INVITATION FOR BID. Notice to Prospective Bidders. March 6, 2009

Transcription

1 C o a l i n g a S t a t e H o s p i t a l P. O. Box 5000, Coalinga, CA (559) INVITATION FOR BID Notice to Prospective Bidders March 6, 2009 You are invited to review and respond to this Invitation for Bid (IFB), entitled: Funeral Home for (IFB Title) (IFB Number) In submitting your bid, you must comply with the instructions. 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 below. In the opinion of the Department of Mental Health, Coalinga State Hospital, this Invitation for Bid is complete and without need of explanation. However, if you have questions, or should you need any clarifying information, the contact person for this IFB is: Liz Moreno Coalinga State Hospital Contracts Office Public Phone Number: (559) Fax Number: (559) Address: emoreno@csh.dmh.ca.gov Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum. Liz Moreno Contracts Analyst

2 Coalinga State Hospital Page 2 of 21 Table of Contents Section Pages A) Purpose and Description of Service. 3 B) Bidder Minimum Qualifications 3 C) Bid Requirements and Information 3 7 1) Key Action Dates/Time Schedule 3 2) Submission of Bid ) Evaluation and Selection.. 5 4) Award and Protest. 6 5) Disposition of Bid 6 6) Agreement Execution and Performance. 7 D) Preference Programs E) Required Attachments ) Required Attachment Check List. 8 2) Official State Bid/Bidder Certification Sheet ) Budget Detail ) Payee Data Record (STD 204) ) Small Business Preference ) Bidder References. 15 7) Contractor s Certification Clauses (CCC Page 1) ) Darfur Contracting Act 19 F) Note to Bidders Sample Standard Agreement (STD. 213) 21 1) Exhibit A, Scope of Work ) Exhibit B, Payment Provisions 1 3) Budget Detail ) Exhibit C, General Terms and Conditions (View at DGS Internet Site: 5) Exhibit D, Special Terms and Conditions ) Exhibit E, HIPAA Business Associate Provisions 1-2 7) Exhibit F, Insurance Requirements 1-2

3 Coalinga State Hospital Page 3 of 21 A) Purpose and Description of Services Contractor shall provide Department of Mental Health, Coalinga State Hospital (CSH) all labor, tools, materials, equipment, non-consumable supplies, transportation, including travel and per diem, licenses, permits, certificates and every other item of expense necessary to provide Professional Cremation Services. Contractor shall provide services in accordance with the State Cemetery Act, Chapter 12 and Chapter 19, Business and Professions Code and as specified herein. Services shall be provided seven (7) days a week, including holidays. Bidders must refer to Exhibit A - Scope of Work for complete description of services. (3 pages) B) Bidder Minimum Qualifications Contractor shall possess and maintain throughout the term of this agreement, a current and valid license to do business in the State of California and shall maintain at Contractor s expense, any and all necessary license(s), permit(s), and certificate(s) required by law for accomplishing any work required in connection with this contract. Such license(s) permit(s), and certificate(s) shall be in full force and effect prior to conducting any work required in connection with this contract. Contractors located 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. Contractors, which are corporations located within the State of California may submit a copy of the incorporation document/letter from the Secretary of State. Contractors located outside the State of California shall meet all terms and conditions for operating a business in the state, province, or country in which it is headquartered, and shall submit an affidavit to show that the business is in good standing in that state, province, or country. C) Bid Requirements and Information 1) Key Action Dates/Time Schedule Event Date Time IFB available to prospective bidders: 3/06/09 8:00 AM Final Date for Bid Submission: 3/23/09 4:00 PM Bid Opening: 3/24/09 9:00 AM Notice of Intent to Award Posted: 3/24/09 3:00 PM Proposed Award Date: 4/01/09 8:00 AM

4 Coalinga State Hospital Page 4 of 21 2) Submission of Bid a) All bids must be submitted under sealed cover and sent to Coalinga State Hospital by dates and times shown in Section C, Bid Requirements and Information, Item 1 Key Action Dates/Time Schedule (Page 3). The sealed cover must be plainly marked with the IFB number and title, must show your firm name and address, and must be marked DO NOT OPEN, as shown in the following example: (IFB Number) (IFB Title) (Agency Name and Address) DO NOT OPEN Bids not submitted under sealed cover shall be rejected. A minimum of two (2) copies of the bid must be submitted. b) All bids shall include the documents identified in Section E, Required Attachment Checklist (Page 8). Bids not including the proper required attachments shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements. c) All documents requiring a signature must bear an original signature of a person authorized to bind the bidding firm. d) Mail or deliver bids to the following address: U.S. Postal Deliveries: Hand Deliveries: (UPS, Express Mail, Federal Express) Coalinga State Hospital Procurement/Contracts Department Attn: Liz Moreno P. O. Box 5000 Coalinga, CA Coalinga State Hospital Procurement/Contracts Department Attn: Liz Moreno West Jayne Avenue Coalinga, CA e) Bids must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and shall cause a bid to be rejected. f) A bid shall be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all bids and may waive any immaterial deviation in a bid. The State s waiver of immaterial defect shall in no way modify the IFB document or excuse the bidder from full compliance with all requirements if awarded the agreement. g) Costs for developing bids and in anticipation of award of the agreement are entirely the responsibility of the bidder and shall not be charged to the State of California.

5 Coalinga State Hospital Page 5 of 21 h) An individual who is authorized to bind the bidding firm contractually shall sign the Official State Bid Form/Bidder Certification Sheet, Page 9. The signature must indicate the title or position that the individual holds in the firm. An unsigned bid shall be rejected. i) A bidder may modify a bid after its submission by withdrawing its original bid and resubmitting a new bid prior to the bid submission deadline. Bidder modifications offered in any other manner, oral or written, will not be considered. j) A bidder may withdraw its bid by submitting a written withdrawal request to the State, signed by the bidder or an agent authorized in accordance with (h) above. A bidder may thereafter submit a new bid prior to the bid submission deadline. Bids shall not be withdrawn without cause subsequent to bid submission deadline. k) The awarding agency may modify the IFB prior to the date fixed for submission of bids by the issuance of an addendum to all parties who received a bid package. l) The awarding agency reserves the right to reject all bids for reasonable cause. If all bids are too high, the agency is not required to award an agreement. m) Bidders are cautioned to not rely on the State during the evaluation to discover and report to the bidder any defects and errors in the submitted documents. Bidders, before submitting their documents, must carefully proof them for errors and adherence to the IFB requirements. n) Where applicable, bidder must carefully examine work sites and specifications. Bidder shall investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered. No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications. o) The State does not accept alternate contract language from a prospective bidder/contractor. A bid with such language will be considered a counter proposal and shall be rejected. The State s General Terms and Conditions (GTC) are not negotiable. p) No oral understanding or agreement shall be binding on either party. 3) Evaluation and Selection a) At the time of bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this IFB. b) The State will evaluate each bid to determine its responsiveness to the published requirements. c) Bids that contain false or misleading statements, or which provide references, which do not support an attribute or condition claimed by the bidder, may be rejected. d) Award if made, will be to the lowest responsive responsible bidder.

6 Coalinga State Hospital Page 6 of 21 4) Award and Protest a) Whenever an agreement is awarded under a procedure which provides for competitive bidding, but the agreement is not be awarded to the low bidder, the low bidder shall be notified by telegram, electronic facsimile transaction, overnight courier, or personal delivery five (5) working days prior to the award of the agreement. b) Upon written request by any bidder, notice of the proposed award shall be posted in a public place in the office of the awarding agency at least five (5) working days prior to awarding the agreement. c) If any bidder, prior to the award of agreement, files a written protest with the Department of General Services, Office of Legal Services, 707 Third Street, 7 th Floor, Suite 7-330, West Sacramento, CA and the awarding agency on the grounds that the (protesting) bidder is the lowest responsible bidder, the agreement shall not be awarded until either the protest has been withdrawn or the Department of General Services has decided the matter. d) Within five (5) days after filing the initial protest, the protesting bidder shall file with the Department of General Services and the awarding agency a detailed written statement specifying the grounds of the protest. The written protest must be sent to the Department of General Services, Office of Legal Services, rd Street, 7 th Floor, Suite 7-330, West Sacramento, California A copy of the detailed written statement must be mailed to the awarding agency. It is suggested that you submit any protest by certified or registered mail. e) Upon resolution of the protest and award of the agreement, Contractor must complete and submit to the awarding agency the Payee Data Record (STD 204), to determine if the Contractor is subject to state income tax withholding pursuant to California Revenue and Taxation Code Section and This form can be found on the Internet at under the heading FORMS MANAGEMENT CENTER. No payment shall be made unless a completed STD 204 has been returned to the awarding agency. f) Upon resolution of the protest and award of the agreement, Contractor must sign and submit to the awarding agency, Page (1) of the Contractor Certification Clauses (CCC) which can be found on the Internet at This document is only required if the bidder has not submitted this form to the awarding agency within the last three (3) years. 5) Disposition of Bids a) Upon bid opening, all documents submitted in response to this IFB will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by the public. b) Bid packages shall be returned only at the bidder s expense, unless such expense is waived by the awarding agency.

7 Coalinga State Hospital Page 7 of 21 6) Agreement Execution and Performance a) Performance shall start not later than the express date set by the awarding agency and the Contractor, after all approvals have been obtained and the agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, the awarding agency, upon five (5) days written notice to the Contractor, reserves the right to terminate the agreement. In addition, the Contractor shall be liable to the State for the difference between Contractor s bid price and the actual cost of performing work by the second lowest bidder or by another contractor. b) All performance under the agreement shall be completed on or before the termination date of the agreement. D) Preference Programs Small Business Preference applies to this IFB: This website provides information and procedures for bidders who wish to apply for the Small Business Preference Program. Please note that although participation in this preference program is optional, all bidders must complete and submit Attachment 5, Small Business Preference. Bidders that are certified as a small business in California are encouraged to apply for this IFB. In addition, per new Small Business Preference regulations, prime contractors who subcontract with a certified small business for not less than 25% of the total contract are eligible for small business preference. E) Required Attachments Refer to the following pages for additional Required Attachments that are a part of this agreement.

8 Coalinga State Hospital Page 8 of 21 Attachment 1 REQUIRED ATTACHMENT CHECKLIST A complete bid or bid package will consist of the items identified below. Complete this checklist to confirm the items in your bid. Place a check mark or X next to each item that you are submitting to the State. For your bid to be responsive, all required attachments must be returned. This checklist must be returned with your bid package also. Attachment Attachment Name/Description Attachment 1 Required Attachment Checklist Attachment 2 Official State Bid Form/Bidder Certification Sheet Attachment 3 Budget Detail Attachment 4 Payee Data Record (STD 204) Attachment 5 Small Business Preference Attachment 6 Bidder References Attachment 7 Contractor Certification Clauses (CCC 307). The CCC can be found on the Internet at Page 1 must be signed and submitted prior to award of the contract, but is not required if the bidder has submitted this form to the awarding agency within the last three(3) years. Attachment 8 Darfur Contracting Act Must be initialed and signed No Attachment # Copy of current Business License No Attachment # Copy of Certificate of Insurance No Attachment # Copy of Funeral Establishment and Funeral Directors License and copy of Certificate of Authority and/or Crematory License of the facility performing the cremation.

9 Coalinga State Hospital Page 9 of 21 Attachment 2 OFFICIAL STATE BID FORM BIDDER CERTIFICATION SHEET This Official State Bid Form/Bidder Certification Sheet must be signed and returned along with all the Required Attachments as an entire package in duplicate with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions. Do not return Section C, Bid Requirements and Information (Pages 1 through 7), nor the Sample Agreement (scope of work). A. Our all inclusive bid amount for the Twenty-Four Month period is $. (Total from Page 11) B. All required attachments are included with this Official State Bid Form/Bidder Certification Sheet. C. 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 Official State Bid Form/Bidder Certification Sheet Shall be Cause for Rejection 1. Company Name: 2. Telephone Number: ( ) 2(a). Fax Number: ( ) 3. Address: Indicate your organization type: 4. Sole Proprietorship 5. Partnership 6. Corporation Indicate the applicable employee and/or corporation number: 7. Federal Employee ID No. (FEIN): 8. California Corporation No: Indicate applicable license and/or certification information: 9. Contractor s State Licensing Board Number: 10. PUC License Number: 11. Required (Specify): CAL-T- 12. Bidder s Name (Print): 13. Title: 14. Signature: 15. Date: 16. Are you certified with the Department of General Services, Office of Small Business Certification and Resources (OSBCR) as: (A) Small Business Enterprise YES NO (B) Disabled Veteran Business Enterprise YES NO If yes, enter Certification Number: * If yes, enter your Service Code Number: * *NOTE: A copy of your Certification must be included if either of the above items is checked YES Date application was submitted to OSBCR, if an application is pending:

10 Coalinga State Hospital Page 10 of 21 Completion Instructions for Official State Bid Form/Bidder Certification Sheet Complete the items on the Official State Bid Form/Bidder Certification Sheet by following the instructions below. Item Instructions A. Your all inclusive (total bid) amount for the contract period must be shown in this item. B. Compliance required. Item is self-explanatory. C. Compliance required. Item is self-explanatory. 1. Must be completed. Item is self-explanatory. 2. Must be completed. Item is self-explanatory. 2(a) Must be completed. Item is self-explanatory. 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 and 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. 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 your firm holds a California contractor s license. This information will be used to verify possession of a contractor s license for public works agreements. 10. Complete if your firm holds a PUC license. This information will be used to verify possession of a PUC license for public works agreements. 11. 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. 12. Must be completed. Item is self-explanatory. 13. Must be completed. Item is self-explanatory. 14. Must be completed. Item is self-explanatory. 15. Must be completed. Item is self-explanatory. 16. 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. A copy of your Certification is required to be included if either of the items are checked YES. If you are not certified to one or both, place a check in the NO box(s). If your certification is pending, enter the date your application was submitted to OSBCR.

11 Coalinga State Hospital Page 11 of 21 Attachment 3 Budget Detail Reimbursement Schedule Estimated for a 24 month term Contractor agrees to provide at the following rates: A. Estimated number of Cremations X Rate Per Cremation = (A.) Grand Total 24 X $ = $ B. Additional Charges if Needed: FLAT RATE Estimates Only Transportation from San Luis $ (roundtrip) $3, Obispo or Fresno to Coalinga Transportation from San Luis $ (roundtrip) $ 4, County to Fresno (or visa versa) Fresno Coroner Fee (may apply) $ $ 1, Shipping cremated remains within USA $65.00 $ 1, Refrigeration Fee Per Day (After ten (10) days) $50.00 $12, GRAND TOTAL $23, Total A = $ Grand Total (A + B) = Total B = $ 23, $ (Amount to be entered on page 9) Contractor may offer a discount on invoices in order for the invoices to be paid within 30 (thirty) days of receipt. Discount offered must be at least one-half percent and a minimum of $5.00. Discount offered on invoices paid within 30 (thirty) days of receipt - % In the event of a tie, absent other determining factors, the lowest responsible bid with the highest discount shall prevail.

12 Coalinga State Hospital Page 12 of 21 Attachment 4 STATE OF CALIFORNIA PAYEE DATA RECORD (Required in lieu of IRS W-9 when doing business with the State of California) STD. 204 (REV.2-99) SECTION 1 must be completed by the requesting state agency before forwarding to the payee. 1 PLEASE RETURN TO: 2 COALINGA STATE HOSPITAL, CONTRACTS OFFICE P.O. BOX 5000 Coalinga, CA (559) Liz Moreno PAYEE S BUSINESS NAME PURPOSE: Information contained in this Form will be used by state agencies to Prepare information Returns (Form 1099 And for withholding on payments to non- Resident payees. Prompt return of this fully Completed form will prevent delays when Processing payments. (See Privacy State on reverse.) SOLE PROPRIETOR-ENTER OWNER S FULL NAME HERE (Last, First, M.I.) MAILING ADDRESS (Number and Street or P.O. Box Number) (City, State, and Zip Code) 3 PAYEE ENTITY TYPE CHECK ONE BOX ONLY LEGAL CORPORATION MEDICAL CORPORATION (Including dentistry, podiatry, psychotherapy, optometry, chiropractic, etc.) EXEMPT CORPORATION PARTNERSHIP ESTATE OR TRUST NOTE: State and local governmental entities, including school districts are not required to submit this form. 4 PAYEE S TAXPAYER I.D. NUMBER 5 PAYEE RESIDENCY STATUS 6 ALL OTHER CORPORATIONS INDIVIDUAL OR SOLE PROPRIETOR SOCIAL SECURITY NUMBER REQUIRED FOR INDIVIDUAL/SOLE PROPRIETOR BY AUTHORITY OF THE REVENUE AND TAXATION CODE SECTION (SEE REVERESE) FEDERAL EMPLOYER S IDENTIFICATION NUMBER (FEIN) - IF PAYEE ENTITY TYPE IS A CORPORATION, PARTNER- SHIP, ESTATE OR TRUST, ENTER FEIN. CHECK APPROPRIATE BOX(ES) SOCIAL SECURITY NUMBER - - IF PAYEE ENTITY IS INDIVIDUAL OR SOLE PROPRIETOR, ENTER SSN. California Resident Qualified to do business in CA or a permanent place of business in CA Nonresident (See Reverse) Payments for services by nonresidents may be subject to state withholding WAIVER OF STATE WITHHOLDING FROM FRANCHISE TAX BOARD ATTACHED SERVICES PERFORMED OUTSIDE OF CALIFORNIA I hereby certify under penalty of perjury that the information provided on this document is true and correct. If my residency status should change, I will promptly inform you. AUTHORIZED PAYEE REPRESENTATIVB S NAME (Type or Print) TITLE NOTE: Payment will not be processed without an accompanying taxpayer I.D. number. NOTE: a. An estate is a resident if decedent was a California resident at time of death. b. A trust is a resident if at least one trustee is a CA resident (See reverse.) CERTIFYING SIGNATURE SIGNATURE DATE TELEPHONE NUMBER

13 Coalinga State Hospital Page 13 of 21 STATE OF CALIFORNIA PAYEE DATA RECORD STD. 204 (REV.2-99) (REVERSE) ARE YOU A RESIDENT OR A NONRESIDENT? Each corporation, individual/sole proprietor, partnership, estate or trust doing business with the State of California must indicate their residency status along with their taxpayer identification number. A corporation will be considered a resident if it has a permanent place of business in California. The corporation has a permanent place of business in California if it is organized and existing under the laws of this state or, if a foreign corporation has qualified to transact intrastate business. A corporation that has not qualified to transact intrastate business (e.g., a corporation engaged exclusively in interstate commerce) will be considered as having a permanent place of business in their state only if it maintains a permanent office in this state that is permanently staffed by its employees. For individuals/sole proprietors, the term resident includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose which will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident. For withholding purposes, a partnership is considered a resident partnership if it has a permanent place of business in California. An estate is considered a California estate if the decedent was a California resident at the time of death and a trust is considered a California trust if at least one trustee is a California resident. ARE YOU SUBJECT TO NONRESIDENT WITHHOLDING? Payments made to nonresident payees, including corporations, individuals, partnerships, estates, and trusts, are subject to withholding. Nonresident payees performing services in California or receiving rent, lease, or royalty payments from property (real or personal) located in California will have 7% of their total payments withheld for state income taxes. However, no withholding is required if total payments to the payee are $1500 o less for the calendar year. A nonresident payee may request that income taxes be withheld at a lower rate or waived by sending a completed form FTB 588 to the address below. A waiver will generally be granted when a payee has a history of filing California returns and making timely estimated payments. If the payee activity is carried on outside of California or partially outside of California, a waiver or reduced withholding rate may be granted. For more information, contact: Franchise Tax Board Nonresident Withholding Section Attention: State Agency Withholding Coordinator P.O. Box 651 Sacramento, CA Telephone: (916) FAX: (916) If a reduced rate of withholding or waiver has been authorized by the Franchise Tax Board, attach a copy to this form. More information on residency status can be obtained by calling the Franchise Tax Board at the numbers listed below: From within the United States, call From outside the United State, call For hearing impaired with TDD, call PRIVACY STATEMENT Section 7(b) of the Privacy Act of 1974 (Public Law ) requires that any federal, state, or local governmental agency which requests an individual to disclose his social security account number shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it. The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State must provide their Taxpayer Identification Number (TIN) as required by the State Revenue and taxation Code, Section to facilitate tax compliance enforcement activities and to facilitate the preparation of Form 1099 and other information returns as required by the Internal Revenue Code, Section 6109(a). The TIN for individual and sole proprietorships is the Social Security Number (SSN). It is mandatory to furnish the information requested. Federal law requires that payments for which the requested information is not provided be subject to a 31% withholding and state law imposes noncompliance penalties of up to $20,000. You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business. Please call the Department of Finance, Fiscal Systems and Consulting Unit at (916) , if you have nay questions regarding this Privacy Statement. Questions related to residency or withholding should be referred to the telephone numbers listed above. All other questions should be referred to the requesting agency listed in Section 1.

14 Coalinga State Hospital Page 14 of 21 Attachment 5 SMALL BUSINESS PREFERENCE NOTICE TO ALL BIDDERS Small Business Preference Section 14835, ET. Seq. Of the California Government Code requires that a five percent (5%) preference be given to bidders who qualify as a small business. The rules and regulations of this law, including the definition of a small business for the delivery of services, are contained in Title 2, California Administrative Code, Section 1896, et. seq. A copy of the regulations is available on request. To claim the Small Business Preference, which may not exceed $50,000 for any bid, your firm must have its principal place of business located in California and be verified by the State Office of Small Business Certification and Resources. Questions regarding the preference approval should be directed to that office at (916) or (916) Please complete this form and return with your Bid. Are you claiming preference as a small business? ( ) YES ( ) NO Are you subcontracting not less than 25% of the total contract to a small business? ( ) YES ( ) NO Primary contractor or sub-contractor Small Business Number Name of CONTRACTOR/Organization Street Address, City, State, Zip Code Today s Date

15 Coalinga State Hospital Page 15 of 21 Attachment 6 BIDDER REFERENCES Failure to complete and return this attachment with your bid, along with a letter of recommendation from each company referenced below, will cause your bid to be rejected and deemed non-responsive. 1. A letter of recommendation from each company referenced below is required, stapled to this attachment, to ensure contractor has the qualifications, experience and capabilities to perform the services specified in Scope of Work, Exhibit A. All letters of recommendation must be on the referenced company s letterhead and signed by the referenced company s evaluator, enabling Coalinga State Hospital to verify the authenticity of each reference given. 2. List three references below of similar types of services performed within the last five years. If three references cannot be provided, please explain why on an attached sheet of paper. Reference 1 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: Reference 2 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: 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:

16 Coalinga State Hospital Page 16 of 21 Attachment 7 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 Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County of CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (GC (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: 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. (GC 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. (Public Contract Code 10296) (Not applicable to public entities.)

17 Coalinga State Hospital Page 17 of 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. Current State Employees (PCC 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 (PCC 10411):

18 Coalinga State Hospital Page 18 of 21 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. (PCC 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. (PCC (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. 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.

19 Coalinga State Hospital Page 19 of 21 DARFUR CONTRACTING ACT Attachment 8 Effective January 1, 2009, all Invitations for Bids (IFB) or Requests for Proposals (RFP) for goods or services must address the requirements of the Darfur Contracting Act of 2008 (Act). (Public Contract Code sections 10475, et seq.; Stats. 2008, Ch. 272). The Act was passed by the California Legislature and signed into law by the Governor 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 A scrutinized company is a company doing business in Sudan as defined in Public Contract Code section Scrutinized companies are ineligible to, and cannot, bid on or submit a proposal for a contract with a State agency for goods or services. (Public Contract Code section 10477(a)). Therefore, Public Contract Code section (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 when it submits a bid or proposal to a State agency. (See # 1 on the sample Attachment). 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). (See # 2 on the sample Attachment). The following sample Attachment may be included in an IFB or RFP to satisfy the Act s certification requirements of bidders and proposers. Pursuant to Public Contract Code section 10478, if a bidder or proposer currently or within the previous three years has had business activities or other operations outside of the United States, it must certify that it is not a scrutinized company as defined in Public Contract Code section Therefore, to be eligible to submit a bid or proposal, please complete only one of the following three paragraphs (via initials for Paragraph # 1 or Paragraph # 2, or via initials and certification for Paragraph # 3): 1. We do not currently have, or we have not had within the previous Initials three years, business activities or other operations outside of the United States. OR 2. We are a scrutinized company as defined in Public Contract Code Initials section 10476, but we have received written permission from the Department of General Services (DGS) 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. 3. We currently have, or we have had within the previous three years, Initials business activities or other operations outside of the United States, + Certification but we certify below that we are not a scrutinized company Below as defined in Public Contract Code section OR CERTIFICATION For # 3. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective proposer/bidder to the clause listed above in # 3. This certification is made under the laws of the State of California. Proposer/Bidder Firm Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County and State of YOUR BID OR PROPOSAL WILL BE DISQUALIFIED UNLESS YOUR BID OR PROPOSAL INCLUDES THIS FORM WITH EITHER PARAGRAPH # 1 OR # 2 INITIALED OR PARAGRAPH # 3 INITIALED AND CERTIFIED.

20 Coalinga State Hospital Page 20 of 21 NOTE TO BIDDERS The following fourteen (14) pages represent a sample of the contract that will be awarded, if any, from this IFB: SAMPLE Standard Agreement (STD 213) Exhibit A Scope of Work Exhibit B Payment Provisions and Budget Detail Exhibit D Special Terms and Conditions Exhibit E HIPAA Business Associate Provisions Exhibit F - Insurance Requirements Please review it carefully and present any questions in writing to the contact identified for this IFB. REMINDER: Exhibit C General Terms and Conditions must be viewed by all parties at Internet Site:

21 Coalinga State Hospital Page 21 of 21 STANDARD AGREEMENT STD 213 (Rev 06/03) AGREEMENT NUMBER REGISTRATION NUMBER This Agreement is entered into between the State Agency and the Contractor named below: STATE AGENCY'S NAME DEPARTMENT OF MENTAL HEALTH COALINGA STATE HOSPITAL CONTRACTOR'S NAME 2 The term of this Through Agreement is: Start Date Based Upon DGS Approval 3. The maximum amount $ of this Agreement is: 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 1-4 pages Exhibit B Payment Provisions and Budget Detail 1-2 pages Exhibit C* General Terms and Conditions GTC # 307 Check mark one item below as Exhibit D: X Exhibit D Special Terms and Conditions (Attached hereto as part of this agreement) 1-4 pages Exhibit D* Special Terms and Conditions Exhibit E HIPAA Business Associate Provisions 1-2 pages Exhibit F Insurance Requirements 1-2 pages Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached hereto. WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CONTRACTOR S NAME (if other than an individual, state whether a corporation, partnership, etc.) California Department of General Services Use Only BY (Authorized Signature) PRINTED NAME AND TITLE OF PERSON SIGNING DATE SIGNED(Do not type) ADDRESS STATE OF CALIFORNIA AGENCY NAME: DEPARTMENT OF MENTAL HEALTH COALINGA STATE HOSPITAL BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Stanley A. Bajorin, Chief Deputy of Administrative Services ADDRESS: Procurement Department Contracts Office th Street, Contracts Unit, Room 101 Sacramento CA Exempt per: