
2. If no subcontractors are proposed, do not complete the table. Read the certification at the bottom
of the form and complete “Page ___ of ___” on the form.
If subcontractors will be used, complete the table listing all subcontractors. If necessary, attach
additional pages and complete the “Page ___ of ___” accordingly.
Subcontractor Name, Contact Person, Phone Number & Fax Number—List each element for all
subcontractors.
Subcontractor Address & Email Address—Enter the address and if available, an Email address.
CA Certification (MB, SB, DVBE or None)—If the subcontractor possesses a current State of
California certification(s), verify on the OSDC website (www.pd.dgs.ca.gov/smbus) that it is still valid
and list all current certifications here. Otherwise, enter “None”. [Note: A SB/NVSA should not be
participating as a subcontractor]
Work performed or goods provided for this contract—Identify the distinct element of work
contained in the contract to be performed or the goods to be provided by each subcontractor.
Certified subcontractors must provide a commercially useful function for the contract. (See paragraph
1.b above for code citations regarding the definition of commercially useful function.) If a certified
subcontractor is further subcontracting a greater portion of the work or goods provided for the
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DOR Short Form BEP Bid Packet (Rev 05/10/12)
resulting contract than would be expected by normal industry practices, attach a separate sheet of
paper explaining the situation.
Corresponding % of bid price—Enter the corresponding percentage of the total bid price for the
goods and/or services to be provided by each subcontractor. Do not enter a dollar amount.
Good Standing?—Provide a response for each subcontractor listed. Enter either “Yes” or “No” to
indicate that the prime bidder has verified that the subcontractor(s) is in good standing for all of the
following:
• Possesses valid license(s) for any license(s) or permits required by the solicitation or by law
• If a corporation, the company is qualified to do business in California and designated by the State of
California Secretary of State to be in good standing
• Possesses valid State of California certification(s) if claiming MB, SB, and/or DVBE status
• Is not listed on the OSDC website as ineligible to transact business with the State
51% Rental?—This pertains to the applicability of rental equipment. Based on the following
parameters, enter either “N/A” (not applicable), “Yes” or “No” for each subcontractor listed.
Enter “N/A” if the:
• Subcontractor is NOT a DVBE (regardless of whether or not rental equipment is provided by the
subcontractor) or
• Subcontractor is NOT providing rental equipment (regardless of whether or not subcontractor is a
DVBE)
Enter “Yes” if the subcontractor is a California certified DVBE providing rental equipment and the
subcontractor owns at least 51% of the rental equipment (quantity and value) it will be providing for
the contract.
Enter “No” if the subcontractor is a California certified DVBE providing rental equipment but the
subcontractor does NOT own at least 51% of the rental equipment (quantity and value) it will be
providing.
3. Read the certification at the bottom of the page. An individual that is authorized to bind the
firm contractually is to print their name, sign and date the form. Also, complete the “Page
___of ____” accordingly.
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DOR Short Form BEP Bid Packet (Rev 05/10/12)