Specifications

STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
OBS 554
DVBE Bid Incentive Request and Acknowledgement
Name of Prime Contractor: CDCR IFB or RFP Number:
Completion of this document confirms DVBE BID Incentive request and acknowledges that the firm named below agreed
to be identified by a bidding firm as a proposed DVBE subcontractor or supplier for a CDCR agreement. Unless otherwise
stated, the DVBE incentive shall be equal to a bidder’s DVBE participation level. Unless otherwise stated, the DVBE Bid
Incentive is subject to a minimum of 3 percent and a maximum of 5 percent during the bid evaluation process. Each
named DVBE must have an application on file with the Department of General Services, Office of Small Business and
Disabled Veteran Business Enterprise Certification Services (OSDS) by 5:00 p.m. on the day bids are due. If the DVBE is
a subcontractor, then they must acknowledge their participation as claimed herein via the DVBE Subcontractor/Supplier
Acknowledgement below:
Subcontractor/Supplier Acknowledgement
Subcontractor acknowledgements:
A. The subcontracting firm named herein has committed to perform or provide services/labor or supplies equal to a
percentage of the total bid/cost proposal price submitted by the bidding firm named above.
B. The subcontracting firm named herein acknowledges the total dollar value of claimed participation identified above.
C. The subcontracting firm named herein agrees to provide the following subcontracted services/labor or supplies
under the resulting contract if the bidding firm named above receives the contract award:
Provide a brief description in the box below of the commercially useful function(s) that the subcontractor/supplier identified
herein will provide or supply. Attach additional page(s) if necessary.
l
The subcontracting firm named herein understands it is its sole responsibility to contact the bidding firm named above to
learn if the Proposer was awarded the contract pursuant to the referenced bid number and to confirm its subcontract
agreement. If the bidding firm named above receives an award based in part on the DVBE incentive, the bidding
firm/contractor is obligated to use each DVBE subcontractor or supplier identified in its proposal unless a subcontractor
substitution is requested after contract execution pursuant to Public Contract Code Section 4107 and Title 2 California
Code of Regulations Section 1896.10.
The person signing below certifies the information supplied on this form is true and accurate to the best of their knowledge
and agrees to allow the State to confirm this information, if deemed necessary.
Total Dollar Value of DVBE
Subcontractor Use:
Total DVBE
Percentage:
DVBE Certification #: DVBE Certification
Expiration Date:
Name of Proposed DVBE Subcontractor/Supplier: Date Signed:
Street Address: City: State: Zip Code:
Telephone Number:
( )
DVBE E-mail Address (if applicable):
DVBE Federal Employer ID (FEIN) #:
Printed/Typed Name: Title:
Signature of Subcontractor/Supplier Representative:
For State Use Only
Information Verified by:
Date:
Bid 6000001312
State of California
11/14/2013 2:35 PM
p. 143
6000001312
6000001312