CALIFORNIA, STATE OF - WORKFORCE DEVELOPMENT BOARD

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StateofCalifornia—Department ofConeral service, Procurement Division GSPO-05-1 05 (REV 08/09) Instructions BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) most complete the Bidder Declaration. Tau 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 92, If the prime bidder possesses one or more of the toIIowing certificatl an s, enter the applicable (ertifications) on the line: Microbusiness(MB) Small Business (5B) Nonprofit Veteran Service Agency(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 At.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 goads or services to be provided by subcantractom. Bidders certified as MB, SO, NVSA,and/or DVBE must provide a commercially useful function as defined in Military and Veterans Cade Section 999 for DVBEs and fiovernment(ode Section 14837(d)(4)(A) for small/ miuobuslnesses. Bids most propose that certified bidden 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 primes contract. I.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"Nb; The Military and Veterans Code Section 9992 (b) defines'broker' or"agent"as a certified DVBE contractor or subcon- tractor 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 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 efther"Yes"or"No"to identify If the prime bidder awns at least 51% of the equipment provided (quantityand 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. 2. (continued) Column Labels SrahcanmlchOrName, Conmctl eison, Phone Number&Fav Number —List each element for all subcontractors. SubrontractarAddress&EmallAddress—Enter the address and if available, an Email address. (ACertification (MR,Sit, NVSA,DVREorNone)—If the subcontractor possesses a current State of . California certlfiwtlonls).verify on thiswebsite itam eorocorceodlasaaovl. Work performed orgoods 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 11 above for code citations regarding the definition of commercially useful function.) If a certified subcontractor is further subcontract - ing a greater portion of the work or goads provided for the resulting contract than would be expected by normal industry practices,attach a separate sheet of paper explaining the situation. Corresponding %ofbidprice—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 600d5mmfiag?—Provide a response for each subcontractor listed. Enter either"Yes"or"No"to indicate that he prime bidder has verified that the subcontractors) is In good standing for all of the fallowing: Possesses valid license(s) for any Kernels) or permits required by the solicitation or bylaw If a corporation, the company is qualified to do business in California and designated by the State of California Secretary of State to he in good standing Possesses valid State of California certification(s) if claiming MS, SB,NVSA,and/or DVBE status 51%Rental?—This pertains to the appllcabllityofrental equipment Based on the following parameters, enter either"NIA" (not applicable)."Yee"or"No"far 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 KNOT providing rental equipment (regardless ofwhetherornot subcontractor is a DVBE) Enter"Yes"ifthe subcontractor Isa California certified DVBEprovfding rental equipment and the subcontractor ownsat least 5191. 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 sub- contractor does NOT own at least 51%of the rental equipment (quantity and value) it will be providing, Read the certification at the bottom of the page and complete the"Page _of_"accordingly.