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State of California-Natural Resources Agency DEPARTMENT OF PARKS AND RECREATION DPR 285, AGREEMENT FOR SERVICES CHECKLIST/TRANSMITTAL Maximum $9,999.99 (Used for Services, Consulting Services and A&E Contracts) TO DPR CONTRACT ADMINISTRATORDATE Contract Services Unit David Burns 1.0_1.1.6118 DISTRICT/DIVISION CONTACT PHONE NO. Twin Cities/OHMVR ( 925) 409-8400 CONTRACTOR CONTRACT NO. American Valley Waste Oil Inc A1855029 Verify that contractor/vendor is NOT on FTB/BOE Delinquent Tax Listings prior to contract award. DOCUMENT NO.OF COPIES INCLUDED? O DPR 285, AGREEMENT FOR SERVICES 10 r i g i n a I&2 C� es License No.for Services (If Applicable) Examples: Pesticide Application(Dept.of Pesticide Reg.),www.odr)r.ca..Qovldocs/license/currlic.htm 1 Ye NIA J CA Board of Professional Engineers(Dept.of Consumer Affairs),www.Dels.ca.gov CA Architects Board(Dept.of Consumer Affairs),www.cab.ca.gov Small Business and/or DVBE Certification No. and Expiration Date www.bidsvnc.com/DPXBisCASB (Note: URL is case sensitive) (Include Printout) 1 Yei N/A 1 GTC&CCC boxes checked and current version numbers entered (NOTE: Copy of signed CCC to be kept in the originating unit's file.) Award Method(Check only one): Informal Quote, Fair and Reasonable Determination or Exemption SCOPE: Any changes to the scope(including differences between Estimate and Total Amount)must be noted in the scope description &invoice attached if amount changed. NOTE: Increases to the "Total Amount"once written on the form are prohibited. A new DPR 285 must be created that reflects the changes and new"Total Amount." 1) EXHIBIT A, SPECIFICATIONS&OTHER ATTACHMENTS(If Applicable) ' (Do not include printed copy of GTC/CCC.) Original of Each Yes NIA O STD.204-PAYEE DATA RECORDIDPR 88-SUPPLEMENT(If Applicable) } 1 (Only when there is no vendor number/vendor information or number is not currentJ��'f ° Yes NIA ® DPR 74, DARFUR CONTRACTING ACT CERTIFICATION (If Applicable) ��`` 1 Yes NIA J 0 CONTRACTOR BUSINESS STATUS(Choose appropriate one)(Include Printout) 1 Yes NIA b CORPORATION STATUS PRINT OUT: http://kepler.sos.ca.gov/ (Under ( _Im $soo) ❑ DE 542-REPORT OF INDEPENDENT CONTRACTOR: www.edd.ca.gov Refer to Contracts Users Guide, Miscellaneous Information chapter for instruction. Use only for amounts over$600.00. Must be sent to EDD within 20 days. Please include Federal ID No: 68-030-3606 and CA Employer Act No:9360549-1. ®CERTIFICATES OF INSURANCE(if Applicable) General Liability,Auto Liability and Workers'Compensation,ORIM Approval, 1 Yes N/A Endorsements:Additional Insured and Waiver of Subrogation NOTE: General Liability Insurance of$1,000,000 per occurrence-$2,000,000 general aggregate& OR1M approval prior to work is required if the work is'hazardous." The seven applicable categories of hazardous are: 1- Pest control, fumigation,crop of agriculture spraying or application of chemicals of any kind; 2- Handling of hazardous substances; 3- Transporting persons; 4- Elevator Maintenance; 5- Use of aircraft or watercraft, 6- Exhibitions; 7- Excavation, drilling or demolition. ® LABOR RELATIONS(All Service Agreements) 1 Yes Employee Bargaining Unit Notification is required for all service agreements. Requires separate document signed by Labor Relations prior to award of contract to certify compliance with Government Code 19132(b)(1). Labor.Relations@parks.ca.gov DPR 285 DISTRIBUTION STANDARD DISTRIBUTION: Division0strict keep original,attach scanned copy of the original to the FI$Cal Purchase Order(PO),copy to the Contractor DISTRIBUTION WHEN PAID BY CAL-CARD: Same as Standard Distribution-plus: FI$Cal PO must be assigned to the PCard Cardholder *When using a DPR 285 for a professional service(A&E)contract contact the Contract Analyst for details. DPR 285C(Rev.212018)(Excel 212312018)