Common use of Participant Waivers Clause in Contracts

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) State of California—Department of General Services, Procurement Division GSPD–05–105 (EST 8/05) Solicitation Number 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration. 1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the line: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) THE 32ND DISTRICT AGRICULTURAL ASSOCIATION State of California—Department of General Services, Procurement Division GSPD–05–105 (EST 8/05) Solicitation Number 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration. 1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the line: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s attorneys fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) State of California—Department of General Services, Procurement Division GSPD–05–105 STD. 213 A (EST 8/05Rev 6/03) Solicitation NumberR A F CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED Pages AGREEMENT NUMBER SA-241-16MS AMENDMENT NUMBER #1 REGISTRATION NUMBER 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided This Agreement is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration. 1.a. Identify all current certifications issued by entered into between the State of California. If the prime bidder has no California certification(s), check the line labeled “None” Agency and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the lineContractor named below: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) State of California—Department of General Services, Procurement Division GSPD–05–105 (EST 8/05) Solicitation Number 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration. 1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the line: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) State of California—Department of General Services, Procurement Division GSPD–05–105 (EST 8/05) Solicitation Number 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBE: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be used, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration. 1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certifications, enter the applicable certification(s) on the line: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractors. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”

Participant Waivers. For hazardous participant events, the contractor/renter agrees to obtain a properly executed release and waiver of liability agreement (Form required by contractor/renter’s insurance company or CFSA Release and Waiver Form) from each participant prior to his/her participation in the events sponsored by contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories: Athletic Team Events; Equestrian-related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle, skates, skateboard, or scooter. Contact California Fair Services Authority at (000) 000-0000 for further information. Contact Name: Contact Telephone : The undersigned represents and warrants that attached to this Xxxxx’s Law Screening Certification and Listing is a full, true, correct, complete, and accurate listing of all persons scheduled to work or volunteer for the company/organization identified above (“Contractor”) during the annual OC Fair or Youth Expo. If any other or additional individuals will be performing work, labor, or services, I understand that my company/organization is required to submit a supplemental listing(s) identifying those individuals. The undersigned represents and warrants that all persons and individuals performing services on behalf of Contractor, including, but not limited to, its agents, employees, subcontractors, and volunteers have been screened for sex offender registration before each individual commenced work, services, and/or was present at the OCFEC facility. The undersigned represents and warrants that no individual who is a registered sex offender will be assigned or permitted to perform services on behalf of Contractor at or on OCFEC premises. To the fullest extent permitted by law, Contractor will defend, indemnify, and hold harmless OCFEC from and against all claims, damages, losses, and expenses, of every kind, nature and description (including, but not limited to, attorney’s attorneys fees, expert fees, and costs of suit), directly or indirectly arising from, or in any way related to the performance or nonperformance of Contractor’s obligations under this Xxxxx’s Law Screening Certification and Listing, regardless of responsibility of negligence; by reason of death, injury, property damage, however caused or alleged to have been caused, and even though claimed to be due to the negligence of the OCFEC. Provided, however, that in no event shall Contractor be obligated to defend or indemnify the OCFEC with respect to the sole negligence or willful misconduct of the OCFEC, its employees, or agents (excluding the Contractor, or any of its employees or agents). The undersigned represents and warrants that he/she is fully authorized to execute this Xxxxx’s Law Screening Certification and Listing on behalf of Contractor. Company/Organization Representative’s Signature Title of Representative Printed Name Date Full Name (Last, First Middle) Full Name (Last, First Middle) State of California—Department of General Services, Procurement Division GSPD–05–105 STATE OF CALIFORNIA STD. 213 A (EST 8/05Rev 6/03) Solicitation NumberR A F CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED Pages AGREEMENT NUMBER SA-005-15ET AMENDMENT NUMBER #5 REGISTRATION NUMBER 1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current California certification(s) (MB, SB, SB/NVSA, DVBE): or None (If “None”, go to Item #2) b. Will subcontractors be used for this contract? Yes No (If yes, indicate This Agreement is entered into between the distinct element of work your firm will perform in this contract e.g., list the proposed products produced by your firm, state if your firm owns the transportation vehicles that will deliver the products to the State, identify which solicited services your firm will perform, etc.). Use additional sheets, as necessary. c. If you are a California certified DVBEState Agency and Contractor named below: (1) Are you a broker or agent? Yes No (2) If the contract includes equipment rental, does your company own at least 51% of the equipment provided in this contract (quantity and value)? Yes No N/A 2. If no subcontractors will be usedThe term of this FED ID: Agreement is 02/01/15 through 01/31/19 3. The maximum amount of this $61,793.05 Amendment Agreement after this amendment is: $1,606,894.93; $1,996,972.93 with inclusion option years 4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein: 1. This amendment effective date is July 13, skip to certification below. Otherwise, list all subcontractors for this contract. (Attach additional pages if necessary): CERTIFICATION: By signing the bid response, I certify under penalty of perjury that the information provided is true and correct. BIDDER DECLARATION Instructions All prime bidders (the firm submitting the bid) must complete the Bidder Declaration2018. 1.a. Identify all current certifications issued by the State of California. If the prime bidder has no California certification(s), check the line labeled “None” and proceed to Item #2. If the prime bidder possesses one or more of the following certificationsExcept as herein amended, enter the applicable certification(s) on the line: 1.b. Xxxx either “Yes” or “No” to identify whether subcontractors will be used for the contract. If the response is “No”, proceed to Item #1.c. If “Yes”, enter on the line the distinct element of work contained in the contract to be performed or the goods to be provided by the prime bidder. Do not include goods or services to be provided by subcontractorsall other terms and conditions remain as previously agreed upon. 1.c. This item is only to be completed by businesses certified by California as a DVBE. (1) Declare whether the prime bidder is a broker or agent by marking either “Yes” or“No”. The Military and Veterans Code Section 999.2 (b) defines“broker” or “agent” as a certified DVBE contractor or subcontractor that does not have title, possession, control, and risk of loss of materials, supplies, services, or equipment provided to an awarding department, unless one or more of the disabled veteran owners has at least 51-percent ownership of the quantity and value of the materials, supplies, services, and of each piece of equipment provided under the contract. (2) If bidding rental equipment, mark either “Yes” or “No” to identify if the prime bidder owns at least 51% of the equipment provided (quantity and value). If not bidding rental equipment, mark“N/A” for “not applicable.”