HomeMy WebLinkAbout25C - AGMT - TELEPHONE SRVS REIMBURSEMENTREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
AUGUST 5, 2014
TITLE:
AGREEMENT WITH THE STATE OF
CALIFORNIA FOR TELEPHONE SERVICE
REIMBURSEMENT
CITY MANAGER
RECOMMENDED ACTION
CLERK OF COUNCIL USE ONLY:
;'•C• _r,
❑ As Recommended
❑ As Amended
• Ordinance on 13' Reading
• Ordinance on 2nn Reading
❑ Implementing Resolution
❑ Set Public Hearing For
CONTINUED TO
rte►'*
Authorize the City Manager or his designee and the Clerk of the Council to execute an agreement with
the State of California, Employment Development Department, to reimburse the City for telephone
service costs, in an amount not to exceed $39,077 subject to non - substantive changes approved by the
City Manager and City Attorney.
DISCUSSION
The State of California, Employment Development Department (EDD), shares office space at the Santa
Ana W /O /R /K Center and also utilizes the city -owned telephone system. This agreement reimburses
the City for the monthly telephone service charges and actual long distance and toll charges incurred
by the EDD staff for use of the City's telephone system. The agreement term will be for two years from
July 1, 2014 through June 30, 2016 in the amount of $39,077.
STRATEGIC PLAN ALIGNMENT
Approval of this item allows the City to meet Goal #4 Fiscal Sustainability, Objective #1 Maintain a
stable, efficient and transparent financial environment.
FISCAL IMPACT
Funds will be deposited into the W /O /R/K Center's One Stop Program Communications account (no.
12318751- 62010 - 15700301213- 3070).
25C -1
Agreement to Reimburse Telephone Service
August 5, 2014
Page 2
Deborah Sanchez
Economic Development Specialist III
Community Development Agency
DS /kg
Exhibit: 1. State of California Agreement
APPROVED AS TO FUNDS AND ACCOUNTS:
Francisco Gutierrez
Executive Director
Finance & Management Services Agency
25C -2
STATE OF CALIFORNIA
STANDARD AGREEMENT
STD. 213 (Rev 06103)
AGREEMENT NUMBER
EXHIBIT 7
M595188
1.
This Agreement is entered into between the State Agency and the Contractor named below:
STATE AGENCY'S NAME
Employment Development Department
CONTRACTOR'S NAME
City of Santa Ana Work Center
2.
The term of this
Agreement is: July 1, 2014 through June 30, 2016, or upon final approval.
3.
The maximum amount $39,077.00
of this Agreement is: Thirty Nine Thousand Seventy Seven Dollars and No Cents
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.
Exhibit A Scope of Work
1 Page
Attachment A -1 Specifications
1 Page
Exhibit B Budget Detail and Payment Provisions
1 Page
Attachment B -1 Budget Detail Sheet
1 Page
Attachment B -2 Contract Rate Sheet
1 Page
Exhibit C * General Terms and Conditions
GTC 610
Exhibit D Special Terms and Conditions
1 Page
Items shown with an Asterisk(*), are hereby incorporated by reference and made part of this Agreement as if attached hereto.
These documents can be viewed at www.ols.dgs.ca.gov/ Standard %20Language /default.htm
IN WITNESS WHEREOF, this Agreement has been executed by the
CONTRACTOR
CONTRACTOR'S NAME (ifother than an Indlvldual, state whether a corporation, partnership, etc.f
City of Santa Ana Work Center
hereto.
BY M,,thodzed Signatwe) DATE SIGNED (Do not type)
6
PRINTED NAME AND TITLE OF PERSON SIGNING
David Cavazos, Santa Ana City Manager
ADDRESS
20 Civic Center Plaza, Santa Ana, CA 92702
STATE OF CALIFORNIA
AGENCVNAME
Employment Development Department
By (Authorized Signahve)
DATE SIGNED (DOnattype)
California Department of General
Services Use Only
OX Exemptper.
DGS Exemption Letter No. 54.4
Xochitl Montano, Manager, Contract Services Group �p�iCi�� $s 'j'Q� �'{,��
ADDRESS
800 Capitol Mall, MIC 62, Sacramento, CA 95814
City Attorney
EXHIBIT A
(Standard Agreement)
SCOPE OF WORK
EDD Agreement No. M595188
EDD /City of Santa Ana
Page 1 of 1
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 share of the telephone service
costs at the Santa Ana One -Stop Career Center located at 1000 Santa Blvd in Santa Ana,
CA. 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
1000 E. Santa Ana Blvd. Suite 103
Santa Ana, CA 92701
Phone: (714) 565 -2680
Fax: (714) 558 -4684
Contractor
City of Santa Ana
Deborah Sanchez
Community Development Agency
Economic Development Division /Santa Ana WIB
1000 E. Santa Ana Blvd. Suite 200
Santa Ana, CA 92701
Phone: (714) 241 -6160
Fax: (714) 241 -6329
25C -4
EDD Agreement No, M595188
EDD(City of Santa Ana
Page 1 of 1
ATTACHMENT A -1
(Standard Agreement)
SPECIFICATIONS
The EDD agrees to utilize the Partners telephone services at the Santa Ana County One -Stop
Career Center in Santa Ana, CA.
The term of this Agreement shall be July 1, 2014 through June 30, 2016 or upon final approval
The total amount of the fiscal and variable telephone services charges of this Agreement shall
not exceed Thirty Nine Thousand Seventy Seven Dollars and No Cents ($39,077.00). See
Attachment B -1, Budget Detail Sheet. The contract amount is based on the estimated cost of
service as shown in Attachment B -2, Contract Rate Sheet.
Telephone Service Scenarios
The EDD staff will utilize the Partner (Career Center) 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.
The partner agrees to coordinate the specific line appearance and ring programming of the
EDD staff telephone instruments with the EDD Voice Operations Unit and the local office
manager. EDD staff instruments shall restrict 900, 976, 3rd party, caller ID, and international
calls.
The Partner agrees to perform Moves, Adds, and Changes, (MAC's) to EDD assigned system
instruments.
The Partner also agrees to perform MAC's for peripheral EDD lines and instruments not
connected to the partner telephone system. Peripheral lines are identified as fax, modem,
Unemployment Insurance direct connects, etc.
The Partner agrees to invoice the Department, in arrears, for applicable one -time charges.
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.
25C -5
EDD Agreement No. M595188
EDD /City of Santa Ana
Page 1 of 1
EXHIBIT B
(Standard Agreement)
BUDGET DETAIL AND PAYMENT PROVISIONS
Invoicing and Payment
I
a) The total amount of this Agreement shall not exceed Thirty NinejThousand Seventy
Seven Dollars and No Cents ($39,077.00).
b) Invoices may be submitted monthly in triplicate, in arrears, and must reference the EDD
Agreement Number M595188, and shall be forwarded to:
Employment Development Department
Attention: Ana Martini, Operation Manager EPM II
1000 E. Santa Ana Blvd Suite 103
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.
25C -6
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25C -7
ATTACHMENT B -2
(Standard Agreement)
CONTRACT RATE SHEET
Santa Ana One -Stop
Item
Basic rate for phone service including line,
Equipment, Voice mail and EDD's
share of DID and Pt -to -Pt circuits.
Long distance and toll charges including
incoming and outgoing calls.
Moves, Adds, and Changes (Technician)
City of Santa Ana as of 2114/2014
25C -8
EDD Agreement No. M595188
EDD /City of Santa Ana
Page 1 of 1
Monthly Cost
$31.00 per line
Actual cost varies monthly and is
billed in arrears.
$ 100 including equipment
EDD Agreement No. M595188
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 Investment Act
Contractor agrees to conform to nondiscrimination provisions of the Workforce Investment
Act (WIA) and other federal nondiscrimination requirements as referenced in 29 CFR,
Part 37.
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 Majeure
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.
25C -9
CCC -307
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 Ntimber
City of Santa And
95- 6000785
By (Authorized Signature)
i
Printed Name and Title of Person Signing
David Cavazos, City Manager
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 8103) (Not applicable to public entities.)
2. DRUG -FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drag -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 drag 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
25C -10
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 firm'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. eow, 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,
25C -11
or the Department of Justice to determine the contractor's compliance with the
requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts over $100,000 executed or amended after
January 1, 2007, the contractor certifies that contractor is in compliance with Public
Contract Code section 10295.3.
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 - malting
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 conunission, payment for
preparatory time and payment for per diem. (Pub. Contract Code § 10430 (e))
25C -12
2. LABOR CODEMORKERS' 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.
S:\ADMIN\HOMEPAGE \CCC \CCC- 307.doe
25C -13
RFQ No. 65966
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.
David Cavazos, City Manager
and Title of Authorized Representative
Signature
FD118 (Rev. 9/22/04) 25C-14
Date
RFQ No. 65966
Page 2 of 2
INSTRUCTIONS FOR CERTIFICATION
1. 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 Nonprocurement 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.
FD 118 (Rev. 9/22/04)
25C -15
DARFUR CONTRACTING ACT
Effective January 1, 2009, procurements for Non - Information Technology (Non -IT) goods or
services must address the requirements of this Act. The Act is intended to preclude State
agencies generally from contracting with SCRUTINIZED companies that do business in the
African nation of Sudan (of which the Darfur region is a part), for the reasons described in Public
Contract Code section 10475.
A SCRUTINIZED company is a company doing specified types of business in Sudan as defined
in Public Contract Code section 10476. SCRUTINIZED companies are ineligible to, and cannot,
bid on or submit a proposal for a contract with a State agency for Non -IT goods or services
(Public Contract Code section 10477(a)). Public Contract Code section 10478 (a) requires a
company that currently has (or within the previous three years has had) business activities or
other operations outside of the United States to certify that it is not a SCRUTINIZED company in
order to submit a bid or proposal to a State agency. A SCRUTINIZED company may still,
however, submit a bid or proposal for a contract with a State agency for goods or services if the
company first obtains permission from the Department of General Services (DGS) according to
the criteria set forth in Public Contract Code section 10477(b).
If your company, within the previous three years, had any business activities or other operations
outside of the United States, you need to complete the Darfur Contracting Act
Certification. This applies regardless of the procurement approach, method, or solicitation
format used including, but not limited to: Formal Bids, Informal Bids, Request for Proposals,
Invitation for Bids, Non - Competitive Bids, the SB /DVBE Option, and under $5,000 fair and
reasonable pricing.
FDO19 (Rev. 7/28/10)
25C -16
DARFUR CONTRACTING ACT CERTIFICATION
Public Contract Code, Sections 10475 -10481 applies to any company that currently or within
the previous three years has had business activities or other operations outside of the United
States. For such a company to bid on or submit a proposal for a State of California contract, the
company must certify that it is either a) not a scrutinized company; or b) a scrutinized company
that has been granted permission by the Department of General Services to submit a proposal.
If your company has not, within the previous three years, had any business activities or
other operations outside of the United States, you do not need to complete this form.
OPTION #1 - CERTIFICATION
If your company, within the previous three years, has had business activities or other operations
outside of the United States, in order to be eligible to submit a bid or proposal, please insert
your company name and Federal ID Number and completethe certification below.
I, the official named below, CERTIFY UNDER PEWTY OF PERJURY that a) the prospective
proposer /bidder named below is not a scrutinii d company per Public Contract Code 10476;
and b) I am duly authorized to legally bind tie prospective proposer /bidder named below. This
certification is made under the laws of tb State of California.
Ii Federal ID Number
OPTION #2 —WRITTEN PERMISSION FROM DGS
Pursuant to Public Contract Code, Section 10477(b), the Director of the Department of General
Services may permit a scrutinized company, on a case -by -case basis, to bid on or submit a
proposal for a contract with a state agency for goods or services, if it is in the best interests of
the state. If you are a scrutinized company that has obtained written permission from the DGS
to submit a bid or proposal, complete the information below.
We are a scrutinized company as defined in Public Contract Code, Section 10476, but we have
received written permission from the Department of General Services to submit a bid or
proposal pursuant to Public Contract Code, Section 10477(b). A copy of the written permission
from DGS is Included with our bid or proposal.
I Company/Vendor Name (Printed) Federal ID Number
Initials of Submitter
I�
Printed Name and Title of Person Initialing
FDO19 (Rev. 7/28/10)
25C -17
25C -18