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HomeMy WebLinkAboutCALIFORNIA, STATE OF EMPLOYMENT DEVELOPMENT DEPARTMENTC INSURANCE NOT REQUIRED wGRK MAY PROCEED MAY 2 3 7019 STATE.Ot� 41y R5�16' A TMENT OF GENERAL SERVICES -STANDARD AGRE�ft�I��T STD 213 (Rev, 10/2018) A-2019-070-02A AGREEMENTNUMBER PURCHASING AUTHORITY NUMBER (if applicable) M9109990 1 EDD 7100 1. This Agreement is entered into between the Contracting Agency and the Contractor named below: CONTRACTING AGENCY NAME Employment Development Department (EDD) CONTRACTOR NAME City of Santa Ana Work Center' 2. The term of thi: START DATE October 1, 2018 THROUGH END DATE June 30, 2020 3. The maximum amount of this Agreement Is: $28,383.00 Twenty Eight Thousand Three Hundred Eighty Three Dollars and Cents 5 4.The parties agree to comply with the terms and conditions of the following exhibits, which are by this reference made a part of the Agreement. EXHIBITS TITLE PAGES Exhibit A Scope of Work 1 Attachment A-1,Specifications 1 Exhibit B Budget Detail and Payment Provisions 1 Attachment B-1, Budget Detail 2 Attachment B-2, Rate Sheet 1 *Exhibit C General Terms and Conditions GTC 04/2017 Exhibit Special Terms and Conditions 1 Items shown with on asterisk(*), are hereby incorporated by reference and made part of this agreementos if attached hereto. These documents can be viewed at www.dgs.co.gov/ols/resources/standardcontractionguage.aspx IN WITNESS WHEREOF, TH/SAGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO. CONTRACTOR NAME (if other than an individual, state whether a corporation, partnership, etc.) Cityof Santa Ana Work Center CONTRACTOR BUSINESS ADDRESS CITY ZIP 801 Santa Ana Blvd., Suite 200 Santa Ana 92701 PRINTED NAME OF PERSON SIGNING Norma Mitre TITLEKRISTINE RIDGE Acting Clerk of the Council CITY MANAGER CONTRACTOR AUTHORIZEDSI TORE DATE SIGNED STATE OF CALIFORNIA CONTRACTING AGENCY NAME Employment Development Department CONTRACTING AGENCY ADDRESS CITY STATE ZIP 722 Capitol Mall, MIC 62-C Sacramento CA 95814 PRINTED NAME OF PERSON SIGNING TITLE Sheri L. Collins Manager CONTRACTING AGENCY AUTHORIZED SIGNATURE mtum UMUINAl , Executed Copy to COTC (M-30/Til) Pane 1 of 2 STATE OF CALIFORNIA -DEPARTMENT OF GENERAL SERVICES STANDARD AGREEMENT STD 213(Rev. 10/2018) AGREEMENTNUMBER PURCHASING AUTHORITY NUMBER (if applicahle) M9109990 1 EDD 7100 Paoe 2 of EXHIBIT A (Standard Agreement) SCOPE OF WORK EDD Agreement No. M9109990 EDD/City of Santa Ana Page 1 of 1 This Agreement is entered into by and between the Employment Development Department, hereinafter referred to as EDD, and the City of Santa Ana, hereinafter referred to as Partner, for the purpose of reimbursing the Partner for the EDD's fair share of the telephone costs for the Santa Ana One -Stop Career Center located at 801 W. Civic Center, Suite 200, Santa Ana, CA 92701, The EDD is co -located at this site under the Workforce Investment Act mandate. 2. The services shall be reimbursed in accordance with Attachment A-1, Specifications, Attachment B-1, Budget Detail Sheet and Attachment B-2, Contract Rate Sheet. 3. The project representative during the term of this Agreement will be: State Agency Employment Development Department Ana Martini 801 W. Civic Center Dr. Santa Ana, CA 92701 Phone: (714) 565-2680 Fax: (714) 558-4664 Contractor City of Santa Ana Deborah Sanchez 801 W. Civic Center Drive, Suite 200 Santa Ana, CA 92701 Phone: (714) 565-2621 Fax- (714) 565-2602 EDD Contract No. M9109990 EDD/City of Santa Ana Page 1 of 1 Attachment A-1 Specifications 1. PARTNER: City of Santa Ana 2, ADDRESS: 801 W Civic Center Dr., Suite 200, Santa Ana, CA 92701 3. CONTACT: Deborah Sanchez 4. TELEPHONE: 714-565-2621 5, The Employment Development Department (EDD) agrees to utilize the partners telephone services at the Santa Ana Work. Center located at 801 Civic Center Dr., Suite 200, Santa Ana, CA 92701. 6. The term of this agreement shall be October 1, 2018 through June 30, 2020. 7. The total amount of the fiscal and variable telephone services charges of this agreement shall not exceed $28,383.00. See total on Attachment B-1 Budget Detail. The contract amount is based on the estimated cost of service as shown in Attachment B-2. 8. Telephone Service Scenarios ❑ EDD staff will utilize the Partner (City of Santa Ana) telephone services. The partner agrees to provide the EDD staff with proprietary telephone system Instruments attached. Telephone services shall include, instrument, installation, cross connects, dial tone access, long distance access, programming, voicemail, maintenance, and shared incoming trunk cost. 9. The partner agrees to coordinate the specific line appearance and ring programming of the EDD staff telephone instruments with the EDD Voice Operations Unit Analyst and the local office manager. EDD staff instruments. shall restrict 900, 976, 31 party, caller ID, and international calls. 10, The Partner agrees to perform Moves, Adds and Changes, (MAC's) to EDD assigned system instruments, 11. The Partner agrees to invoice the Department, in arrears, for applicable one-time charges. 12. The Partner agrees to invoice the Department (EDD) monthly in arrears for the agreed upon ongoing telephone service charges, and, actual long distance and toll charges incurred by the EDD staff using the partner telephone.system. Long distance and toll charges shall be itemized by station number in a monthly cost accounting report that will be made available to the EDD manager. EDD Agreement No. M9109990 EDD/City of Santa Ana Page 1 of 1 EXHIBIT B (Standard Agreement) BUDGET DETAIL AND PAYMENT PROVISIONS 1. Invoicing and Payment a) The total amount of this Agreement shall not exceed Twenty Eight Thousand Three Hundred Eighty Three Dollars and No Cents ($28,383.00). b) Invoices may be submitted monthly in triplicate, in arrears, and must reference the EDD Agreement Number M9109990, and shall be forwarded to: Employment Development Department Attention: Ana Martini 801 West Santa Ana Blvd., Suite 200 Santa Ana, CA 92701 2. Budget Contingency Clause It is mutually understood between the parties that this Agreement may have been written before ascertaining the availability of congressional and legislative appropriation of funds, for the mutual benefit of both parties, in order to avoid program and fiscal delays which would occur if the Agreement were executed after that determination was made, This Agreement is valid and enforceable only if (1) sufficient funds are made available by the State Budget Act of the appropriate State Fiscal Year(s) covered by this Agreement for the purposes of this program; and (2) sufficient funds are made available to the State by the United States Government or by the State of California for the Fiscal Year(s) covered by this Agreement for the purposes of this program. In addition, this Agreement is subject to any additional restrictions, limitations or conditions established by the United States Government and/or the State of California, or any statute enacted by the Congress and Legislature, which may affect the provisions, terms or funding of the Agreement in any manner. The parties mutually agree that if the Congress and/or Legislature does not appropriate sufficient funds for the program, this Agreement shall be amended to reflect any reduction in funds. The EDD has the option to terminate the Agreement under the 30-day termination clause or to amend the Agreement to reflect any reduction of funds. 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in, Government Code § 927, et seq. Attachment B-1 Budget Detail Santa Ana Workforce Development Board AICC Comprehensive Infrastructure Budget, and Other System Cost Budget EDD Contract No. M9109990 EDD/City of Santa Ana Page i of 2 Tadlcnh EaOta al% sa n s,mm Perrent'. I 43sa4 st l a { 4r 4 ,t �b �t¢O �J*Itel�t i t"'C*f y'; '�'!h.s Y i ri . AA 4 $.fy tf$q}�p�fs t.Tyl rf�f y y �',,F''r.`�t ., s ` Cosh Total Monthly Pm peaty Rent Ona-Time Charges One-Tisne Phone Cost Monthly Phone Contrail Monthly Property Item Total Monthly Remand Equipment Cost Rent _ Base Rent Ind. Janitorial, Maint and Utilities $42,506.20 $17.080.40 $17.909.40 Operational Cost 2%of Rent $359.791 $359.79 Management Fee 1,76%of Rent $316.61 $316.61 ota Rent 423 Utilities/Main/Service Telephone Services Per Person Mont y costs o Dia Tone and Voice Mail Assigned $1785.00 $807.50 $807.50 Shared Phones by usage persertage $212.60 $92AG $92.60 Security Guard (Annual) Induces$840 Parking $60.156.76 $1,821.35 $1,821.35 Total Utilities/Maintenance $2,721A8 $0.00 $2,721.45 *Equipment New Phone System Phones by assigned phones $9,536.29 $0.00 $4,314.04 $0.00 Shared Basic Phones $687.86 $0.00 $299.74 $0.00 Licenses assigned phones $4,680.48 $0.00 $2.117.36 $0.00 Licenses $557.20 $0.00 $242.80 Koo Switches $5,035.07 $0.00 $2,194.25 $0.00 Finial support Cost 05.66 3 . Total Equipment $21,478.0 $0.00 $%168.22 $35.66 $0.00 $36.66 **Technology and Access Casts $0.00 Network Wireless Bride Network $14,080.23 1 $6,135.57 $0,05 AccessSstem/Card Key Card System $17,104.28 $7,492.55 $0.00 Data &?hone Cabling Cabling $58,097.10 $25,316.28 $0.00 $0.00 Information Technology Cost Per Month (Annual Wireless Network Bridge Maintenance $1.485.00 $53.93 $53.93 e**Coolers Annual Resource Room use y clients onl $1,304B $4T38 $47.38 apyroom pi staff only $838.92 $30.46 $30.46 Total Technology and Access $03,000.17 $0.001 $38,944.40 $131.76 $0.00 $131.76 In -Rind Infrastructure Total $116,264.14 *42,50630 $3$,840..40 $9,186.22 $2,88$,8$ $ 8,$66b0 $ ,664.68 ***Coplers ore leased equipment and are charged by percentage. Additional charge for usage will be calculated and charged LLJ M 'E p E "6 N �N w V i I I I c °tllak4 � I C I, N yp �I� a13 c I �iI p 515E ', w 1 Z W1 I� of o 0IL o 0 ' v a v I I' t�W III I i I i. V Q •W o.. O O o) �1 ,I � � F W I N� N N +��. �`1 • Ci LU w i r 1 c au 1r- i =uj V- I m» w Qq w �+ C w �p 1 i N ;� E V .r- V z0 "' c I OU i N N N �f I� o W I o� o�tm Fe f0q A m°. `0 yqaqy t5 . C C W.._.. c. � ¢. H ' I __. W A 10 ( Q Io 0 0 o EDD Agreement No, M9109990 EDD/City of Santa Ana Page 1 of 1 EXHIBIT D (Standard Agreement) SPECIAL TERMS AND CONDITIONS 1. Settlement of Disputes In the event of a dispute between EDD and the Partner over any part of this Agreement, the dispute may be submitted to non -binding arbitration upon the consent of both EDD and the Partner. An election for arbitration to this provision shall not preclude either party from pursuing any remedy for relief otherwise available. 2. Workforce Innovation and Opportunity Act MIOA) Contractor agrees to conform to nondiscrimination provisions of the. Workforce Innovation and Opportunity Act (WIOA) and other federal nondiscrimination requirements as referenced in 29 CFR, Part 37 and 38. 3. Termination Clause This Agreement may be terminated by EDD by giving written notice to the Partner 30 days prior to the effective date of such termination. 4. Agency Liability The Partner warrants by execution of this Agreement, that no person or selling agency has been employed or retained to solicit or secure this Agreement upon agreement or understanding for a commission, percentage, brokerage, or contingent fee, excepting bona fide employees or bona fide established commercial or selling agencies maintained by the Partner for the purpose of securing business. For breach or violation of this warranty, the State shall, in addition to other remedies provided by law, have the right to annul this Agreement without liability, paying only for the value of the work actually performed, or otherwise recover the full amount of such commission, percentage, brokerage, or contingent fee. 5. Force Maieure Neither party shall be liable to the other for any delay in or failure of performance, nor shall any such delay in or failure of performance constitute default, if such delay or failure is caused by "Force Majeure." As used in this section, "Force Majeure" is defined as follows: Acts of war (e.g., riots and strikes) and acts of God (e.g.., earthquakes, floods, and other natural disasters) such that performance is impossible. CCC 04/2017 CERTIFICATION I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number City of Santa Ana 95-6000785 By (Authorized Signature) Printed Name and Title of Person Signing NORMA MITRE Kristine Ridge, City Manager Acting Clerk of the Council Date Executed 'Executed in the County of Orange CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code § 12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.) 2. DRUG -FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug -Free Workplace Act of 1990 and will provide a drug -free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug -Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug -free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug -free workplace policy statement; and, 2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement. Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code § 10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the frrm's offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non -renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor's records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor's compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3. 8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code § 10410): 1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411): 1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision -making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy -making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code § 10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code § 10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement. 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. Page 1 of 2 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTION This certification is required by the regulations implementing Executive Order, 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26, 1988, Federal Register (Pages 19160-19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF THE CERTIFICATION.) The prospective recipient of Federal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective recipient of Federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Kristine Ridge, City Manager Name and Title of Authorized Representative ASTOFORM 4� Attorney NORMA MITRE Acting Clerk of the Council FD118 (Rev. 9/22/04) Page 2 of 2 INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal, the prospective recipient of Federal assistance funds is providing the certification as set out below. 2. The certification in this clause is material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of Federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules and implementing Executive Order 12549. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. 6. The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier Covered Transactions, "without modification, in all lower tier covered transaction and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of Its principals. Each participant may but is not required to, check the List of Parties Excluded From Procurement or Nonorocurement Programs. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntary excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and/or debarment. FD118 (Rev. 9/22/04) 7/1/18 Governor Gavin Newsom STATE OF CALIFORNIA PUBLIC LIABILITY AND WORKERS' COMPENSATION INSURANCE FISCAL YEAR JULY 1, 2018 / JUNE 30, 2019 To Whom It May Concern: In accordance with Government Code section 11007.4, the State of California has elected to be self -insured for liability exposures. Under this form of insurance, the State and its employees acting in the course and scope of their employment are insured for tort liability arising out of official State business. All claims against the State of California based on tort liability should be presented as a government claim to the Government Claims Program, P.O. Box 989052 MS 414, West Sacramento, CA 95798-9052. (Gov. Code section 900, et. seq) Internet link: hthp:!lwww clLgLgov/orim/Prograrn5/ GovernmeMGIairns S - The State of California has also elected to be insured for its motor vehicle liability exposures through the State Motor Vehicle Liability Self -Insurance Program (VELSIP). This program provides liability coverage arising out of the operations of motor vehicles used by state employees for official state business (California Vehicle Code Sections 17000 and 17001), Motor vehicle liability claims against the State of California should be presented to the Office of Risk and Insurance Management, P.O. Box 989052 MS-403, West Sacramento, CA 95798- 9052, (800) 900-3634, c! irnLaLdq .ca.qov. If your motor vehicle liability claim is not resolved within six months from the date of loss, California law requires you to file a formal claim with the Government Claims Program, P.O. Box 989052 MS 414, West Sacramento, CA 95798-9052. (Gov. Code section 900, et. seq.) Internet link: httP://wyw.dg;_ca.cLgv riin/Programs_.'; » ernmentC!a:d'!,,,,aSLx. The State of California has a Master Agreement with the State Compensation Insurance Fund regarding workers' compensation benefits for all state employees, as required by the Labor Code. Sincerely, J; Navdeep Mahl Associate Risk Analyst Insurance Services Unit Phone: (916) 376-5305 Fax: (916)376-5275 Navdeep.Mahl@dgs.ca.gov To request updated letter of self-insurance, please submit to riskrnanaeamenP(�dus.ca.aov Office of Risk and Insurance Management I State of California I Government Operations Agency 707 3rd Street, 1st Floor I West Sacramento, CA 95605 1 t 916.376.5300 f 916.376.5277