Disabled Veteran Business Enterprise

Cal. Form PUR-003

California Superior Local Rules

ATTACHMENT SDSC PUR-003 (Rev. 1/16) DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) Page 1 of 2 Mandatory Form INCENTIVE QUALIFICATION DECLARATION SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) INCENTIVE QUALIFICATION DECLARATION Complete this form only if Bidder wishes to claim the DVBE incentive associated wi th this solicitation. Review the DVBE Incentive Qualification Declaration Instructions (SDSC Form #PUR-003A) prior to completing this form. If Bidder submits incomplete or inaccurate information, it will not receive the DVBE incentive. Check the applicable box(es) and complete the

section for which bidder is seeking qualification for DVBE incentive.

SECTION A. BIDDER IS A DVBE Complete this

section if Bidder is a DVBE. 1. DVBE Certification ID number: 2. DVBE Certification active from: to 3. Percentage of the contract work Bidder will subcontract to non-DVBE subcontractors: 4. All disabled veteran owners and managers of Bidder must complete and sign the DVBE Status Declaration (SDSC Form #PUR-004). Bi dder must submit the comp leted DVBE Status Declaration along with this DVBE Incentive Qualification Declaration. 5. Bidder must submit a copy of its DVBE certification along with this DVBE Incentive Qualification Declaration.

SECTION B. BIDDER HAS A DVBE BUSINESS UTILIZATION PLAN (BUP) Complete this

section if Bidder has an approved DVBE BUP on file with the Department of General Services (DGS) and this solicitation is for goods (IT or Non-IT), or IT serv ices (do not complete if this solicitation is for non-IT services). 1. Date BUP was approved by DGS: 2. Date through which BUP is valid: 3. Bidder must submit a copy of it s “Notice of Approved D VBE Business Utilization Plan” issued by DGS along with this DVBE Incentive Qualification Declaration.

SECTION C. BIDDER WILL USE DVBE SUBCONTRACTORS Complete this

section if the Bi dder will use DVBE Subcontractors. Enter the total number of DVBE subcontractors that Bidder will use for this contract: Provide the following information or materials for each DVBE Subcontractor the Bidder will use for this contract. Attach additional sheets if necessary. 1 . S u b c o n t r a c t o r N a m e : 2. Subcontractor Contact Person: 3. Subcontractor Address: 4. Subcontractor Telephone Number: 5. Subcontractor Email Address: 6. Subcontractor DVBE Certific ation ID Number: 7. Subcontractor DVBE Certification Active from: to 8.

Bidder must submit a copy of Subc ontractor’s DVBE certification along wi th this DVBE Incentive Qualification Declaration. 9. Describe the goods and/or services to be provided by Subcontractor in connection with the contract: ATTACHMENT SDSC PUR-003 (Rev. 1/16) DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) Page 2 of 2 Mandatory Form INCENTIVE QUALIFICATION DECLARATION 10. Explain how Subcontractor is performing a “commercially useful function” for purposes of this contract. (See Incentive Qualification Declaration Instructions for the definition of “commercially useful function.”) 11.

Enter the percentage of the total bid price for the good s and/or services to be provided by Subcontractor: _________% 12. Provide written confirmation from Subcontractor that it will provide the goods and/or services identified above if Bidder is awarded the contract. 13. All disabled veteran owners an d managers of Subcontrac tor must complete an d sign the DVBE Status Declaration. Bidder must submit the completed DVBE Status Declarat ion along with this DVBE Incentive Qualification Declaration.

CERTIFICATION I, the official named below, declare under penalty of perjury u nder the laws of the state of California that the information provided on this form is true and correct and that I am duly authorized to legally bind the Bidder to this certification. Company Name: T a x I D N u m b e r : Address: Telephone Number: Executed in the County of in the State of . Date: Type or print name/title Signature ATTACHMENT SDSC PUR-003A (Rev. 1/16) DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) Mil. & Vet.

Code § 999 Informational Form INCENTIVE QUALIFICATION DECLARATION INSTRUCTIONS Page 1 of 2 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) INCENTIVE QUALIFICATION DECLARATION INSTRUCTIONS General Instructions In this form, “Bidder” refers to a person or entity that submit s a response to a competitive solicitation issued by the court, including Request for Quotations (RFQs), Inquiry for Bids (I FBs), and Request for Proposals (RFPs); and “bid” refers to a response to a competitive solicitation issued by the court, including RFQs, IFBs, and RFPs.

If Bidder wishes to claim the DVBE incentiv e in a solicitation where a DVBE incentiv e is offered, it must submit a DVBE Incentive Qualification Declaration (SDSC Form #PUR-003). The court will determine whether Bidder is eligible to receive the DVBE incent ive based on information provided in the DVBE Incentive Qualification Declaration. The court may, but is not obligated to, verify or seek clarification of any information set forth in the DVBE Incent ive Qualification Declaration. If Bidder submits incomplete or inaccurate information, it will not receive the DVBE incentive.

Section A Instructions 1. Provide Bidder’s DVBE Certification ID number, if app licable. This number is in Bidder’s Department of General Services (DGS) Supplier Profile, accessible at https://caleprocure.ca.gov/pages/PublicSearch/supplier- search.aspx . 2. Provide the applicable dates. These dates are li sted in Bidder’s DGS Supplier Profile website. 3. This percentage is eq ual to the amount to be paid by Bidder to t he non-DVBE subcontractors divided by Bidder’s total bid price, multiplied by 100. Enter a percentage; do not enter a dollar amount.

For example, if the amount to be paid by Bidder to non-DVBE subcon tractor is $35,000 and Bidder’s total bid price is $125,000, enter “28%” (35000 ÷ 125000 = 0.28; 0.28 x 100 = 28). 4. The DVBE Status Declaration (SDS C Form #PUR-004) is separate from the DVBE Incentive Qualification Declaration. The Bidder mu st submit along with the DVBE Incentive Qualification Declaration a DVBE Status Declaration completed and signed by the disabled veteran owners and managers of Bidder. 5. Each entity certified as a DVBE by DGS will have received a DVBE certification. Bidder must submit a copy of its DVBE certification.

Section B Instructions Complete this

section if Bidder has an approved DVBE Business Utilizat ion Plan (BUP) on file with the Department of General Services (DGS) and this solicitation is for goods (IT or Non-IT), or IT services (do not complete if this solicitation is for non-IT services). 1. Provide the date on which DGS approved Bidder’s BUP. 2. Provide the date through which the BUP is valid. 3. Bidder must provide a copy of its “Notice of Approved DVBE Business Utilization Plan” issued by DGS. This copy must be provided along with the DVBE Incentive Qualification Declaration.

Section C Instructions A DVBE Subcontractor (Subc ontractor) is any certified D VBE (whether a person, firm, co rporation, or organization) contracting to perform part of Bidder’s contract. Enter the total number of Subcontractors Bidder will use for the contract. Provide complete information (items 1-13 of

Section

C) for each Subcontractor. Attach additional sheets if necessary. 1. Provide the full legal name of Subcontractor. 2. Provide the name of a contact person at Subcontractor. The contact person must be able to verify the information provided in the DVBE Incentive Qualification Declaration regarding that Subcontractor. 3. Provide the full addr ess of Subcontractor. 4. Provide Subcontractor’s telephone number, including area code. 5. Provide Subcontractor’s email address.

If Subcontra ctor does not have an email address, write “N/A.” ATTACHMENT SDSC PUR-003A (Rev. 1/16) DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) Mil. & Vet. Code § 999 Informational Form INCENTIVE QUALIFICATION DECLARATION INSTRUCTIONS Page 2 of 2 6. Provide Subcontractor’s DVBE Cert ification ID number. This number is in Subcontractor’s DGS Supplier Profile, accessible at https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx. 7. Provide the applicable dates. These dates are in Subcontractor’s DGS Supplier Profile, accessible at https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx. 8.

Each entity certified as a DVBE by DGS will have rece ived a DVBE certification. Bi dder must submit a copy of each Subcontractor’s DVBE certification. Provide a copy of Subcontractor’s DVBE certification. 9. Provide a detailed description of the goods and/or services Subcontractor will provide for the contract. 10. Provide an explanation of how Subcontractor’s goods and/ or services constitute a “commercially useful function” for purposes of the contract. Pursuant to Mil. & Vet.

Code § 999, a person or an entity is deemed to perform a “commercially useful function” if a person or entity does all of the following: (

i) is responsible for the execution of a distinct element of the work of the contract; (ii) carrie s out the obligation by actually performing, managing, or supervising the work involved; (iii) perf orms work that is normal for its busi ness services and fu nctions; (iv) is responsible, with respect to products, inventories, materials, and supplies required for the contract, for negotiating price, determining quality and quantity, ordering, installing, if applicable, and making payment; and (

v) is not further subcontracting a portion of the work that is greater than that expected to be subcontracted by normal industry practices. Note: a person or entity will not be considered to perform a “commercially useful function” if its role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of DVBE participation. 11. This percentage is equal to the amount to be paid by Bidder to Subcontractor divided by Bidder’s total bid price, multiplied by 100. Enter a percentage; do not enter a dolla r amount.

For example, if the amount to be paid by Bidder to Subcontractor is $6,600 and Bidder’s total bid price is $75,000, enter “8.8%” (6600 ÷ 75000 = 0.088; 0.088 x 100 = 8.8). 12. The Bidder must submit a written confirmation from the Subc ontractor, indicating that Subcontractor will provide the required goods and/or services if Bidder is awarded the contract. 13. The DVBE Status Declaration is a separate form from the DVBE Incentive Qualificati on Declaration.

The Bidder must submit along with the DVBE Ince ntive Qualification Declaration a D VBE Status Declaration completed and signed by all disabled veteran owners and managers of the Subcontractor. Certification Instructions Provide Bidder’s full legal name, federal tax ID number, address, and telephone number on the appropriate lines. The certification must be signed by an authoriz ed Bidder representative. Provide the name and title of the authorized Bidder representative, and the date, county and state where that person signed the certification.

Document details

Collection	California Superior Local Rules
Citation	Cal. Form PUR-003
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	342cb76fa9e52d99f6df4bfe5e368f72e6b53f47

Source file is stored in the law ingest library (pdf).