Conditions for Approval
By signing this application, the participating charitable
organization agrees to the following conditions:
1) This digital application form must be complete and submitted
no later than the February 26th, 2021 filing date. A timely
submission is necessary to ensure that the organization will, if
approved by the Department of General Services (DGS), be included
by name in the 2021 Our Promise: California State Employees
Giving at Work Initiative.
2) If DGS or its designee requests information supporting a
certification of eligibility, the information must be furnished
within two business days. The burden of demonstrating eligibility
shall rest with the applicant.
3) The administrative fee for the 2021 OP Initiative is as
a) $.38 cent per transaction fee as set by the State
Controller’s Office (SCO). This fee is subject to change.
b) 14% administrative set rate:
- 8% allocated to United Way
California Capital Region (UWCCR) to manage and process the
campaign year round
- 5.5% for reimbursement to the local
Principal Combined Fund Drive (PCFD) for fundraising expenses
- .5% to DGS for related campaign
This fee structure is subject to change. You will be informed of
any changes made prior to the 2021 Our Promise Campaign.
c) The overall DGS approved percentage rate and SCO per
transaction fee will be published in the 2021 OP Initiative
literature distributed and on the website.
4) To hold harmless the State of California, including but not
limited to its officers and employees, from any liability that
may result from requesting, canceling or changing any payroll
deduction, in consideration for and as a condition of the SCO
withholding and transmitting payroll deductions, as authorized by
California Government Code section 1151(f).
5) To immediately send notification by email to firstname.lastname@example.org
of any changes to the information provided in or in connection
with this application. Any changes to our application will be
reviewed by the DGS designee to determine if we still comply with
all applicable requirements.
6) DGS may elect to disqualify or remove an organization that
makes a false certification and/or engages in illegal activity.
7) To retain a copy of this digitally signed application and
produce it to DGS or its designee within two business days of
request for the original application.
We certify under penalty of perjury that:
1) We are currently a charitable organization qualified as
“exempt” under Section 23701d of the California Revenue and
Taxation Code and paragraph (3) of subsection © of section 501
of the Internal Revenue Code of 1954 .
a) We are in compliance with the provisions of the California
Fair Employment and Housing Act, Part 2.8 (commencing with
Government Code section 12900).
b) Our organization, its Board Members and Executive Officers are
not in violation of any State of California or federal laws and
c) We are a valid
501(c)(3) nonprofit organization and are in good standing
with the Registry
of Charitable Trusts to operate or to solicit for charitable
purposes in California. A status of “current” or “exempt
active” is required. An unregistered charity or a registered
charity that is delinquent, suspended or revoked is not in good
standing. (Gov. Code, § 12599.6, subd. (f)(1); Cal. Code Regs.,
tit 11, §999.9.4.) A charity that is not in compliance with
the registration and reporting requirements listed above, will
not be certified in the Our Promise: California State Employees
Giving at Work Initiative.
2) After careful review of the instructions, we have completed
the application and to the best of our knowledge, all of the
answers are true, correct and complete. By completing this
application, we are requesting certification as a Independent
Nonprofit in the OP initiative and do not want to be listed under
a Charitable Federation or PCFD (aka local United Way).