STATE OF CALIFORNIA ATTACHMENT B

DEPARTMENT OF GENERAL SERVICES

OFFICEOFFLEETANDASSETMANAGEMENT

VENDORAPPLICATIONFORM

OFA 50 (Rev 09/14)

ThisVendorApplicationFormisdesignedtoensurethatallvendorsprovidetherequestedinformationinordertobeauthorizedtoprovide automotive repair/servicesforstateagencies.

  1. BusinessName: DBA,ifapplicable: Address:. City: County: State: ;ZipCode:. Telephone:. FAX:

Email Address: ______

Amount of time company has been in business providing automotive repair/services:____years______months

  1. Typesofvehiclesserviced:Light duty [ ]Heavy duty [ ]Specialty [ ]
  2. Name of flat rate manual______
  3. Hourly public flat rate______
  4. Hourly fleet flat rate______
  5. Parts, fleet discount______%
  6. Pickup/delivery at no chargeYes [ ] No [ ]

Checktypeofrepair/serviceprovided. CheckwheretechniciansareASEcertified.

Repair/ServiceASECertifiedRepair/ServiceASECertified

[ ]A[ ]Engine performance/drivability[ ]J[ ]Manual drive train and axles

[ ]B[ ]Minor engine repair[ ]K[ ]Smog Check

[ ]C[ ]Brakes[ ] L[ ]Auto body repair/paint

[ ]D[ ]Electrical/electronic systems[ ]M[ ]Glass

[ ]E[ ]Major engine repair (gasoline)[ ]N[ ]Mobile services

[ ]F[ ]Major engine repair (diesel)[ ]O[ ]Tires

[ ]G[ ]Heating/cooling and air conditioning[ ]P[ ]Towing

[ ]H[ ]Suspension and steering[ ]Q[ ]Upholstery

[ ]I[ ]Automatic transmission/transaxle[ ]R[ ]Specialty

(window tinting, alarms, etc)

AttachcopiesofcurrentASEcertificates.

PrintedNameSignatureofAuthorizedRepresentative

Title:_Date._

By signing this form, I/we agree that we have met all requirements contained in RFQ DGS-OFA-VQ-1, and agree that when services are rendered to state agencies those services will be rendered pursuant to the requirements of RFQ DGS-OFA-VQ-1.

Checkhereifyourfacilityhasthefollowingequipment:

1.

2.

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12.

GENERALEQUIPMENT

lIHoist/lift/rack; Lubricationequipment;Partswasher;Safetystands;Servicemanualsorelectronic accesstoinformation;Torquewrenches(in./lb.ft./lb.); Weldingequipment;Verniercaliperor0-4" micrometer

ENGINEPERFORMANCEIDRIVEABILITY(GAS)

[ICompressiontester;Vacuumpump;Engineanalyzerwithdisplaycapabilityorequivalent;Timinglight; Exhaustgasanalyzer;Dwellmeter;Tachometer;Fuelinjectionpressuretester;Injectorpulsetester;

Computercodescanner;Cylinderleaktester.

ENGINEPERFORMANCEIDRIVEABILITY(DIESEL)

lIDieseltachometer;Dieselcompressiongauge;Nozzletester;Pumptimingtools

EXTERNALENGINEREPAIRIPARTSREPLACEMENT (Includescylinderheads)

[IHandheldtools.

BRAKES

[IBrakedrumgauge;Brakediscmicrometer;Dialindicator;Pressurebleeder.

ELECTRICAL

[IDigitalvolt/ohmmeter;Batteryloadtester;Batterycharger;Starting/chargingsystemtester.

TIRES,STEERINGANDSUSPENSION

[IAlignmentrack/tables*;Wheelbalancer*; Coilspringcompressor;Tirechanger*;Toolsfordisassembly

andassemblyofsteeringjoints.

HEATINGICOOLINGANDAIRCONDITIONING

lIRadiatorandcappressuretester;Airconditioningmanifoldgauge set;Freonrecovery/recycling equipment;Antifreezerecyclingequipment;Coolingsystemthermometer;Airconditioningthermometer.

AUTOMATICTRANSMISSION

[I300PSIpressuregauge;30inchhg.vacuumgauge;Transmissionjacl<;Bushingcutter;Bushingand

sealdriverset;Sealpuller; varioussnapringpliers;Hydraulic press.

MANUALTRANSMISSIONANDREARAXLE

lIAxlepuller;Hydraulicpress*;Clutchaligningtools.

MAJORENGINEREPAIR(GASORDIESEL) Enginereplacement:

[IEnginerepairstand;Enginecrane/hoist;Pullerset.

Enginerebuilding:

[IValverefacerandseatcutter*;Cylinderhone;Cylinderboregauge; 0-4"micrometer.

CheckhereIfyourfacilityusesthefollowingproducts:

13.[IRecycledoil

14. [JRecycledantifreeze

*Not required if service is sublet.

OFA 50, page 2