MENLO PARK FIRE PROTECTION DISTRICT
ATTN: Jon Hitchcock, Senior Management Analyst
jonh@menlofire.org
170 Middlefield Road
MENLO PARK, CA 94025
PREQUALIFICATION FORM AND
PROOF OF COMPLIANCE WITH GOOD FAITH EFFORTS FOR LOCAL HIRING
PREQUALIFICATION FORM CHECKLIST FOR BIDDERS
____ Completed Part 1. Contractor Responsibility Questionnaire
____ Completed Part 2. Past Public Contracting Experience
____ Completed Part 3. Contractor Qualifications Questionnaire
____ Completed Part 4. Proposed Superintendent Questionnaire
The following are due with the bid package or at least 24 hours after being notified that your
company has been notified that it is the lowest responsible bidder.
____ Submission of Local Hiring Telephone Solicitation Log (Exhibit A)
____ Submission of copies of letters to local businesses (Exhibit B – Sample Letter)
____ Submission of Summary Record Demonstrating Good Faith
Efforts for Local Hiring (Exhibit C)
MENLO PARK FIRE PROTECTION DISTRICT
SAN MATEO COUNTY, CALIFORNIA
NOTICE TO BIDDERS
PREQUALIFICATION FORM AND
PROOF OF COMPLIANCE WITH GOOD FAITH EFFORTS FOR LOCAL HIRING
PREQUALIFICATION FORM INSTRUCTIONS
I.
PREQUALIFICATION REQUIRED
Notice is hereby given that the MENLO PARK FIRE PROTECTION DISTRICT (the
“DISTRICT”) has determined that all bidders on the construction of Fire Station 6 (the
“Project”) to be undertaken by the DISTRICT must be prequalified prior to submitting a bid on
that Project in compliance with Resolution #1812-2015. It is mandatory that all Contractors
who intend to submit a bid for the Project, fully complete the prequalification form, provide all
materials requested herein, and be approved by the DISTRICT to be on the final qualified
bidders list. No bid will be considered from a Contractor that has failed to comply with these
requirements. If two or more business entities submit a bid as part of a Joint Venture, or expect
to submit a bid as part of a Joint Venture, each entity within the Joint Venture must be
separately qualified to bid. The last date to submit a fully completed prequalification form is
01/12/2016 at 3:00 PM. Contractors are encouraged to submit prequalification packages as
soon as possible, so that they may be notified of omissions of information to be remedied or of
their pre-qualification status well in advance of the bid advertisement for this project.
The Project includes demolition of the existing Fire Station and other buildings located at 700
Oak Grove Avenue, Menlo Park and the construction of a new two story Fire Station, Engine
Display building and the relocation of a carriage house. The DISTRICT will maintain
operations at this location throughout construction. This is an essential service building which
will require full time ongoing inspection. The Inspector of Record shall verify that materials
onsite are per approved submittals and installations are per the plans and specifications. This
level of inspection is in addition to the required City and Fire District inspections.
To obtain a copy of the Prequalification Form, Scoring Instructions, and Appeal Process
go to www.menlofire.org/rfp.html.
The Prequalification Form is divided into four parts. Part 1 is a Contractor
Responsibility Questionnaire. Part 2 concerns the bidder’s past public contracting experience on
similar projects. Part 3 concerns the Contractor’s qualifications. Part 4 concerns the proposed
superintendent on the project. The DISTRICT will score the information provided in Parts 1-4
in accordance with the DISTRICT’S objective scoring criteria. Answers to questions contained
in the attached form are mandatory. Contractor also agrees to provide all supplementary
information requested, including, but not limited to the following: current bonding capacity,
notarized statement from surety, and the most recent reviewed or audited financial statements
with accompanying notes and supplemental information. A bidder that does not achieve a
passing score will be deemed not qualified for purposes of this Project.
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
2
Pre-qualification packages should be submitted under seal, marked “CONFIDENTIAL”
and identify the Project as “Fire Station 6.” Prequalification packages must be submitted to the
DISTRICT by the 01/12/2016 3:00 PM deadline as follows:
Menlo Park Fire Protection District
ATTN: Jon Hitchcock, Senior Management Analyst
170 Middlefield Road
Menlo Park, CA 94025
Contractors may also elect to submit prequalification packages on any date prior to the
deadline identified above, during regular working hours on any day that the offices of the
DISTRICT are open. The DISTRICT may refuse to grant qualification where the requested
information and materials are not provided, or not provided by the designated date. The closing
time for bids will not be changed in order to accommodate supplementation of incomplete
submissions, or late submissions.
Each prequalification package must be signed under penalty of perjury in the manner
designated at the end of the form, by an individual who has the legal authority to bind the
Contractor on whose behalf that person is signing. If any information provided by a Contractor
becomes inaccurate, the Contractor must immediately notify the DISTRICT and provide
updated accurate information in writing, under penalty of perjury.
The DISTRICT will use the information contained in the prequalification package to
determine whether, pursuant to applicable law, a bidder is deemed qualified for purposes of this
Project. The information contained in the prequalification form is provided under oath. False
information provided in a Prequalification Package or the omission of relevant information
therefrom may, in itself, be sufficient to support a determination that a bidder is not qualified.
The DISTRICT reserves the right to check other sources available.
The DISTRICT’S decision regarding bidder qualification will be based on objective
evaluation criteria.
While it is the intent of the Prequalification Form and documents required therewith to
assist the DISTRICT in determining bidder responsibility prior to bid and to aid the DISTRICT
in selecting the lowest responsible bidder, neither the fact of pre-qualification, nor any prequalification rating, will preclude the DISTRICT from a post-bid consideration and
determination of whether a bidder has the quality, fitness, capacity and experience to
satisfactorily perform the proposed work, and has demonstrated the requisite trustworthiness.
The DISTRICT reserves the right to adjust, increase, limit, suspend, or rescind the prequalification rating based on subsequently learned information. Contractors whose rating
changes in a manner sufficient to disqualify them will be notified and given an opportunity for a
hearing consistent with the procedures described below for appealing a pre-qualification rating.
The DISTRICT reserves the right to waive minor irregularities and omissions in the
information contained in the prequalification package submitted, to make all final
determinations, and to determine at any time that the prequalification procedures will not be
applied to a specific future public works project.
The DISTRICT reserves the right to reject all pre-qualification responses. The
DISTRICT reserves the right to re-submit a pre-qualification questionnaire if the DISTRICT
elects to reject all pre-qualification responses. The DISTRICT will provide notice to each
responding entity in the event it elects to reject all pre-qualification responses.
Where a timely and completed Prequalification Package results in a rating below that
necessary to qualify, an appeal can be made. An appeal may be made by the bidder by delivering
a notice to the DISTRICT of its appeal of the decision with respect to its qualification rating, no
later than two working days after the notice of a finding. Upon request of the Contractor, the
DISTRICT will provide notification to the Contractor in writing of the basis for the
disqualification and any supporting evidence that has been received from others or adduced as a
result of investigation. The Contractor shall be given the opportunity to rebut any evidence
used as a basis for disqualification and to present evidence to the DISTRICT as to why the
Contractor should be found qualified. If the Contractor chooses not to avail itself of this
process, the proposed qualification rating may be adopted without further proceedings. Without
a timely appeal, the bidder waives any and all rights to challenge the decision of the DISTRICT,
whether by administrative process, judicial process or any other legal process or proceeding.
The Fire Chief or his/her designee shall make the final determination concerning appeals
based upon the facts set forth in the notice. It is the intention of the DISTRICT that project
schedules and deadlines will not be delayed or postponed to allow for completion of an appeal
process.
The pre-qualification packages submitted by Contractors are not public records and are
not open to public inspection. All information provided will be kept confidential to the extent
permitted by law. However, the contents may be disclosed to third parties for purpose of
verification, or investigation of substantial allegations, or in the appeal hearing. State law
requires that the names of contractors applying for pre-qualification status shall be public
records subject to disclosure, and basic Contractor identification information will be used for
that purpose.
Each Contractor that completes this questionnaire may request that the DISTRICT use
the completed questionnaire for consideration of the Contractor for bids on future DISTRICT
projects for up to one year after submission of the completed questionnaire. Such request must
be made at or before submission of bids for future projects.
* * * * *
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
4
NOTICE: Contractors using subcontractors for this Project, please be advised that the
DISTRICT may require, as to subcontractors, one of the following:
The qualification of subcontractors in the following crafts or trades,
following acceptance of your bid, but before the award is made:
_______________________________________________________________
_______________________________________________________________
Pre-qualification of all subcontractors.
Pre-qualification of subcontractors in certain crafts.
Post-bid qualification review.
Pre-qualification and Post-bid qualification review for subcontractors not
required.
II.
DEMONSTRATION OF GOOD FAITH EFFORTS FOR LOCAL HIRING
As part of its Prequalification Package, each Contractor must demonstrate good faith
efforts to hire locally within the DISTRICT’s service territory. A bidder or contractor will be
deemed by the DISTRICT to have made a “good faith effort” to hire locally when the bidder or
contractor has undertaken all of the following recruitment activities:
A.
Prior to two (2) weeks before bid opening, the bidder or contractor has made
telephone solicitation of at least six (6) known potential local contractors,
residents served by the DISTRICT, or employers within the DISTRICT’s service
territory (County of San Mateo) and provided documentation of such telephone
solicitation on a DISTRICT approved telephone solicitation log, attached hereto
as Attachment A; and
B.
Prior to two (2) weeks before bid opening the bidder or contractor has sent
letters (via U.S. Mail or electronically), which are in substantial conformance with
the DISTRICT-approved sample letter in Attachment B, to at least six (6)
employers within the DISTRICT service territory and/or residents of the
DISTRICT, that are known or potential subcontractors or material and
equipment suppliers, informing them that the bidder or contractor is seeking subbids, material, and/or equipment suppliers for certain areas of work; and
C.
Submitting records documenting compliance in substantial conformance with the
summary sheet attached hereto as Attachment C.
The existence of a crew or workforce usually employed by a contractor does not affect
the contractor’s responsibilities under this policy. All forms required herein must be attested to
as true as to the information set forth therein and must be submitted under penalty of perjury.
Contractor must submit Attachments A-C to the District either with its bid or at least 24
hours after being notified that your company is the lowest responsible bidder. The
Attachments are to be submitted to the same person and at the same location in which
the bid package was delivered.
For the purposes of local hiring, the District’s Service Territory is considered to be the
County of San Mateo.
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
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III.
1.
PREQUALIFICATION FORM
CONTRACTOR RESPONSIBILITY QUESTIONNAIRE
Company Name:
CA Lic. No.(s):
Owner(s) of Company:
Contact Person:
Address:
Phone:
Email:
Contractor will be found non-responsible if:
o The answer is “no” to any of questions (a) - (e) or (k) - (m) of this section;
or
o The average is more than one (1) for question (f) of this section; or
o The answer is “yes” to any of questions (g) - (j) of this section.
a.
Contractor possesses a valid and current California Contractor’s B license for
project or projects for which it intends to bid.
Yes
b.
Contractor has a current liability insurance policy with policy limits that satisfy
the draft project contract located at www.menlofire.org/rfp.html and either
possesses or is willing and able to obtain all other required insurance policies at
the limits provided for in the project contract.
Yes
c.
No
Contractor has current workers compensation insurance policy as required by the
Labor Code or is legally self-insured pursuant to Labor Code section 3700 et seq.
Yes
d.
No
No
Contractor has no employees
Contractor has attached a notarized statement from a surety duly licensed to do
business in the State of California, and having a financial rating from A.M. Best &
Co. rating of at least A:VII, which states that Contractor’s current bonding
capacity is sufficient for the project.
Yes
No
NOTE: Notarized statement must be from the surety company, not an agent or broker.
e.
Contractor has attached written evidence from an insurance underwriter having a
financial rating from A.M. Best & Co. rating of at least A:VII or written evidence
from the California Worker’s Compensation Insurance Rating Bureau,
confirming the Contractor’s Experience Modification Rating (“EMR”) for the
last five years.
Yes
f.
No
Contractor’s California Experience Modification Rate for last 5 years: Any
Contractor with an average EMR over the last five years greater than 1.0 will be
rejected as not responsible.
2011
2012
2013
2014
2015
Average (2011-2015): ________________
g.
Has your contractor’s license been revoked at any time in the last five years?
Yes
h.
Has a surety firm completed a contract on your behalf, or paid for completion
because your firm was default terminated by the project owner within the last five
(5) years?
Yes
i.
No
No
At the time of submitting this form, is your firm ineligible to bid on or be
awarded a public works contract, or perform as a subcontractor on a public
works contract, pursuant to either Labor Code section 1777.1 or Labor Code
section 1777.7?
Yes
No
If the answer is “yes” state the beginning and ending dates of the period of
debarment:_________________________________________________
j.
At any time during the last five years, has your firm, or any of its owners or
officers been convicted of a crime involving the awarding of a contract of a
public agency construction project, or the bidding or performance of a public
agency contract?
Yes
No
If the answer is “Yes,” please provide details of conviction:
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
8
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
k.
Have you attached your latest copy of a reviewed or audited financial statement
with accompanying notes and supplemental information?1
Yes
No
NOTE: A financial statement that is not either reviewed or
audited is not acceptable. A letter verifying availability of a line of
credit may also be attached; however, it will be considered as
supplemental information only, and is not a substitute for the
required financial statement.
l.
Do you currently have a valid business license issued by the City of Menlo Park
or will you and each of your Subcontractors acquire one if awarded this contract?
Yes
No
If already licensed by the City of Menlo Park, please attach a copy of the license.
m.
Is your firm submitting with its bid or willing to submit no later than 24 hours
after being notified that your company is the lowest responsible bidder, materials
that demonstrates good faith efforts for local hiring, which includes evidence of
contact via phone and letter, in substantially the form of Exhibits A-C attached
hereto?
Yes
2.
No
PAST PUBLIC CONTRACTING EXPERIENCE
Contractor must have completed, with filed notices of completion, at least three (3) Public
Works, K through 14 schools under the jurisdiction of DSA, hospitals under the jurisdiction of
OSHPD, California courts under the jurisdiction of the Judicial Council of California, or
Essential Service building (police stations, fire stations, ect.) projects of similar size and
complexity with a minimum project value of four million dollars each OR at least three (3)
Private Sector projects of similar size and complexity with a minimum project value of ten
million dollars each. State: the name of the project, a general description of the work performed
Public Contract Code section 20101(e) exempts from this requirement a contractor who has qualified as a small
business pursuant to Government Code section 14837(d)(1), if the bid is “no more than 25 per cent of the qualifying
amount provided in section 14837(d)(1).” As of January 1, 2006, the qualifying amount is $10 million, and 25 per cent
of that amount, therefore, is $2.5 million.
1
by Contractor, the value of the work performed, the completion date or expected completion
date; the Owner, address, contact name, and current telephone number. Attach additional
sheets as necessary.
Contractors not meeting this requirement will be found non-responsible. For each of the three
Public Works Projects, Contractor must provide:
a.
Project Name, description, and value (Include original project duration, actual
project duration, original contract award amount, ending contract amount,
identify any litigation or arbitration associated with the project, and amounts of
any settlement agreements and liquidated damages):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
b.
Owner Name, Contact Information (Address, Phone No, Email):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
c.
Architect or Engineer Name, Contact Information (Address, Phone No, Email):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
d.
Construction Manager Name, Contact Information (Address, Phone No, Email):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
10
3.
CONTRACTOR QUALIFICATIONS QUESTIONNAIRE
Contractor shall fully and completely answer each question set forth. Attach additional sheets if
necessary. Print or type each response. If your response to any question is "no" or "none," you
must state "no" or "none." "Not applicable" or other similar response will not be accepted.
a.
The Contractor has been engaged in the contracting business under California
License Number(s): ________________________ since the year _____ .
b.
State the full legal name of the Contractor.
c.
State the nature of the Contractor's business entity. (Sole proprietorship, joint
venture, partnership, corporation, etc.)
d.
State any other names that Contractor has used or done business under in the
past five (5) years.
e.
Has there been a change in ownership of the firm at any time during the last
three years? A corporation whose shares are publicly traded is not required to answer this
question.
f.
State the name and address of each person or other legal entity, which has a legal
or equitable ownership of ten percent (10%) or more of the Contractor’s business
entity. For each such person or legal entity, state that person or entity's ownership
interest, title and responsibilities.
g.
State your firm’s gross revenues for each of the last three years:
2014___________
h.
2012___________
Has Contractor's control over a public work of improvement ever been
terminated? If so, state the name, address and telephone number of the owner of
such public work, including the name of the public entity’s contact person, and
further explain the reason for termination.
Yes
i.
2013___________
No
Within the past five years, has Contractor ever failed to complete a public works
construction project within the time allowed by the contract plus any written
agreed upon contract time extensions? If so, state the name, address and
telephone number of the owner of the public work including the name of the
public entity’s contact person, and further explain the reasons for the delay.
Yes
No
j.
Has any surety of Contractor in the past five (5) years paid or satisfied any claim
on behalf of Contractor? If so, state all facts and circumstances, including the
name, address and telephone number of surety and all claimants.
Yes
k.
No
_____ # of instances
No
Has the Contractor, or any person or other legal entity, which has a legal or
equitable ownership of ten percent (10%) or more ever been accused of
presenting false claims to a public agency or public owner, as such claims are
defined in California Government Code Section 12650, et seq. (False Claims Act),
or 31 United States Code Section 3729, et seq.? If so, describe in detail all facts,
circumstances and the outcome.
Yes
p.
No
Has the Contractor, or any person or other legal entity, which has a legal or
equitable ownership of ten percent (10%) or more of the Contractor ever been
charged with a felony? If so, describe in detail all facts, circumstances and the
outcome, furnishing the name and address of the court in which the charge(s)
were filed, including the matter name and case number.
Yes
o.
_____ # of instances
Was your firm in bankruptcy at any time during the last 5 years? Responses in
the previous question are exempt from this response. If yes, please attach a copy
of the bankruptcy petition, showing the case number and the date on which the
petition was filed, and a copy of the Bankruptcy Court’s discharge order, or of
any other document that ended the case, if no discharge order was issued.
Yes
n.
No
Is your firm currently the debtor in a bankruptcy case? If yes, please attach a
copy of the bankruptcy petition, showing the case number, and the date on which
the petition was filed.
Yes
m.
_____ # of claims
Has any surety of Contractor ever been called upon to complete a project of
Contractor? If so, state all facts and circumstances, including the name, address
and telephone number of surety and all claimants.
Yes
l.
No
No
Has any public agency ever determined or ruled that the Contractor, or any
person or other legal entity, which has a legal or equitable ownership of ten
percent (10%) or more of the Contractor is not a responsible Contractor? If so,
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
12
state the name, address and telephone number of the public agency, including the
name of the agency’s contact person.
Yes
No
q.
If the Contractor’s accounts receivable or right to payment has ever been
assigned to a third party, state the name of the third party and whether the third
party has a secured or unsecured interest. Attach a copy of the assignment
agreement to this questionnaire.
r.
For every lawsuit or arbitration between Contractor and the owner of any work
of improvement, limited to such lawsuits or arbitrations initiated or completed
within the past five years, state the name and address of the tribunal, the matter
number, the parties, a general description of the nature of the dispute, and the
outcome. Attach a separate page describing each, if any.
Yes
s.
No
_____ # of instances
Has CAL OSHA cited and assessed penalties against your firm for any “serious,”
“willful” or “repeat” violations of its safety or health regulations in the past
five years?
Yes
No
_____ # of instances
If “yes,” attach a separate signed page describing the citations,
including information about the dates of the citations, the nature
of the violation, the project on which the citation(s) was or were
issued, the amount of penalty paid, if any. If the citation was
appealed to the Occupational Safety and Health Appeals Board
and a decision has been issued, state the case number and the date
of the decision.
t.
Has the federal Occupational Safety and Health Administration cited and
assessed penalties against your firm in the past five years?
Yes
No
_____ # of instances
If “yes,” attach a separate signed page describing each citation.
u.
Has the EPA or any Air Quality Management District or any State or Regional
Water Quality Control Board cited either your firm or the owner of a project on
which your firm was the contractor, in the past five years?
Yes
No
_____ # of instances
If “yes,” attach a separate signed page describing each citation,
including information about the dates of the citation(s), the risk
level of the project, the nature of the violation, the project on
which the citation(s) was or were issued, the amount of penalty
paid, if any. If the citation was appealed and a decision has been
issued, state the decision
v.
At any time in the last five (5) years has your firm been assessed and paid
liquidated damages or in lieu of liquidated damages entered into a settlement
agreement after or prior to completion of a project under a construction contract
with either a public or private owner? If yes, identify all such projects, the date of
completion, amount of liquidated damages assessed and all other information
necessary to fully explain the assessment of liquidated damages.
Yes
w.
No
_____ # of instances
The following certification must be signed by an owner, general partner, or
officer of Contractor or subcontractor.
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA, AND DO PERSONALLY CERTIFY AND ATTEST THAT: I HAVE
THOROUGHLY REVIEWED THE COMPLETED STATEMENT OF PREQUALIFICATIONS FORM AND ATTACHMENTS, IF ANY, AND KNOW ITS
CONTENTS, AND SAID STATEMENT OF QUALIFICATIONS FORM AND
ATTACHMENTS, IF ANY, ARE TRUTHFUL, COMPLETE AND ACCURATE; AND
THAT THE MENLO PARK FIRE PROTECTION DISTRICT MAY REASONABLY RELY
UPON THE CONTENTS AS BEING COMPLETE AND ACCURATE; AND, FURTHER,
THAT I AM FAMILIAR WITH CALIFORNIA PENAL CODE SECTION 72 AND
CALIFORNIA GOVERNMENT CODE SECTION 12650, ET SEQ., PERTAINING TO
FALSE CLAIMS, AND FURTHER KNOW AND UNDERSTAND THAT SUBMISSION
OR CERTIFICATION OF A FALSE CLAIM MAY LEAD TO FINES, IMPRISONMENT
AND/OR OTHER SEVERE LEGAL CONSEQUENCES.
Executed on the date indicated below, at the location indicated below.
Location: _____________________________________________________
Contractor:____________________________________________________
(Company Name)
By: ________________________________________________________
Date:_______________________________________________________
(Printed name of signor)
(Title of signor)
MENLO PARK FIRE PROTECTION DISTRICT
PREQUALIFICATION FORM
[Station 6]
14
4.
PROJECT SUPERINTENDENT EXPERIENCE:
Provide the name of Contractor’s proposed superintendent who will be in direct charge of the
overall project for the full duration of the contract. Provide references for at least two (2) Public
Works, K through 14 schools under the jurisdiction of DSA, hospitals under the jurisdiction of
OSHPD, California courts under the jurisdiction of the Judicial Council of California or
Essential Service building (police stations, fire stations, ect.) projects of similar size and
complexity with a minimum project value of four million dollars each OR at least two (2) Private
Sector projects of similar size and complexity with a minimum project value of ten million
dollars each during the past five years completed by the proposed superintendent in which the
proposed superintendent was under the direct employment of Contractor and performed the duties
as a Superintendent on the referenced projects. A project will not be considered complete unless
a Notice of Completion (“NOC”) has been filed. Also comment on whether the proposed
Superintendent has been removed by an Owner or the General Contractor from a project within
the last 5 years. Contractor will be immediately disqualified if the proposed Superintendent was
removed from the project by an Owner or by the Contractor due to performance,
insubordination, negligence or due to contractual violations. Also indicate whether the proposed
Superintendent has been removed by an Owner or by the Contractor for any other reason and
provide an explanation as to why they were removed.
Proposed Superintendent Information:
Name:
CA Lic. No.(s):
Address:
Phone:
Fax:
Email:
Reference No. 1
Project Description:
Project Value:
Owner Address:
Owner Phone:
Owner Email:
Project Start Date &
NOC Date:
Reference No. 2
Project Description:
Project Value:
Owner Address:
Owner Phone:
Owner Email:
Project Start Date &
NOC Date:
LOCAL HIRING POLICY
ATTACHMENT A:
Sample Local Hiring Telephone Log
Project Title:
Name of Person Placing Calls:
Work Area:
Date Time
Company
Name
Phone
No.
Contact
Person
Address
Selected
(Y/N)
I hereby declare under the penalty of perjury under the laws of the State of California that the
foregoing is a true and correct telephone log.
Date:
_____________________________________
Signature:
_____________________________________
Printed Name:
_____________________________________
Title:
_____________________________________
LOCAL HIRING POLICY
ATTACHMENT B
Sample Letter From Contractor or Bidder
[On Contractor Letterhead]
VIA U.S. MAIL OR E-MAIL
[date]
Attn: Estimator
Construction Contractor / Subcontractor Address
Re: Request for Subcontractor Bids
To Whom it May Concern:
[ABC corporation] is a construction firm who intends to submit a bid on the following Menlo
Park Fire Protection District Project
Project Name
Bid Due Date
We are seeking bids from local contractors or subcontractors operating within the District’s
service territory. Please contact us immediately to submit a proposed scope of work.
The plans, specifications and copies of the District’s proposal may be obtained at [Location of
documents and contact information]
Sincerely,
Contractor Representative
LOCAL HIRING POLICY
ATTACHMENT C:
Summary Record Documenting Demonstrating Good Faith Efforts for Local Hiring
Project Title:
Business
Name
Sent
Letter
(L)or
Called (C)
Example:
Company A
(L)
Business Address
123 Alpha St, East
Palo Alto, CA 94303
Business
Phone
Number
Date
Contacted
650-123-4567
1/1/13
Trade
Services
Requested
Trade
Services
Selected
Painting,
Electrical,
Plumbing
Electrical,
Plumbing
I hereby declare under the penalty of perjury under the laws of the State of California that the
foregoing is a true and correct summary record demonstrating good faith efforts for local hiring.
Date:
_____________________________________
Signature:
_____________________________________
Printed Name:
_____________________________________
Title:
_____________________________________
2046250.3