FCS3

ATTACHMENT C

Solicitation Number DRR21047

State ofCallfomla-Department ofGeneral Services,Procurement Division GSPD-05-105 (REV08/09)

BIDDER DECLARATION

1. Prime bidder information (Review attached Bidder Declaration Instructions prior to completion of this form): a. Identify current Califo rnia certification(s) (MB, SB,NVSA, DVBE): SB(Micro) #1796777 or None il (If"None':go to Item #2) b. Will subcontractors be used for this contract? Yes IZI. No D (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. DKE Enterprises, Inc. (dba PK Enterprises) will serve as prime contractor and project manager to coordinate all work to be performed including support services by subcontractors. DK Enterprises will prepare work products that will be delivered electronically to CalRecycle. 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 own at least 51%ofthe 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): CA Certification (MB,SB, Corresponding Good 51% NVSA, DVBE or None) % ofbid price Standing? Rental? □ □ Work performed orgoods provided for this contract Material and product testing - will provide select testing services as needed. To be determined 1 Yes NA Subcontractor Address & Email Address 1235 35th St. N.W Canton, OH 44709-2610 ohlemacher@aol.com

Subcontractor Name,Contact Person, Phone Number& Fax Number Akron Polymer Technology Services (APTS) Crittenden Ohlemacher, Ph.D. Additional Lab Technicians Phone: (330) 409-3618 Akron Rubber Development Laboratories, Inc. (ARDL) Ted Nelson Phone: (419) 889-9135 Fax: (330) 794-661 Alpha Analytical Laboratories, Inc.; Steven Mcweeney

To be determined 1

Material and product testing - will provide select testing services as needed.

2887 Gilchrist Rd. Akron, OH 44305 ted_nelson@ardl.com

□ □ Yes NA

208 Mason Street Ukiah, CA 95482 stephen@alpha- labs.com

T o be determined 1

Material and product testing - will provide select testing services as needed.

SB(Micro) 0001025

□ □ Yes NA

Mobile: (707) 769-3128 Office: (707) 468-0401 Fax: (707) 468-5267

1. This subcontractor will provide testing, certification and/or manufacturer technical assistance services under Tasks 3 and 4. The specific tasks to be performed and budgets will be determined in conjunction with CalRecycle during the project.

4

1

CERTIFICATION: By signing the bid response, I certifyunder penalty of perjury that the information provided Is true and correct.

Page _ of_