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STATE OF CALIFORNIA <br />AGREEMENT SUMMARY <br />STD 215 (Rev. 08/2017) <br />12. AGREEMENT <br />NUMBER <br />M52226-7100 <br />AMENDMENT NUMBER <br />AGREEMENT <br />TERM <br />FROM <br />TERM <br />THROUGH <br />TOTAL COST OF <br />THIS TRANSACTION <br />BID, SOLE SOURCE, EXEMPT <br />Original <br />7/1/2020 <br />6/30/2022 <br />$77,000.00 <br />Exempt <br />Amendment 1 <br />Amendment <br />TOTAL <br />$77,000.00 <br />13. 61UUINU METHUD USED <br />❑ Request for Proposal (RFP) (Attach justification if secondary method is used) ❑ Use of Master Service Agreement <br />❑ Invitation for Bid (IFB) 0 Exempt from Bidding (Give authority for exempt status) ❑ Sole Source Contract (Attach STD. 821) <br />0 Other (Explain) SCM Vol. 1 5.80 (B) (2)(d) co -location <br />Note: Proof of advertisement in the State Contracts Register or an approved form STD. 821, Contract Advertising Exemption Request, must be attached <br />14. SUMMARY OF BIDS (List of bidders, bid amount and small business status) (if an amendment, sole source, or exempt, leave blank) <br />15. IF AWARD OF AGREEMENT IS TO OTHER THAN THE LOWER BIDDER, EXPLAIN REASON(S) (If an amendment, sole source, or exempt, leave blank) <br />16. WHAT IS THE BASIS FOR DETERMINING THAT THE PRICE OR RATE IS REASONABLE? <br />Exempt- co -location <br />17a. JUSTIFICATION FOR CONTRACTING OUT (Check one) <br />❑Contracting out is based on cost savings per Government Code Contracting out Is Justified based on Government Cade 19130(b). When this box <br />19130(a). The State Personnel Board has been so notified. Z is checked, a completed JUSTIFICATION - CALIFORNIA CODE OF <br />REGULATIONS, TITLE 2, SECTION 547.60 must be attached to this document. <br />❑ Not Applicable (Interagency I Public Works! Other) <br />17b. EMPLOYEE BARGAINING UNIT NOTIFICATION <br />❑✓ By checking this box, I hereby certify compliance with Government Code section 19132(b)(1). <br />AUTHORIZED SIGNATURE <br />A � <br />SIGNER'S NAME (Print or Type) <br />Andrea Clayton <br />run AUKEEMEN I S IN EXCESS Ol-000: Has the letting of the agreement <br />been reported to the Department of Falklmployment and Housing? ❑ No 0 Yes ❑ N/A <br />HAVE CONFLICT OF INTEREST ISSUES BEEN IDENTIFIED AND RESOLVED <br />AS REQUIRED BY THE STATE CONTRACT MANUAL SECTION 7.107 ❑ No ❑ Yes Q N/A <br />20. FOR CONSULTING AGREEMENTS: Did you review any <br />contractor evaluations on file with the DGS Legal Office? ❑ None on file ❑ No ❑ Yes 0 NIA <br />21. IS A SIGNED COPY OF THE FOLLOWING ON FILE AT YOUR AGENCY FOR THIS CONTRACTOR? <br />A. Contractor Certification Clauses B. STD 204 Vendor Data Record <br />❑ No ❑✓ Yes ❑ NIA ❑ No Q Yes ❑ N/A <br />24, ARE DISABLED VETERANS BUSINESS ENTERPRISE GOALS <br />REQUIRED? (if an amendment, explain changes if any) ❑,/ No (Explain below) ❑ Yes <br />Exempt <br />SIGNED <br />REQUIRED ESOL IONS <br />f u IMSZ v <br />ARE <br />ATTACHED <br />❑ No ❑ Yes ❑✓ NIA <br />IS THIS A SMALL BUSINESS AND)( <br />A DISABLED VETERAN BUSINESS <br />CERTIFIED BY DGS? <br />Q No ❑ Yes <br />SBIDVBE Certification Number: <br />% of Agreement <br />25. IS THIS AGREEMENT (WITH AMENDMENTS) FOR A PERIOD OF TIME <br />LONGER THAN THREE YEARS? Q No ❑ Yes (If Yes, provide justification below) <br />1 certify that al) copies of the referenced Agreement will conform to the original agreement sent to the Department of General Services. <br />ITLE (Print or Type) <br />Yanez/AGPA <br />Page 2 of 3 <br />