Laserfiche WebLink
EXHIBIT 1 <br />State of California —Department of General Services Procurement Division <br />GSP045-105(REV 08/09) <br />BIDDER DECLARATION <br />Solicitation Number 84649 <br />Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): <br />a. Identify current California certification(s)IMB,SB,NVSA,OVBE): et <br />—or None I. (If"None;gotoItem ft2) <br />b. Will subcontractors be used for this contract? Yes O✓ No❑(Ifyes, indicate the distinct element of work your firm will perform In this contract <br />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, <br />identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. <br />Qalft oversight & FiscaL9g ne t cgordination_uyikf>,3S�b�ontractgre and partner ggsg,tpan-aement s e sment tr i0.lrlg Q.)7.LtCVF.ii, <br />and support services. <br />c. If you area California certified DVBE: (1) Are you a broker or agent? Yes ❑ NoQ <br />(2) If the contract Includes equipment rental, does 1 our com,�anyo , at least 51% of the equipment <br />provided in this contract (quantity and value)? Yes No MIA J J� <br />2. If no subcontractors will be used, skip to certification below, Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): <br />Subcontractor Name,Contact person, <br />Subcontractor Address <br />CA Certification(MB,SB, <br />Work performed or goods provided <br />Corresponding <br />Good <br />5196 <br />Phone Number &fax Number <br />Hmail Address <br />NVSA, OVBE or None) <br />forthis contract <br />of bid price <br />Standing? <br />Rental? <br />City of <br />Flores heim <br />201 S. Anaheim Blvd. <br />Suite 1001 <br />None <br />Coordination of Services - Case <br />a <br />25 /0 <br />❑ <br />714-76 <br />Management, Assessment, <br />Fax 714-765-4356 <br />Anaheim CA 92805 <br />Training, OJT and support <br />Iflores@anaheim.net <br />services <br />County of Orange <br />Carma Lacy <br />1300 S. Grand Ave <br />Bldg. B, 3rd FI. <br />None <br />Coordination of services - Case <br />Management, Assessment, <br />20% <br />714-480-6420 <br />Santa Ana CA 92705 <br />Training, OJT, and support <br />Fax 714-834-7132 <br />carma.lacy@occr.ocgov.com <br />services <br />0 <br />Working Wardrobes <br />Jerri Rosen <br />1851 Kettering St <br />Irvine, CA 92614 <br />None <br />Case Management, workforce <br />readiness training, soft skills, Job <br />15% <br />❑ <br />714-210-2460 <br />jerd@workingwardrobes.org <br />development and placement, <br />Fax 714-434-2870 <br />Interview/work wardrobe <br />CERTIFICATION: By signing the bid response,l certify under penalty of perjury that the information provided Is true and correct. <br />Page i of 2 _. <br />25G-42 <br />