M e t r o p o l i t a n S t a t e H o s p i t a l

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1 Page 1 of 21 M e t r o p o l i t a n S t a t e H o s p i t a l S. Bloomfield Avenue, Norwalk, CA (562) REQUEST FOR QUOTE This Request for Quote must be signed, completed, and returned to Metropolitan State Hospital by June 14, 2013 by 3:00 p.m. one of the following ways: Mail: Metropolitan State Hospital Attention: Margo Liner/General Services 3 rd Floor, Administration Building South Bloomfield Avenue Norwalk, CA Margo.Liner@msh.dsh.ca.gov Facsimile*: (562) *Facsimile machine quotes will be considered only if they are sent to (562) Quotes sent to any other fax number will not be considered. To be considered, all pages of a faxed quote must be completely received prior to the quote due date and time specified in this solicitation. Please be advised that there is a heavy demand placed on the fax machine receiving quotes, and that Metropolitan State Hospital assumes no responsibility if a bidder cannot transmit their quote via fax, or if the entire quote is not received prior to the quote due date and time. If you have any questions, please contact Margo Liner, (562) By submitting this quote, the Contractor agrees that: 1. Contractor s all-inclusive quote is submitted as detailed in the Cost Sheet. 2. The signature affixed hereon and dated certifies compliance with all the requirements of this quote document. The signature below authorizes the verification of this certification. 3. Quote responses that reference a supplier s own terms and conditions or provisions will be considered nonresponsive and will be rejected. 4. The Department of State Hospital, may require bidder(s) to submit evidence of their qualifications at such times and under conditions, as it may deem necessary. The question of whether a particular bidder is a responsible bidder may involve an evaluation of the bidder s experience, type of facility, expertise or financial resources regarding the particular services requested by the pertinent solicitation. If a bidder has been determined to be non-responsible, the quote shall be rejected.

2 Page 2 of 21 By submitting this quote, the Contractor agrees that (continued): 5. Note that all agreements entered into with the State of California will include by reference General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at Internet Site: If you do not have Internet access, a hard copy can be provided by contacting the person listed above. 6. It is unlawful for any persons engaged in business within this State to sell or use any article or product as a loss leader as defined in Section of the Business and Professions code. 7. The awarding agency may modify the RFQ, prior to the date fixed for submission of quotes, by the issuance of an addendum to all parties who received a quote package. 8. Before submitting a response to this solicitation, bidders should review, correct all errors, and confirm compliance with the RFQ requirements. 9. The State does not accept alternate contract language from a prospective contractor. A quote with such language will be considered a counter proposal and will be rejected. The State s General Terms and Conditions (GTC) are not negotiable. 10. Costs for developing quotes and in anticipation of award of the agreement are entirely the responsibilities of the bidder and shall not be charged to the State of California. 11. No oral understanding or agreement shall be binding on either party. To be considered responsive, pages 6 to 19 must be completed and returned, as well as proof that the Contractor meets all Bidder Minimum Qualifications as defined on page 5. Proposed Term of Contract 1. The anticipated term of this contract resulting from this RFQ will be from June 24, 2013, or upon approval from (MSH) to August 31, The term of the contract may change if MSH makes an award earlier than expected or if MSH cannot execute the contract in a timely manner due to unforeseen delays. 3. The contract resulting from this RFQ shall be of no force or effect until it is signed by both parties and approved by DGS. The Bidder awarded a contract is advised not to commence performance until a contract award has been made, all approvals have been obtained, and the awarded contract has been fully executed. Should performance commence, before all approvals are obtained, services will be considered to have been volunteered. 4. The awarding agency reserves the right to reject all quotes. The agency is not required to award an agreement. THE REST OF THIS PAGE IS BLANK

3 Page 3 of 21 Scope of Work 1. Contractor agrees to provide the Department of State Hospitals Metropolitan (MSH) with installation of emergency power circuits, exclusively for the Personal Duress Alarm System (PDAS) project. 2. The services shall be performed at Metropolitan State Hospital, Bloomfield Ave., Norwalk, CA The services shall be provided during normal business hours Monday through Friday, 8:00 a.m. through 4:30 p.m., or a schedule that is mutually agreed upon by both parties, except state observed holidays. 4. Contractor agrees to supply all labor, equipment, materials, supplies, personnel, license and permits, and insurance necessary or required to provide installation of approximately twenty-six (26) power outlets (1-phase, 120v 20amp) to serve the PDAS in accordance to California Building Code Title 24 as follows: A. CTW Units 402, 404, 406, and 408 (Room 126A to Room 137 in each Unit); 410, 412, 414, and 416 (Room 226A to Room 237 in each Unit) i. Installation of 120V 20A E-power to eight (8) IDF s in patient occupied Units ii. Installation of 100ft. or more of #12 THHN Cable iii. Installation of 100ft. or more of wire mold 2400 raceway or conduit iv. Installation of 1-Quad electrical outlet for E-power v. Provide and install eight (8) circuit breakers to match the existing panel for each location vi. Return the system back to its original state and ensure proper operation B. CTE Units 401, 403, 405, and 407 (Room 133 to Room 137 in each Unit); 409, 411, 413, and 415 (Room 233 to Room 237 in each Unit) i. Installation of 120V 20A E-power to eight (8) IDF s in patient occupied Units ii. Installation of 50ft. or more of #12 THHN Cable iii. Installation of 50ft. or more of wire mold 2400 raceway or conduit iv. Installation of 1-Quad electrical outlet for E-power v. Provide and install eight (8) circuit breakers to match the existing panel for each location vi. Return the system back to its original state and ensure proper operation C. Units 417, 418, 419, and 420 (Room 141 in each Unit) i. Installation of 120V 20A E-power to eight (8) IDF s in patient occupied Units ii. Installation of 30ft. or more of #12 THHN Cable iii. Installation of 30ft. or more of wire mold 2400 raceway or conduit iv. Installation of 1-Quad electrical outlet for E-power v. Provide and install four (4) circuit breakers to match the existing panel for each location vi. Return the system back to its original state and ensure proper operation

4 Scope of Work (Continued) Department of State Hospitals - Metropolitan Page 4 of 21 D. Units 101 and 102 (E panel in the corridor to Room 14 or 15 in each unit) i. Installation of 120V 20A E-power to eight (8) IDF s in patient occupied Units ii. Installation of 100ft. or more of #12 THHN Cable iii. Installation of 100ft. or more of wire mold 2400 raceway or conduit iv. Installation of 1-Quad electrical outlet for E-power v. Provide and install two (2) circuit breakers to match the existing panel for each location vi. Return the system back to its original state and ensure proper operation E. Units 105, 106, 107, and 108 (E panel in the corridor to Room 17 in each Unit) i. Installation of 120V 20A E-power to eight (8) IDF s in patient occupied Units ii. Installation of 10ft. or more of #12 THHN Cable iii. Installation of 10ft. or more of wire mold 2400 raceway or conduit iv. Installation of 1-Quad electrical outlet for E-power v. Provide and install four (4) circuit breakers to match the existing panel for each location vi. Return the system back to its original state and ensure proper operation 5. Contractor shall maintain in effect at all times, during the term of this Agreement a valid Certificate of Insurance in accordance with Exhibit F Insurance Requirements. 6. Contractor shall maintain in effect at all times during the term of this Agreement current licenses, certifications, and permits in accordance with Federal, State, and local government requirements. 7. MSH Contract Manager shall provide a full orientation of all MSH rules and regulations. 8. Contractor agrees to acknowledge and adhere to MSH rules, regulations, policies and procedures. 9. Contractor shall be aware that they are to bring no cell phone with camera capabilities behind the secured area nor shall any Contractor or their employees have the ability to take pictures or video anywhere on MSH grounds without the written consent of the Executive Director. 10. Contractor shall be aware that MSH is a tobacco free facility. Smoking is prohibited in all areas of the hospital, there are no exceptions. 11. Contractor is advised that tan, brown, and khaki clothing will prevent entry to secured compounds of the hospital. 12. Contractor must be prepared to display a list of tools in their possession, when entering and exiting secured compounds of the hospital. 13. All work shall be coordinated and approved by the Contract Manager. In the event additional work shall be required, the Contractor shall provide the Contract Manager with a written estimate for review and approval prior to commencing the work. 14. Contractor and/or Contractor's service staff MUST be able to pass a background check with the State of California to be eligible for a contractor identification badge (ID). The ID badge will allow the Contractor to act as an independent service provider. Contractor and service staff, (if applicable), shall submit to the background check within ten (10) business days upon execution of the contract and provide MSH with proof of submission. Failure to do so will result in termination of the contract. Background check shall be completed at the Contractor's expense. The Contractor and/or service staff shall submit to a LIVE SCAN background check at the Contractor s choice of Law Enforcement Agency. It is the responsibility of the Contractor to obtain Metropolitan State Hospital's ORI Number, which will direct the return

5 Scope of Work (Continued) Department of State Hospitals - Metropolitan Page 5 of 21 results to MSH. Contractor shall obtain a Request for Live Scan Service Form from Metropolitan State Hospital s General Services Department, which will include the Hospital s ORI Number, for the Law Enforcement agency conducting the LIVE SCAN process. 15. Contractor shall provide annual proof of tuberculosis screening to the Medical Services Department in accordance with the California Code of Regulations, Title 22. Testing shall be completed at the Contractor s expense. 16. Contractor shall comply with state prevailing wage law, Chapter 1 of Part 7 of Division 2 of the Labor Code, commencing with Section 1720 and Title 8, California Code of Regulations, Chapter 8, Subchapter 3, commencing with Section 16000, for any public works (as that term is defined in the statues) performed on the Project funded by this Agreement. For purpose of compliance with prevailing wage law, the Contractor shall comply with provisions applicable to an awarding body. Compliance with state prevailing wage law includes without limitation: payment of at least prevailing wage as applicable; overtime and working hour requirements; apprenticeship obligations; payroll recordkeeping requirements; and other obligations as required by law. 17. Contractor shall supply a warranty/guarantee covering labor, materials, and workmanship on all work accomplished under these specifications for a period of one (1) year, commencing on the acceptance date. A copy of the warranty shall be sent to: Department of State Hospitals Metropolitan State Hospitals Attn: General Services Margo Liner S. Bloomfield Ave. Norwalk, CA Bidder Minimum Qualifications Each bidder and/or their subcontractor shall meet the following minimum qualifications. If the bidder and/or subcontractor do not meet the minimum qualifications, the quote may be deemed non-responsive and rejected without further review. A. All bidders are required to submit evidence of their appropriate current licenses, permits, and certification with the quote package: i. Bidders operating within the State of California shall meet all terms and conditions for operating a business in the city/county in which the business is headquartered and provide evidence of that right (e.g. a valid Business License). iii. Contractor must have a current and valid C-10 Electrical Contractor License as issued by the State of California Contractors State Licensing Board. B. All bidders are required to submit proof, with the quote package, of the following: i. Contractor shall submit Bidder s References (attached) and they may be checked to verify work experience. ii. Contractor shall submit a Statement of Qualifications (attached). Contractor and Contractor s personnel must possess a minimum of five (5) years of experience.

6 Cost Sheet Department of State Hospitals - Metropolitan Page 6 of 21 Please read the Scope of Work and quote accordingly. The cost sheet listed below is based on an estimated volume of services, to be provided by Contractor, and is not binding on the contracting agency. The estimated volume of services is not a guarantee, neither expressed nor implied, on the actual volume of monthly services that shall be required for this contract. June 24, 2013 August 31, 2013 Description Labor and Material for installation of emergency power circuits as described in the Scope of Work $ Cost Billing cycle: Monthly Quarterly Semi-Annually Annually Note: All services performed are paid in arrears according to billing cycle indicated above.

7 Page 7 of 21 Quote/Bidder Certification Sheet This Bid/Bidder Certification Sheet must be signed and returned along with all the attachments as an entire package. By signing below, I certify: 12. My all-inclusive bid is submitted as detailed in Attachment 3, Cost Sheet. 13. All required attachments are included with this Certification Sheet. 14. I have reviewed the Bidder Instructions (GSPD-451) at: The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification. An Unsigned Quote/Bidder Certification Sheet May Be Cause for Rejection 1. Company Name 2. Telephone Number 3. Address (street number/state/zip code) ( ) 2a Fax Number ( ) Indicate your organization type: 4. Sole Proprietorship 5. Partnership 6. Corporation Indicate the applicable employee and corporation number: 7. Federal Employee ID No. (FEIN): 8. California Corporation No. 9. Indicate applicable license and/or certification information: 10. Bidder s Name (Print) 11. Title 12. Signature: 13. Date 14. Are you certified with the Department of General Services, Office of Small Business Certification and Resources (OSDC) as a: a. California Small Business No Yes b. Disabled Veteran Business Enterprise No Yes If yes, enter certification number: If yes, enter your service code number: NOTE: A copy of your Certification is required to be included if either of the above items is checked Yes. Date application was submitted to OSDC, if an application is pending: DECLARATIONS UNDER PENALTY OF PERJURY: By signing above, with inclusions of the date of signature, the above signed bidder DECLARES UNDER THE PENALTY OF PERJURY under the laws of the State of California as follows: (1) Statement of Compliance; The above signed as complied with the non-discrimination program requirements of Government Code and Title 2, California Administrative Code Section 8103, and such declaration is true and correct. (2) The National Labor Relations Board declaration set forth in paragraph 48 of the General Provisions is true and correct. (3) If a claim is made for the Small Business or Disabled Veterans Business Preference, the information set forth within is true and correct.

8 Page 8 of 21 Completion Instructions for the Quote/Bidder Certification Sheet Complete the items on the Official State Quote Form/Bidder Certification Sheet by following the instructions below. Item No. Instructions 1, 2, 2a, 3 Must be completed. Item is self-explanatory. 4 Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership or corporation. The sole proprietor is solely liable for all the debts of the business. 5 Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business of profit. 6 Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals. 7. Enter your federal employee tax identification number or Social Security Number if your firm is a sole proprietorship. 8. Enter your corporation number assigned by the California Secretary of State s Office. This information is used for checking if a corporation is in good standing and qualified to conduct business in California. 9. Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required for the type of services being procured. 10, 11, 12, 13 Must be completed. Item is self-explanatory. 14 If certified as a Small Business Enterprise, place a check in the YES box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the YES box and enter your service code on the line. If you are not certified to one or both, place a check in the NO box(es). If your certification is pending, enter the date your application was submitted to OSBCR.

9 Page 9 of 21 Bidder References 1. List below three references for services performed within the last five (5) years, which are similar to the scope of work to be performed in the contract. REFERENCE 1 Name of Firm Street Address City State Zip Code Contact Person Telephone Number Dates of Service Brief Description of Service Provided Value or Cost of Service REFERENCE 2 Name of Firm Street Address City State Zip Code Contact Person Dates of Service Brief Description of Service Provided Telephone Number Value or Cost of Service REFERENCE 3 Name of Firm Street Address City State Zip Code Contact Person Telephone Number Dates of Service Value or Cost of Service Brief Description of Service Provided

10 Page 10 of 21 Disabled Veteran Business Enterprise (DVBE) Participation Program Requirements DVBE participation program requirements are NOT mandatory in this bid package. The bidder s proposal may contain the completed forms from DGS website depending on the option chosen for Disabled Veteran Business Enterprise (DVBE) participation. A. DVBE Incentive Option without the DVBE Program Requirement 1. In accordance with section 999.5(a) of the Military and Veterans Code, an incentive will be given to bidders who provide DVBE participation. For evaluation purposes only, the State shall apply an incentive to bids that propose California certified DVBE participation as identified on the Bidder Declaration Form (GSPD ) and confirmed by the State. The DVBE Incentive will be given according to the following scale to those bidders who meet or exceed the requirements: Confirmed DVBE Participation Incentive Amount 5% and over 5% 4% -4.99% 4% 3%-3.99% 3% 2. The incentive will be calculated based on low price, The net bid price of responsive bids will be reduced (for evaluation purposed only) by the amount of the DVBE incentive as applied to the lowest responsive bid net price. If the #1 ranked responsive, responsible bid is a California certified small business, the only bidders eligible for the incentive will be the California certified small businesses. The incentive adjustment for awards based on low price cannot exceed 5% or $100,000.00, whichever is less, of the #1 ranked net bid price. When used in combination with a preference adjustment, the cumulative adjustment amount cannot exceed $100, B. All bidders who would like to be considered for the DVBE incentive must complete the Bidder Declaration Form (GSOD ) and include it with the bid response. The Bidder Declaration Form can be found at: C. To receive the DVBE incentive, the bidder must do at least one of the following: 1. Be a certified DVBE bidder. As a certified DVBE bidder, the bidder must commit to performing at lease 3% of the contract bid amount with the prime bidder s firm or in combination with another DVBE. All DVBE participation must be documented on the Bidder Declaration Form (GSPD ). In addition, the DVBE bidder shall submit the Disabled Veteran Business Enterprise Declaration (STD 843). All disabled veteran owners and disabled veteran managers of the DVBE(s) must sign the form(s). The form can be found at: and must be included with the bid response. 2. Commit to using certified DVBEs and meet the contract goal of 3% of the combined total cost. At the time that a bidder submits the final proposal, the bidder will have calculated the dollar value of the total cost proposed in response to the requirements of this IFB. For this reason, if the bidder claimed to meet the DVBE goal, the bidder shall identify all subcontractors proposed for participation in the contract, the actual dollar figure, and the percentage (3% or more of the combined total cost shown on the Cost Sheet, representing the rate of participation for each proposed DVBE Subcontractor). This data shall be identified on the Bidder Declaration Form (GSPD ) and submitted with the bidder s completed bid package.

11 Page 11 of 21 Disabled Veteran Business Enterprise (DVBE) Participation Program Requirements (Continued) Due to recent legislation, The Good Faith Effort option will no longer be considered as meeting the DVBE participation requirement. Any bid submitted with the Good Faith Effort option shall cause a proposal to be considered non-responsive and ineligible for contract award. 3. Information submitted by the bidder to claim the DVBE incentive will be verified by the State. Only the DVBEs who shall perform a commercially useful function relevant to the Scope of Work included in this IFB may be used to qualify the bidder for a DVBE incentive. For more information regarding the DVBE incentive, commercially useful function definition, and how to locate DVBEs, please view the following website:

12 Statement of Qualifications Department of State Hospitals - Metropolitan Page 12 of 21 Explain why you believe your firm is qualified to perform the work described in this quote. Address your experience in response to the Scope of Work and Bidder Minimum Qualifications.

13 CCC-307 Contractor Certification Clauses Department of State Hospitals - Metropolitan Page 13 of 21 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 By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County of 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code (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 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: i. The dangers of drug abuse in the workplace; ii. The person's or organization's policy of maintaining a drug-free workplace; iii. Any available counseling, rehabilitation and employee assistance programs; and, iv. Penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: i. Receive a copy of the company's drug-free workplace policy statement; and, ii. Agree to aquotee 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.)

14 Page 14 of 21 CCC-307 Contractor Certification Clauses (Continued) 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, 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 and , 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 and Public Contract Code Section 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 over $100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code section 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.

15 CCC-307 Contractor Certification Clauses (Continued) Department of State Hospitals - Metropolitan Page 15 of 21 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 (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 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 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.

16 CCC-307 Contractor Certification Clauses (Continued) Department of State Hospitals - Metropolitan Page 16 of 21 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 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.

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19 Page 19 of 21 DARFUR CONTRACTING ACT CERTIFICATION Public Contract Code Sections 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 complete the certification below. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California. Company/Vendor Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County and State of 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. Company/Vendor Name (Printed) Federal ID Number Initials of Submitter Printed Name and Title of Person Initialing

20 Insurance Requirements Department of State Hospitals - Metropolitan Page 20 of 21 The Insurance Requirements are not mandatory requirements of this RFQ, but are required upon the award of the Contract. EXHIBIT F INSURANCE REQUIREMENTS 1. APPLICABLE LIABILITY INSURANCE The insurance and/or bonds identified below with a marked box are a part of this Agreement. Only the insurance and/or bonds with marked box have any force or effect under this Agreement. Evidence of liability insurance coverage, in the form a certificate acceptable to the State, shall be provided prior to the execution of this Agreement and the commencement of services. Commercial General Liability Contractor shall maintain commercial general liability insurance covering bodily injury, property damage, and personal injury with limits not less than $1,000,000 per occurrence and $2,000,000 general aggregate. Said policy shall apply separately to each insured against whom any claim is made or suit is brought subject to the Contractor s limits of liability. Pollution/Environmental Impairment Liability Contractor shall maintain Pollution Liability covering the Contractor s liability for bodily injury, property damage and environmental damage resulting from pollution and related cleanup costs incurred, all arising out of the work or services to be performed under this Agreement. Coverage shall be provided for both work performed on site, as well as during the transport of hazardous materials. Limits of not less than $1,000,000 bodily injury and property damage combined single limit per occurrence shall be provided. Motor Vehicle Liability Contractor shall maintain motor vehicle liability insurance with limits not less than $1,000,000 per accident. Such insurance shall cover liability arising out of an accident involving a motor vehicle in use by the Contractor during the prosecution of services under this Agreement, including, but not limited to, Contractor owned, hired, and non-owned motor vehicles. Professional Liability Contractor shall maintain Professional Liability/Medical Malpractice insurance covering any damages caused by an error, omission or any negligent acts. The limits shall not be less than $1,000,000 per occurrence and $2,000,000 general aggregate. In the event a medical professional performing services under this Agreement is a subcontractor or is performing services through a registry, the medical professional actually performing the services shall be the insured and shall comply with the Professional Liability/Medical Malpractice insurance requirements of this Agreement. The prime contractor shall be responsible to enforce this provision and employ only those medical professionals meeting this requirement. Evidence of compliant insurance shall be provided to the California Department of State Hospitals prior to the commencement of services.

21 Page 21 of 21 Performance Bond Insures Contractor will faithfully complete the work on schedule in accordance with this Agreement. Should Contractor fail to meet the schedule, the State can seek a claim with the surety for any loses incurred. If Contractor WILL NOT complete the work, the State may seek another contractor and be reimbursed for the costs of the second contractor. The amount of the bond shall equal the amount of this Agreement. 2. TERM OF INSURANCE Insurance shall be in effect for the entire term of this agreement. If the insurance expires prior to the end of the term of the Agreement, a new certificate must be received by the State at least ten (10) days prior to the expiration of the insurance. 3. TERMINATION FOR NON-COMPLIANCE In the event Contractor fails to keep in effect at all times the specified insurance coverage, the State may, in addition to any other remedies it may have, terminate this Agreement upon the occurrence of such event, subject to the provisions of this Agreement. 4. ENDORSEMENTS Commercial General and Pollution/Environmental Impairment Liability insurance certifications shall include the following endorsement: State of California, its officers, employees, agents and servants are included as additional insured, but only insofar as operations under this Agreement are concerned. 5. CERTIFICATE SUBMISSION Certificates of liability insurance shall be submitted to the following address: Department of State Hospitals Metropolitan State Hospital Attention: Margo Liner S. Bloomfield Ave., Norwalk, CA Phone: (562) Margo.Liner@msh.dsh.ca.gov Revision