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STATE OF CALIFORNIA <br />AGREEMENTISUMMARY <br />ST0218 (Rev U2082) <br />19 EI0OIN6 M8rHo0 USED <br />[.] REQUEST FOR PROPOSAL (RFP) (_ INVITATION FOR BID (IFB) (_,J USE OF MASTER SERVICE AGREEMENT <br />(A@acbjosMkathn llsecandery method Is used) <br />r] SOLE SOURCE CONTRACT EXEMPT FROM BIDDING AXI OTHER (Edam) <br />Whose STD 821) (Ow humanly nr exempt stases) Local <br />NOTE: ProWofaduankemanfm fire Slero Cantrecla Regtaleror an opprovetl tprm <br />STD 821, Contract Advomsing Eamphon Request, must be allecRed <br />11 summyoFams (list of blddW9 bra amount and small busnne,status) III an amendment "(a 9npm8 or exempt, leave blank) <br />15. IF AWAROOF AOflEEM@Nr19 TO OTHER THAN THE LOWER 8100ER, PLEASE EXPLAIN RRASON(Si (tran dmadme0l. 9d88oUICe. 018%empL Ia8V8 bPonkj <br />EDD is co -located with the City of Santa Ana Work Center <br />18 WHAT IBTHESA315 FOR OETERMININ6 TFGAt TRE PPoCE OR RATER R@ABONABLEi <br />NIA <br />1I. JV9TIFICATION FOn GONYgAGflNOOUT (CM1ak Pne <br />L Contracting out is based on cost sovings per Government Code 1g130(o). <br />The State Panoral Board has been so notified, <br />dusa8cadon <br />EDD is responsible for their share of phone service <br />L By cheching INS box, l hargky carfjry somWlanrae Milk Government Code oec0on 191321 <br />+9. FOR AGREEMENTS IN EXCESS OF <br />$5000, HAS THE LETTING OF THE <br />AGREEMENT BEEN REPORTED TO <br />THE DEPARTMENT OF FAIR <br />EMPLOYMENT AND HOUSING? <br />(i h10 [AI YES ❑ N/A <br />EX Contracting out is justified based on Government Code 19130(b). <br />Just1fication for the Agreement is described below. <br />19. HAVE CONFLICT OF INTEREST ISSUE: <br />BEEN IDENTIFIED AND RESOLVED AS <br />REQUIRED BY THE STATE CONTRACT <br />MANUAL SECTION 7AD? <br />`. NO `, ,YES ® NIA <br />A. CONTRACTOR CERTIFICATION WA EE <br />D. STD. 204, VENDOR DATA RECORD <br />❑ ND t..J YES Ly WA ®ND LJ YES L NIA <br />23. R`RE,ummLEO VETERAN SUE <br />ILe1 NO (Explain below) <br />DISABLED VETERAN BUSINESS ENTERPRISES: <br />Explain: <br />NIA- exempt <br />113 NO lj YES ( tndcarotdustry Smup) <br />25. to TH19 AOAEEMENT ('MTM AMENOMEMS)FOR APERtObI <br />FX7 NOj YES <br />DYES (MYE3cvmplotemamitowing) <br />% OF AGREEMENT <br />all <br />eaf to <br />Associate Governmental <br />FOR CONSULTING AGREEMENTS, DID YOU REVIEW <br />ANY CONTRACTOR EVALUATIONS ON FILE WITH THE <br />DGS LEGAL OFFICE? <br />F1 NO <br />22 RSOUIRSI <br />NO <br />will co forxNo <br />YES NONE MA <br />F. YES EXI NIA <br />