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EXHIBIT G COUNTY OF ALAMEDA RFP No. 900973 for Operation and Maintenance Services of Sewer and Water Systems in the Alameda County Service Area (CSA) R-1967-1 Castlewood REQUEST FOR BID PREFERENCE PLEASE READ AND COMPLETE THIS FORM CAREFULLY: IF YOU WOULD LIKE TO REQUEST THE LOCAL BUSINESS,SMALL AND LOCAL BUSINESS,OR EMERGING AND LOCAL BUSINESS BID PREFERENCE,COMPLETE THIS FORM AND RETURN IT WITH YOUR RFP SUBMITTAL. IN ADDITION, IF APPLYING FOR A LOCAL BID PREFERENCE, SUBMIT THE FOLLOWING: • Copy of a verifiable business license, issued by the County of Alameda or a City within the County; and • Proof of six (6) months business residency, identifying the name of the vendor and the local address. Utility bills, deed of trusts or lease agreements, etc., are acceptable verification documents to prove residency. Subject to the requirements of the SLEB program and the criteria of each procurement process, the maximum bid evaluation preference points for being certified is 10% (5% local & 5% certified). Compliance with the SLEB program is required for architectural, landscape architectural, engineering, environmental, land surveying, and construction project management services projects, but no preference points are applied. Check the appropriate boxes below(2 maximum)and provide the requested information. ❑ Request for 5% LOCAL Bid Preference (Complete 1-4,print name,title,sign and date below) I. Company Name 2. Street Address 3. Telephone Number 4. Business License# ❑ Request for 5% SMALL Local Business Bid Preference OR ❑ Request for 5% EMERGING Local Business Bid Preference (Complete certification information below) SLEB Certification#: __ SLEB Certification E xpiration Date NAICS Codes Included in SLEB Certification The Undersigned declares that the foregoing information is true and correct: Print/Type Name: Print/Type Title: Signature: Date: Revision 5-II-10