MiraCosta Community College District
Request for Qualifications
RFQ #01-14 Energy Services Companies
SUBMITTAL:
Submissions must be received on or before:
2:00 PM Thursday, November 14, 2013
Any Request for Qualification received after the time and date stated above shall not be considered
for award.
INQUIRIES:
For any questions or clarifications relating to this RFQ, please contact:
Kim Simonds
Buyer
MiraCosta Community College District
1 Barnard Drive
Oceanside, CA 92056
Phone: 760-795-6755
Fax: 760-795-6795
Email: ksimonds@miracosta.edu
Table of Contents
RFQ #01-14 Energy Services Companies
Table of Contents ............................................................................................................................................... 2
Legal Advertisement ......................................................................................................................................... 3
Campus Maps ..................................................................................................................................................... 5
General Information........................................................................................................................................... 8
General Provisions .......................................................................................................................................... 10
Qualification Criteria ....................................................................................................................................... 15
Qualification Form ........................................................................................................................................... 17
Section 1 - Firm Information ..................................................................................................................... 17
Section 2 – Rating Questions ....................................................................................................................... 18
Section 3 – Insurance / Bonding Requirements ........................................................................................ 20
Section 4 – Performance .............................................................................................................................. 21
Section 5 – Description of Firm Points Matrix............................................................................................ 22
Points Tally Sheet .......................................................................................................................................... 23
Notice of “No Bid” ........................................................................................................................................... 24
Non-Collusive Bidding Declaration ............................................................................................................. 25
Workers’ Compensation Certification ........................................................................................................ 26
Qualification Certification .............................................................................................................................. 27
Payee Data Record .......................................................................................................................................... 28
MCCD RFQ#01-14 Energy Services Companies
Page 2
Legal Advertisement
RFQ #01-14 Energy Services Companies
MIRACOSTA COMMUNITY COLLEGE DISTRICT
REQUEST FOR QUALIFICATION
NOTICE IS HEREBY GIVEN that MiraCosta Community College District, acting by and through its Governing Board,
hereinafter referred to as the District, will receive up to, but not later than 2:00 p.m. on Thursday, November 14, 2013
sealed submittals for the following :
DISTRICT REQUEST FOR QUALIFICATION NUMBER 01-14: Energy Services Company
Such submittals shall be received at the location specified below, and shall be opened at the stated place:
MiraCosta Community College District
Purchasing and Material Management Department
Attention: Kim Simonds, Buyer
One Barnard Drive, Building T-600
Oceanside, California 92056
Each submittal must conform and be responsive to this invitation, the RFQ General Information, Qualification Criteria,
Qualification Questionnaire and all other documents comprising the pertinent Qualification Documents. Copies of the
Contract Documents may be obtained online beginning Monday, September 23, 2014 at the following address:
http://www.miracosta.edu/administrative/purchasing/bidopportunities.html
The District reserves the right to reject any or all submittals or to waive any irregularities or informalities in the bids or in
the bidding. No bidder may withdraw his bid for a period of thirty (30) days after the date set for the opening of the bids.
All inquiries to this solicitation should be directed to Kim Simonds by calling 760-795-6755 or e-mail at
ksimonds@miracosta.edu.
Respectfully Submitted,
Susan Asato, Director of Purchasing & Material Management
Publication: North County Times
Publication Dates:
10/13/13 and 10/20/13
MCCD RFQ#01-14 Energy Services Companies
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Calendar of Events
RFQ #01-14 Energy Services Companies
Schedule
Advertisement / Distribution of Bid ............................................................................................................10/13/13 & 10/20/13
Last Day to Submit Questions and/or Clarifications.................................................................................................... 11/07/13
RFQ Due Date............................................................................................................................................................. 11/14/13
Approximate Date of Evaluated Pool Determination..................................................................................... Week of 12/09/13
Clarifications
Requests for questions, clarifications or additional information must be received by the District prior to the deadline set
forth in the Bid Schedule above. Requests for questions, clarifications or additional information received after that time will
not be responded to. All requests for questions, clarifications or additional information must be in writing and shall be
delivered, by hand delivery, mail, fax or e-mail between the hours of 8:00 a.m. and 4:30 p.m. and prior to the applicable
deadline in the Schedule to the following:
Kim Simonds, Buyer
MiraCosta Community College District
1 Barnard Drive
Oceanside, CA 92056
Phone: 760-795-6755
Fax:
760-795-6795
Email: ksimonds@miracosta.edu
RFQ Submission
Interested companies must submit their clearly marked and sealed bids to:
MiraCosta Community College District
1 Barnard Drive, Building T600
Oceanside, CA 92056
ATTN: Kim Simonds, Buyer
RE: RFQ #01-14 Energy Services Companies
RESPONSES MUST BE RECEIVED BY PERSONAL DELIVERY, COURIER SERVICE OR BY U.S. MAIL AT OR
BEFORE 2:00 PM ON THURSDAY, NOVEMBER 7, 2013 TO THE ABOVE LISTED ADDRESS. LATE SUBMITTALS
SHALL BE DEEMED NON-RESPONSIVE, AND THE DISTRICT SHALL REJECT ANY SUBMITTALS RECEIVED
AFTER THE DEADLINE STATED ABOVE.
MCCD RFQ#01-14 Energy Services Companies
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Campus Maps
RFQ #01-14 Energy Services Companies
Bid Delivery Location (T600)
MCCD RFQ#01-14 Energy Services Companies
Page 5
MCCD RFQ#01-14 Energy Services Companies
Page 6
MCCD RFQ#01-14 Energy Services Companies
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General Information
RFQ #01-14 Energy Services Companies
1. History: The MiraCosta Community College District is currently looking to develop a pool of qualified Energy
Services Companies to complete various planned energy savings projects throughout the entire district pursuant to
Government Code §4217.10 and Public Utilities Code §388.
2. Submittals: Submittals to receive consideration shall be made in accordance with the following instructions:
a. Submittals shall be received in the Purchasing and Material Management Department on or before 2:00 PM
Thursday, November 14, 2013.
b. Please include four (4) bound copies and one (1) unbound copy of your statement of qualification.
c. The respondent shall submit complete information on the services stated in proposal form. Failure to do so may
nullify the prequalification.
d. Before submitting a proposal, respondents shall carefully read the specifications and the forms of other
documents. They shall fully inform themselves as to all existing conditions and limitations, and shall include in the
proposal a sum to cover the cost of all items included in the contract. No allowance will be made because of lack
of such examination or knowledge.
e. The decision as to acceptability of the proposal or the goods and/or services referenced therein rests solely with
the District, including the right to waive any informality in any proposal. The District reserves the right to reject the
proposal of any respondent who has previously failed to perform properly or complete on time, contracts of a
similar nature
f. If any person contemplating submitting a proposal for the proposed contract is in doubt as to the true meaning of
any part of the specifications, or other proposed contract documents, or finds discrepancies in, or omissions from
the specifications, they are instructed to contact Kim Simonds, Buyer, at (760) 795-6755, to request an
interpretation or correction thereof. The District may require that such request be in writing, in which case the
person submitting the request will be responsible for its prompt delivery. Any interpretation or correction of the
proposed documents will be made by Addendum duly issued by the Buyer, and a copy of such Addendum will be
mailed or delivered to each person receiving a set of such documents. The District will not be responsible for any
other explanation or interpretation of the proposed documents.
2. ADDENDA OR BULLETINS:
a. Any addenda or bulletins issued by the MiraCosta Community College District during the time of proposing or
forming a part of the documents issued to the bidder for the preparation of their bid shall be covered in the bid and
shall be made a part of the contract.
b. Any questions regarding the specifications or the bidding process must be called to the attention of the District
later than Thursday, October 31, 2013.
3. WITHDRAWAL OF SUBMITTALS: Any respondent may withdraw its proposal, either personally or by a written
request, at any time prior to the scheduled time for opening of Submittals, but not after. No respondent may withdraw
their proposal for a period of sixty (60) days after the date set for the opening.
4. AWARD OR REJECTION OF SUBMITTALS: The submittals will be used to determine a pool of qualified contractors
with which the District will use in bidding the various projects around the district. The Governing Board of MiraCosta
Community College District, however, reserves the right to reject any/or all Submittals, to accept or reject any one or
more items of a submittal, and to waive any informality in the Submittals or in the bidding. The District reserves the
right to reject the submittal of any respondent who has previously failed to perform properly, or complete on time,
contracts of a similar nature, or to reject the bid of a respondent who is not in a position to perform such contract
satisfactory. The District expressly reserves the right to reject the Submittal of any respondent who is in default of
payment of taxes, licenses or other monies due to the District.
5. EVALUATION OF SUBMITTALS: Proposals will be evaluated to determine the firms best able to meet the needs of
the district. The evaluation will include a consideration of the factors described below. MiraCosta Community College
District reserves the right to reject all firms submitting responses to this RFQ.
a. Experience and expertise of each respondent and its sub-consultant(s)
b. Experience and expertise of each respondent’s key personnel
c. Completeness and clarity of the proposal.
MCCD RFQ#01-14 Energy Services Companies
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d. Oral interview and presentation (if requested by the district).
e. Financial & Operational Capacity of respondent to perform Services as required by the District.
f. Points accumulated in the Qualification Form.
Once the pool of qualified vendors has been established any future jobs will selected amongst the prequalified
contractors.
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General Provisions
RFQ #01-14 Energy Services Companies
1. AWARD: At its sole discretion, MiraCosta Community College District may award an agreement based on bids which
offer the best value, cost effectiveness and other criteria that may be requested in the specifications including, but not
limited to, references and other performance criteria.
2. BIDDERS INTERESTED IN MORE THAN ONE BID: No person, firm or corporation shall be allowed to make or file
or be interested in more than one bid for the same work, unless alternate bids are called for. A person, firm or
corporation submitting a sub-bid to a bidder, or who has quoted prices on materials to a bidder, is not thereby
disqualified from submitting a sub-bid or quoting prices to other bidders.
3. ASSIGNMENT OF CONTRACT: No assignment by the Contractor of any contract to be entered into hereunder or
any part thereof, or of funds to be received thereunder by the Contractor, will be recognized by the District unless
such assignment has had the prior approval of the District and the surety has been given due notice of such
assignment in writing and has consented thereto in writing.
4. REQUIRED RESOURCES VERIFICATION: Prior to contract award, MiraCosta Community College District must be
assured that the bidder selected has all of the resources required to successfully perform under the contract. This
includes, but is not limited to, personnel with skills required, equipment/materials and financial resources sufficient to
provide services called for under this contract. If during the evaluation process, MiraCosta Community College
District is unable to assure itself of the Bidder’s ability to perform under the contract, MiraCosta Community College
District has the option of requesting from the Bidder, any information that the District deems necessary to determine
the bidder’s capabilities. If such information is required, the bidder will be notified and will be permitted seven (7)
working days to submit the requested information.
5. PERMITS AND LICENSES: The bidder and all of the bidder's employees or agents shall secure and maintain in
force all such licenses and permits as are required by law, in connection with the furnishing of materials, articles, or
services listed herein. All services operations and materials shall be in accordance with all applicable Federal, State,
County and City regulations.
6. INVOICES. Separate invoices are required for each purchase order. Invoices shall be submitted in duplicate and
shall contain the following information: purchase order number, item number and description, quantity, unit price and
extended totals for items delivered.
Sales tax, where applicable, shall be shown separately.
Shipping/handling/delivery charges shall also be shown separately and shall include the original or a copy of the
prepaid bill of lading. Failure to enter the above information on the invoice shall cause a delay in payment. All
invoices shall be submitted to the following address:
MiraCosta Community College
Attn: Accounts Payable
One Barnard Dr.
Oceanside, CA 92056
7. PAYMENTS AND TERMS: Within thirty-five (35) days after delivery of any or all of the items set forth herein and
their acceptance by the District, the District agrees to pay to the Contractor, and the Contractor agrees to accept in full
payment therefore, the sums set opposite each item.
8. FORCE MAJEURE. The Contractor shall be excused from performance hereunder during the time and to the extent
that he is prevented from performing by act of God, fire, strike, lockout or commandeering of materials or facilities by
the government, when satisfactory evidence thereof is presented to the District, provided that it establishs that the
non-performance is not due to the fault or neglect of the party not performing.
9. DISTRICT'S RIGHT TO WITHHOLD CERTAIN AMOUNTS AND MAKE APPLICATION THEREOF: The District
may authorize the withholding of a sufficient amount or amounts of any payment otherwise due to the Contractor, as
in its judgment may be necessary to cover defective items not remedied. The District may apply such withheld amount
or amounts to the payment of such claims, at its discretion.
10. NOTICE TO PROCEED AND COMPLETION: Contractor shall begin performance of the Contract promptly upon
delivery and acceptance by the Purchasing & Material Management Department of all Bonds (if required) and receipt
MCCD RFQ#01-14 Energy Services Companies
Page 10
by the Contractor of a fully executed Purchase Order. The Contractor is obligated to completely and satisfactorily
perform the Contract within the period or periods specified in the Contract Documents.
11. LATE FEES: Late deliveries or service performance in excess of twenty (20) calendar days shall be assessed late
delivery charge. This late charge shall be assessed at 2.5% per calendar day of the total dollar value (before tax) of
the late delivered goods or services. This penalty shall commence on the first day following the end of the specified
delivery period. This penalty shall be taken as a credit against the Contractor's invoice to the District. Assessment of
late fees shall not negate any of the other rights and remedies stipulated in the Contract.
12. INDEPENDENT CONTRACTOR: The parties intend that the awarded Contractor, in performing the services herein
specified, shall act as an independent contractor and shall have control of the work and the manner in which it is
performed. Contractor is not to be considered an agent or employee of District and is not entitled to participate in any
pension plans, insurance, bonus or similar benefits District provided to its employees.
13. INDEMNIFICATION: To the fullest extent permitted by law, and as a material part of this agreement, the Contractor
shall indemnify, hold harmless and defend, the District, its Board of Trustees, officers, agents, employees and
volunteers against any and all liability, claims, damages, losses and expenses, including reasonable attorneys’ fees,
arising from all acts or omissions to act of the Contractor or its officers, agents, employees, volunteers and
subcontractors, excluding, however, such liability claims, losses, damages, or expenses arising from the District’s sole
and active negligence or willful acts. Contractor assumes complete liability for any goods or materials furnished by
the District to the Contractor in connection with this agreement. Contractor agrees to pay for such tools or materials
spoiled by it or not otherwise accounted for to the District’s satisfaction. The furnishing to Contractor of any goods or
materials in connection with this agreement shall not be construed to vest title thereto in Contractor.
The District shall not be liable for any accident, loss, assault, battery, defamation, false arrest, false imprisonment,
invasion of privacy, intentional or negligent infliction of emotional distress, injury (including death) or damages
happening or accruing during the term of the performance of the work to persons and/or property, and Contractor’s
shall fully indemnify and protect the District from and against the same.
14. INSURANCE REQUIREMENTS. The Contractor and its officers, employees, agents and subcontractors shall, at their
expense and effort, maintain and comply with Insurance Requirements #a-f below to protect Contractor and the
District from any and all claims for personal injury, bodily injury and property damage arising from, pertaining to or
relating to the scope of work under this agreement.
a. Commercial General Liability. Minimum limits of $1,000,000 per occurrence and $2,000,000 general aggregate
for personal injury, bodily injury an d property damage including products and completed operations, under
Insurance Services Office Occurrence Number CA 00 01, (any auto).
b. Automobile Liability. $1,000,000 per accident for bodily injury and property damage under Business Automobile
Liability Coverage Form Number CA 00 01, (any auto).
c. Any insurance or self-insurance maintained by the District shall be excess of the Contractor’s insurance and shall
not contribute with it.
d. Waiver of Subrogation. Contractor agrees that in the event of loss due to any perils for which it has agreed to
provide Commercial General and Automobile Liability insurance, Contractor shall look solely to its insurance
carrier(s) for recovery and grants a waiver of any right to subrogation which any such insurer of Contractor may
acquire against the District by virtue of payments of any loss under this insurance.
e. Certificate of Insurance. Contractor shall furnish the District with original certificates of insurance and all
amendatory endorsements affecting coverage required by this Agreement and indicating a thirty (30) day
cancellation notice or notice of reduction in coverage.
f. Additional Insured. Insurance shall name the District and its Board of Trustees, officers, employees, agents and
volunteers as Additional Insured under said policy.
Premiums on all insurance policies shall be paid by Contractor and shall be deemed included in this contract.
15. NON-DISCRIMINATION ENDORSEMENT. It is the policy of the District that the Contractor and District mutually
agree that they will comply with all applicable Federal and California state anti-discrimination laws and regulations
and agree not to unlawfully discriminate against any prospective or active employee engaged in the work on the basis
of race, color, age, ancestry, national origin, sex, religious creed, marital status, or physical or mental disability, or
sexual orientation or any other category protected by law, including but not limited to, the California Fair Employment
Practice Act, beginning with Labor Code Section 1410, and Labor Code Section 1735. In addition, the Contractor
agrees to require like compliance by all subcontractors employed. Contractor and District mutually agree that they will
comply with all applicable federal and state anti-discrimination laws and regulations, and agree not to unlawfully
MCCD RFQ#01-14 Energy Services Companies
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discriminate against Students on the basis of race, color, creed, religion, sex, age, national origin, ancestry, marital
status, physical or mental disability, sexual orientation, or any other category protected by law.
16. PROVISIONS REQUIRED BY LAW DEEMED INSERTED: Each and every provision of law and clause required by
law to be inserted in this contract shall be deemed to be inserted herein, and the contract shall be read and enforced
as though it were included herein, and if through mistake or otherwise any such provisions is not inserted, or is not
correctly inserted, then upon application of either party, the contract shall forthwith be physically amended to make
such insertion or correction.
17. ELECTRONIC AND INFORMATION TECHNOLOGIES. The Contractor hereby warrants that the goods or services
to be provided to the District comply with the accessibility requirements of Section 508 of the Rehabilitation Act of
1973, as amended (29 U.S.C. '794d), and its implementing regulations set forth at Title 36, Code of Federal
Regulations, Part 194. The Contractor agrees to promptly respond to and resolve any complaint regarding
accessibility of its products or services. Contractor further agrees to indemnify and hold harmless the District from
any claim arising out of its failure to comply with the aforesaid requirements. Failure to comply with these
requirements shall constitute a breach and be grounds for termination of this order or agreement.
18. CERTIFICATION REGARDING DEBARMENT, SUSPENSION OR OTHER INELIGIBILITY. (applicable to all orders
or agreements funded in part or in whole with federal funds) - The Contractor agrees to comply with applicable
federal suspension and debarment regulations, including, but not limited to, regulations implementing Executive Order
12549 (29 C.F.R. Part 98). The Contractor certifies to the best of its knowledge and belief that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any federal department or agency;
b. Have not, within a three-year period preceding the receipt of this purchase order, been convicted of, or had a civil
judgment rendered against them, for: (1) Commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state or local) or private transaction or contract; (2) Violation
of Federal or State antitrust statutes; (3) Commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, tax evasion, receiving stolen property, making false claims, or
obstruction of justice; or (4) Commission of any other offense indicating a lack of business integrity or business
honesty that seriously and directly affects Contractor’s present responsibility;
c. Are not presently indicted for, or otherwise criminally or civilly charged by any government entity (federal, state or
local), with commission of any of the offenses enumerated above;
d. Have not, within a three-year period preceding the receipt of this purchase order or agreement, had one or more
public transactions (federal state or local) terminated for cause or default;
e. Shall not, except as otherwise provided under applicable federal regulations, knowingly enter into any lower tier
covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or
voluntarily excluded by any federal department or agency from participation in such transaction; and
f. Include in all lower tier covered transactions, and all solicitations for covered transactions, provisions substantially
similar to those set forth herein.
19. STORM WATER PERMIT FOR CONSTRUCTION ACTIVITY. The District has adopted a Storm Water Management
Plan (SWMP). The SWMP was prepared in accordance with Waste Discharge Requirements for Storm Water
Discharges from Small Municipal Separate Storm Sewer Systems (General NPDES Permit No. CAS000004) adopted
by the State Water Resources Control Board. Contractor shall comply with the District’s SWMP requirements and
include all costs for compliance in the Contract amount. Contractor shall also comply with the lawful requirements of
other agencies regarding discharges to the storm drain system or other watercourses, including applicable City,
County, State and Federal storm water requirements.
The contractor shall, if required, shall be solely responsible for preparing and implementing a Storm Water Pollution
Prevention Plan (SWPPP) prior to initiating work. The contractor shall be responsible for complying with the provisions
of the Permit and the SWPPP, including the standard provisions, monitoring and reporting requirements as required
by Permit. It shall be the responsibility of the contractor to evaluate and include in the bid the cost of complying with
the SWPPP and any necessary revisions to the SWPPP. The contractor shall also include in their bid the cost of
monitoring as required by the SWPPP Permit. All trade contractors are responsible for repair and replacement of
SWPPP control measures disturbed by own operations. All trade contractors are responsible for adhering to the
approved SWPPP plan.
20. COMPLIANCE WITH LOCAL, STATE AND FEDERAL REGULATIONS. The Contractor shall comply with all lawful
requirements of the United States, the State of California, the District, and all applicable municipalities and local
agencies.
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21. CONFLICT OF INTEREST AND PROHIBITED INTERESTS. No officer, employee, or any other agent of the District
authorized in any capacity on behalf of the District to exercise any fiduciary, executive, or other similar functions, shall
be allowed to possess or accept, directly or indirectly, or in any part thereof, any financial interest in any contract, bid
or other procurement activity of the District. Additionally, no officer, employee, or any other agent of the District
similarly authorized, shall be allowed to possess or accept any form of gift, payment, undue advantage or influence,
directly or indirectly, or in any part thereof.
The District reserves the right, before any contract or procurement award is made, to require an affidavit from the
respective bidder or contractor to disclaim in writing any conflict of interest. Furthermore, the District reserves the
right to reject any bidder or contractor if any such conflict is discovered, and subsequently award to the next preferred
vendor.
All District contracts, bids and procurement transactions are executed in compliance with Government Codes 1090 et
sequitur, 87100 et seq., and 89503 et seq., as stated in District Purchasing and Contracting Policy BP6330.
22. ANTI-KICKBACKS AND FRAUD: Under Federal Pub. L. 99-634, Section 51 to 58 of the “Anti-Kickback Act of 1986”,
which is an amendment of 1946, “the practice of subcontractors of paying fees or kickbacks, or of granting gifts or
gratuities or employees of cost-plus-a-fixed-fee or cost-reimbursable prime contractors, for the purpose of securing
the ward of contract...” These practices are illegal and the District will not condone or participate in any such
practices. Penalties include a maximum 10-year prison terms and a $250,000 fines ($1,000,000 for business
entities). The State of California 1990 Public Contract-Disciplinary Procedure SB No. 2290, otherwise known as
KOPP and SEYMOUR Acts, Section 7115, prohibits fraud and collusion in an attempt to fix prices and kickbacks.
23. TERMINATION FOR DEFAULT: If the Contractor fails or neglects to supply or deliver any of said goods, articles, or
service at the prices named and at the time and place stated, the District may, without further notice or demand,
cancel and rescind this contract or may purchase said goods, supplies, or services elsewhere, and hold the
Contractor responsible and liable for all damages which may be sustained thereby, or on account of the failure or
neglect of the Contractor in performing any of the terms and conditions of this contract; it being specifically provided
and agreed that time shall be of the essence in this agreement. The foregoing provisions are in addition to and not in
limitation of any other rights or remedies available to the District.
24. DOCUMENT MODIFICATIONS: This writing is intended both as the final expression of the Agreement between the
parties hereto with respect to the included terms and as a complete and exclusive statement of the terms of the
Agreement. No modification of this Agreement shall be effective unless and until such modification is evidenced by a
writing signed by both parties.
25. TRANSFER OF RIGHTS: Contractor assigns to the District all rights throughout the work in perpetuity in the nature
of copyright, trademark, patent, right to ideas, in and to all versions of the plans and specifications now or later
prepared by Contractor in connection with the project, if any. Contractor agrees to take such actions as are
necessary to protect the rights assigned to the District in this Agreement, and to refrain from taking any action which
would impair those rights. Contractor’s responsibilities under this contract include, but are not limited to, placing
proper notice of copyright on all versions of the plans and specifications as Contractor may direct, and refraining from
disclosing any versions of the plans and specifications to any third party without first obtaining written permission of
the District.
26. EXTRA (CHANGED) WORK: Only the Director of Purchasing and Material Management or designee may authorize
extra (and/or changed) work. The parties expressly recognize that District and College personnel are without
authorization to either order extra (and/or changed) work or waive contract requirements. Failure of the Contractor to
secure proper authorization for extra work shall constitute a waiver of any and all right to adjustment in the contract
price or contract time due to such unauthorized extra work and the Contractor thereafter shall be entitled to no
compensation whatsoever for the performance of such work.
27. OWNERSHIP OF WORK PRODUCT: The District shall be the owner of and shall be entitled to immediate
possession of accurate reproducible copies of any design computations, plans, correspondence or other pertinent
data and information gathered or computed by the Contractor prior to termination of any Agreement by the District or
upon completion of the work pursuant to an Agreement.
28. ATTORNEYS' FEES: If suit is brought by either party to this Agreement to enforce any of its terms (including all
component parts of the Contract Documents), and the District prevails in such suit, the Contractor shall pay all
litigation expenses incurred by the District, including attorneys' fees, court costs, expert witness fees and investigation
expenses.
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29. CONTRACTOR'S WARRANTY: The District has relied upon the professional ability and training of the Contractor as
a material inducement to enter into any Agreement. The Contractor hereby warrants that all its work will be performed
in accordance with generally accepted professional practices and standards as well as the requirements of applicable
federal, state and local laws, it being understood that acceptance of Contractor’s work by the District shall not operate
as a waiver or release.
30. TAXES: The Contractor agrees to file federal and state tax returns and pay all applicable state and federal taxes on
amounts paid pursuant to this Agreement. In case the District is audited for compliance regarding any applicable
taxes, the Contractor agrees to furnish the District with proof of payment of taxes on those earnings.
31. DRUG FREE/SMOKE FREE/ALCOHOL FREE POLICY. All District sites are designated drug-free/smokefree/alcohol-free. The use or abuse of controlled substances, tobacco products, and alcohol will not be tolerated.
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Qualification Criteria
RFQ #01-14 Energy Services Companies
Each respondent shall provide the information indicated below:
1. Description of Firm. Provide a statement of experience regarding the company’s experience in providing services
for energy savings projects. This should include the following:
a. Credentials related to energy efficiency analysis and life cycle cost analysis.
b. Experience related to energy efficiency analysis and life cycle cost analysis. Please include a list of specific
projects the firm has completed in the past five years (This should include the project name, owner, dates of the
period of service, and dollar value of the services performed by the firm.).
c. Credentials related to sustainable construction and/or energy efficiency standards (e.g. Coalition for High
Performance Schools and Leadership in Energy and Environmental Design.
d. Experience related to sustainable construction and/or energy efficiency standards, including a list of specific
projects the firm has completed in the past five years (This should include the project name, owner, dates of the
period of service, and dollar value of the services performed by the firm.).
e. Credentials for mechanical systems and central plant design and engineering.
f. Experience on projects involving central plant design, including all mechanical and electrical systems and
distribution piping throughout a campus or building complex, including a list of specific projects the firm has
completed in the past five years (This should include the project name, owner, dates of the period of service, and
dollar value of the services performed by the firm.).
g. Experience related to Division of the State Architect approval and administration, including a list of specific
projects the firm has completed in the past five years (This should include the project name, owner, dates of the
period of service, and dollar value of the services performed by the firm.).
h. Experience related to Community College Districts administration including a list of specific projects the firm has
completed in the past five years (This should include the project name, owner, dates of the period of service, and
dollar value of the services performed by the firm).
i. Experience on projects involving LED parking lot and roadway light retrofit projects including all electrical systems
and electrical distribution throughout a campus or building complex, including a list of specific projects the firm
has completed in the past five years (This should include the project name, owner, dates of the period of service,
and dollar value of the services performed by the firm).
j. Experience on projects involving interior lighting retrofit projects including all electrical systems and electrical
distribution throughout a campus or building complex, including a list of specific projects the firm has completed in
the past five years (This should include the project name, owner, dates of the period of service, and dollar value
of the services performed by the firm).
k. Experience on project involving integration of new equipment and central plant systems with energy management
systems and existing related legacy systems including a specific list of projects the firm has completed in the past
five years (This should include the project name, owner, dates of the period of service, and dollar value of the
services performed by the firm.).
l. Experience on projects comprising HVAC systems for California Community College Districts that the firm as both
started and completed including a list of specific projects the firm has completed in the past five years (This
should include the project name, owner, dates of the period of service, and dollar value of the services performed
by the firm.).
m. Experience performing comprehensive building retro-commissioning for existing HVAC systems with integrated
Energy Management System (EMS) controls, central utility plants, electrical and lighting, plumbing and hot water
boiler systems, irrigation, etc. (This should include the project name, owner, dates of the period of service, and
dollar value of the services performed by the firm.).
n. Evidence and description of Financial & Operational Capacity to support the services required by the District.
2. Description of Key Personnel. Provide the specific descriptions of the background, experience and qualifications of
all key personnel who will have an active part in providing the services requested. All professionals should be
experienced, and if required, licensed, certified, or registered in their areas of expertise. The same specific
information as to credentials and experience of the firm.
3. Identification of Sub-consultants. Each respondent shall identify any sub-consultant(s) and/or sub-contractor(s) it
intends to utilize in the performance of its services.
MCCD RFQ#01-14 Energy Services Companies
Page 15
4. Additional Information. Provide any additional information pertinent to the services that can be provided. The
District encourages the inclusion of letters of reference and/or testimonials.
5. Qualification Form. Provide a completed copy of the attached Qualification Form in the submittal package.
6. Required Forms. Provide completed copies of the Non-Collusive Bidding Declaration, Workers’ Compensation
Certification, Qualification Certification and the Payee Data Record.
MCCD RFQ#01-14 Energy Services Companies
Page 16
Qualification Form
RFQ #01-14 Energy Services Companies
Section 1 - Firm Information
Proper Name of Respondent
Address
Authorized Agent Name and Title
City, State, Zip
Authorized Agent Signature
Phone
E-mail address
Fax
Federal Tax Identification Number
Date Business Formed
Please list your license information:
License Number
License Class
License Expiration Date
Please list any supplemental classification(s) held, if any and license number(s):
License Number
License Class
License Expiration Date
License Number
License Class
License Expiration Date
License Number
License Class
License Expiration Date
Have you ever been licensed in California under a different name or different license number?
Yes
No
If yes, list all name(s) and license number(s):
Corporate Officers – Partners, Proprietor, Owners, Key Personnel:
Name
Position
Years w/ Firm
MCCD RFQ#01-14 Energy Services Companies
% of Ownership
Page 17
Section 2 – Rating Questions
Question
1. How many years has your organization been in business in California
as a contractor under your present business name and license
number?
Response
Years
Points
Points
(For Office Use Only
(3 Yrs or less = 1 pt., 3-6 Yrs = 2 pt., 6+ Yrs = 3 pts.)
2. Have the owners or principals had their license(s) suspended, put on
probation or revoked by the Contractors State License Board?
(Revoked = 0 pts., Probation = 1 pts., Suspended = 2 pts., Good Standing = 3 pts.)
3. How many years has your organization completed the type of work as
required in this Request for Qualification?
Good Standing
Suspended
Probation
Revoked
Points
Years
(For Office Use Only
School Projects
(For Office Use Only
(3 Yrs or less = 1 pt., 3-6 Yrs = 2 pts., 6+ Yrs = 3pts)
4. How many school district projects has your firm completed in the past
5 years?
Points
(For Office Use Only
(4+ = 3 pts., 3 = 2 pts., 2 = 1 pts., 1 or less = 0 pts.)
Points
5. Within in the last five (5) years, has any employee or entity filed a complaint against your firm with the California
Contractors License Board?
(Yes = 0 pts., No = 1 pts.)
Yes
No
If yes, please explain:
Points
(For Office Use Only)
6. Has your firm ever failed to complete a project in the past five (5) years?
Points
(Yes = 0 pts., No = 1 pts.)
(For Office Use Only)
Yes
No
If yes, please explain:
7. Has your firm ever been declared in default on a project in the past five (5) years?
Points
(Yes = 0 pts., No = 1 pts.)
(For Office Use Only)
Yes
No
If yes, please explain:
8. Has your firm been assessed liquidated damages on a job in the past five (5) years?
Points
(Yes = 0 pts., No = 1 pts.)
(For Office Use Only)
Yes
No
If yes, please explain:
MCCD RFQ#01-14 Energy Services Companies
Page 18
9. Has your firm ever had insurance terminated by a carrier in the past five (5) years?
(Yes = 0 pts., No = 1 pts.)
Yes
No
Points
(For Office Use Only)
If yes, please explain:
10. Has your firm or any officer of your firm been found guilty of violating any federal, state or local law, rule or regulation
regarding a construction contract?
(Yes = 0 pts., No = 1 pts.)
Points
Yes
No
(For Office Use Only)
If yes, please explain:
Section 2 Grand Total
(For Office Use Only)
MCCD RFQ#01-14 Energy Services Companies
Page 19
Section 3 – Insurance / Bonding Requirements
11. Does your firm maintain the insurance requirements as listed below?
(Yes = 0 pts., No = 10 pts.)
Yes
Points
(For Office Use Only)
No
The Contractor and its officers, employees, agents and subcontractors shall, at their expense, maintain and comply with
Insurance Requirements #1-6 below to protect Contractor and District from any and all claims for personal injury, bodily
injury and property damage arising from, pertaining to or relating to the scope of work under this agreement.
a. Commercial General Liability. Minimum limits of $1,000,000 per occurrence and $2,000,000 general aggregate
for personal injury, bodily injury an d property damage including products and completed operations, under
Insurance Services Office Occurrence Number CA 00 01, (any auto).
b. Automobile Liability. $1,000,000 per accident for bodily injury and property damage under Business Automobile
Liability Coverage Form Number CA 00 01, (any auto).
c. Any insurance or self-insurance maintained by the District shall be excess of the Contractor’s insurance and shall
not contribute with it.
d. Waiver of Subrogation. Contractor agrees that in the event of loss due to any perils for which it has agreed to
provide Commercial General and Automobile Liability insurance, Contractor shall look solely to its insurance
carrier(s) for recovery and grants a waiver of any right to subrogation which any such insurer of Contractor may
acquire against the District by virtue of payments of any loss under this insurance.
e. Certificate of Insurance. Contractor shall furnish the District with original certificates of insurance and amendatory
endorsements effecting coverage required by this Agreement and indicating a thirty (30) day cancellation notice
or notice of reduction in coverage.
f. Additional Insured. Insurance shall name the District and its Board of Trustees, officers, employees, agents and
volunteers as Additional Insured under said policy.
Premiums on all insurance policies shall be paid by Contractor and shall be deemed included in this contract.
Workers’ Compensation: The Contractor and all of their officers, employees, agents, volunteers, and subcontractors
agree to; (1) procure and maintain in full force and effect Workers’ Compensation and Employer’s Liability insurance
covering its employees and agents while these persons are participating in the scope of work hereunder: (2) The insurer
for the Contractor shall agree to waive all rights of subrogation against District, its Board of Trustees, officials, employees,
agents and volunteers for losses under the terms of the insurance policy which arise from work performed by the
Contractor.
*Please provide a copy of your certificate of insurance with you submittal.
12. Is your firm able to obtain the Payment and Performance Bonds as required below?
(Any respondent unable to obtain the proper bonds will automatically not be deemed qualified.)
Points
(For Office Use Only)
Yes
No
Upon award of any bid the district shall require Performance and Payment Bonds as regulated by state regulations.
The Performance Bond must be executed by an admitted Surety approved to conduct business in the State of Californai
which meets the highest standards the District is legally permitted to establish and which it has established.
The Payment Bond must be in the amount of one hundred percent (100%) of the total amount payable. The Payment
Bond must be executed by an admitted Surety approved to conduct business in the State of California which meets the
highest standards the District is legally permitted to establish.
Section 3 Grand Total
(For Office Use Only)
MCCD RFQ#01-14 Energy Services Companies
Page 20
Section 4 – Performance
13. Has your firm completed projects for any California Community College?
Points
(Yes = 0 pts., No = 5 pts.)
(For Office Use Only)
Yes
No
If yes, please provide information on the last 3 community college jobs.
(2 pts. will be awarded for each reference below.)
Contact & Phone
Number
Owner
Job Description
Contract
Amount
14. Has your firm completed projects for any other California Public Agency?
(Yes = 0 pts., No = 5 pts.)
Yes
No
Points
If yes, please provide information on the last 3 public agency jobs.
(For Office Use Only)
(2 pts. will be awarded for each reference below.)
Owner
Contact & Phone
Number
Job Description
Contract
Amount
Section 4 Grand Total
(For Office Use Only)
MCCD RFQ#01-14 Energy Services Companies
Page 21
Section 5 – Description of Firm Points Matrix
(Scoring Matrix for Page 15, Section 1)
a. Credentials related to energy efficiency analysis and life cycle cost analysis.
Points
(For Office Use Only)
(Yes = 2 pts., No = 0 pts.)
b. Experience related to energy efficiency analysis and life cycle cost analysis.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
c. Credentials related to sustainable construction and/or energy efficiency standards.
Points
(For Office Use Only)
(Yes = 2 pts., No = 0 pts.)
d. Experience related to sustainable construction and/or energy efficiency standards
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
e. Credentials for mechanical systems and central plant design and engineering.
f.
Points
(Yes = 2 pts., No = 0 pts.)
(For Office Use Only)
Experience on projects involving central plant design, including all mechanical and electrical
systems and distribution piping throughout a campus or building complex.
(For Office Use Only)
Points
(Rate - Maximum 4 pts. / Minimum 0 pts.)
g. Experience related to Division of the State Architect approval and administration, including a list
of specific projects the firm has completed in the past five years.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
h. Experience related to Community College Districts administration including a list of specific
projects the firm has completed in the past five years.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
i.
Experience on projects involving LED parking lot and roadway light retrofit projects including all
electrical systems and electrical distribution throughout a campus or building complex.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
j.
Experience on projects involving interior lighting retrofit projects including all electrical systems
and electrical distribution throughout a campus or building complex.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
k. Experience on project involving integration of new equipment and central plant systems with
energy management systems and existing related legacy systems.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
l.
Experience on projects comprising HVAC systems for California Community College Districts that
the firm as both started and completed.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
m. Experience performing comprehensive building retro-commissioning for existing HVAC systems
with integrated Energy Management System (EMS) controls, central utility plants, electrical and
lighting, plumbing and hot water boiler systems, irrigation, etc.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
n. Evidence and description of Financial & Operational Capacity to support the services required by
the District.
Points
(For Office Use Only)
(Rate - Maximum 4 pts. / Minimum 0 pts.)
Section 5 Grand Total
(For Office Use Only)
MCCD RFQ#01-14 Energy Services Companies
Page 22
Points Tally Sheet
Section 2
Points
(Maximum 18 pts.)
Section 3
Points
(Maximum 10 pts.)
Section 4
Points
(Maximum 22 pts.)
Section 5
Points
(Maximum 50 pts.)
Grand Total
Points
(Maximum 100 pts.)
For Office Use Only
MCCD RFQ#01-14 Energy Services Companies
Page 23
Notice of “No Bid”
RFQ #01-14 Energy Services Companies
If you choose not to respond to this Request for Qualifications for Energy Services Companies, please indicate below.
This will help us to create and maintain more accurate and effective respondents’ lists:
 We do not wish to bid on this project at this time. Please retain us on the respondents list in consideration of future
projects.
 We do not wish to bid on this project, nor on any similar projects in future with regard to this commodity.
Reason for not bidding:
Proper Name of Respondent
Address
Authorized Agent Name and Title
City, State, Zip
Authorized Agent Signature
Phone
E-mail address
Fax
MCCD RFQ#01-14 Energy Services Companies
Page 24
Non-Collusive Bidding Declaration
RFQ #01-14 Energy Services Companies
I,
(Name of Bidder's Authorized Officer or Agent) declare as follows:
That I am the
(Title) of
(Legal Name of Bidder), the party making the attached bid; that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not
collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or
sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put
in a sham bid, or that anyone shall refrain from bidding, that the bidder has not in any manner, directly or indirectly, sought
by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix
any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against
the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in this
bid are true, and, further, that the bidder has not, directly or indirectly, submitted his bid price or any breakdown thereof, or
the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation,
partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a
collusive or sham bid.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed
the
day of
, 20
, at
.
Signature of Bidder's Authorized Officer or Agent
MCCD RFQ#01-14 Energy Services Companies
Page 25
Workers’ Compensation Certification
RFQ #01-14 Energy Services Companies
RESPONDENT’S CERTIFICATION REGARDING WORKERS’ COMPENSATION
State of California Labor Code section 3700 in relevant part provides:
Every employer except the State shall secure the payment of compensation in one or more of the following ways:

By being insured against liability to pay compensation in one or more insurers duly authorized to write
compensation insurance in this State.

By securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given
upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any
compensation that may become due to his employees.
I am aware of the provisions of section 3700 of the Labor Code which require every employer to be insured against
liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of the code, and I will
comply with such provisions before commencing the performance of the work of this contract.
Proper Name of Bidder
Signature of Authorized Agent/Officer
Date
In accordance with article 5 (commencing at section 1860), chapter 1, part 7, division 2 of the Labor Code, the above
certificate must be signed and filed with the awarding body prior to performing any work under this contract.
MCCD RFQ#01-14 Energy Services Companies
Page 26
Qualification Certification
RFQ #01-14 Energy Services Companies
I,
, the
of the firm, hereby certify under
penalty of perjury under the laws of the State of California, that all of the information submitted by the
respondent in connection with this submittal and all of the representations made herein are true and correct and
that the respondent named below is legally authorized to enter into contracts with the District.
Executed on this
day of
, 2013 at
County, California.
Name of Firm
Address
Printed Name of Responsible Financial Agent
City, State, Zip
Authorized Agent Signature
Phone
E-mail address
Fax
Federal Tax ID #
MCCD RFQ#01-14 Energy Services Companies
Page 27
MiraCosta Community College District
PAYEE DATA RECORD
(Required in lieu of IRS W-9)
PLEASE
RETURN or
FAX TO:
MiraCosta Community College District
Attn: Purchasing Department
One Barnard Drive
Oceanside, CA 92056
Phone: (760) 795-6793
FAX:
(760) 795-6795
PURPOSE: Information contained in this form will be used by
the District to prepare State of California Employment
Development Department DE542 Reporting, Internal Revenue
Form 1099, and for withholding on payments to nonresident
payees. Prompt return of this fully completed form will
prevent delays when processing payment.
(See Privacy Act Notice on page 4 of instructions)
PARTS 1-7 are to be completed by PAYEE
PART 1
PAYEE DATA
Please print
using block
letters
Name (If sole proprietor or single-owner LLC, enter owner’s full name here — Last Name, First Name, and Middle Initial) (See page 2, Specific Instructions):

Business name, if different from above—trade or “doing business as (DBA)” name. (See page 2, Specific Instructions)

Mailing address (Number and Street including Suite No. or Apartment No. – DO NOT USE POST OFFICE BOX ADDRESS):

City, state and zip code:

Phone number:
Fax number:

PART 2
podiatry, psychotherapy, optometry,
chiropractic, etc.)
EXEMPT CORPORATION (Nonprofit)
CHECK ONE BOX
ONLY
PART 3
PAYEE’S
TAXPAYER I.D.
NUMBER

MEDICAL CORPORATION (including dentistry,
PAYEE ENTITY
TYPE
Toll free number:
ALL OTHER CORPORATIONS

PARTNERSHIP
ESTATE OR TRUST
LIMITED LIABILITY PARTNERSHIP (LLP)
INDIVIDUAL/SOLE PROPRIETOR
LIMITED LIABILITY COMPANY (LLC)
ELECTING CORPORATE STATUS ON
FORM 8832
LIMITED LIABILITY COMPANY (LLC)
Single Owner
FEDERAL/STATE/LOCAL GOVERNMENT
SOCIAL SECURITY NUMBER IS REQUIRED FOR INDIVIDUAL/SOLE PROPRIETOR BY AUTHORITY OF THE
REVENUE AND TAXATION CODE SECTION 18646.
IF PAYEE ENTITY TYPE IS A COPORATION, PARTNERSHIP, LLP,
CORPORATE STATUS LLC, ESTATE OR TRUST, OR
FEDERAL/STATE/LOCAL GOVERNMENT, ENTER FEIN:
IF PAYEE ENTITY TYPE IS INDIVIDUAL/SOLE PROPRIETOR,
OR SINGLE OWNER LLC, ENTER SSN:


FEDERAL EMPLOYER’S IDENTIFICATION NUMBER (FEIN)

SOCIAL SECURITY NUMBER (SSN)
PART 4
FOR U.S. PAYEES EXEMPT FROM BACKUP WITHHOLDING (See page 3 of instructions)
PART 5
CHECK APPROPRIATE BOXES
Exempt from
backup withholding
California Resident – Qualified to do business in CA or a permanent place of business in CA
PAYEE
RESIDENCY
STATUS
Nonresident (See page 3 of instructions) Payments to non residents for services may be subject to state withholding
WAIVER OF STATE WITHHOLDING FROM FRANCHISE TAX BOARD ATTACHED
SERVICES PERFORMED OUTSIDE OF CALIFORNIA
PART 6
CERTIFYING
SIGNATURE
NOTE: Payment
will not be
processed without
an accompanying
taxpayer I.D.
number.
NOTE:
a. An estate is a resident if
decedent was a California
resident at time of death.
b. A trust is a resident if at least
one trustee is a California
resident.
(See page 3 of instructions)
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me),
and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the
Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or
(c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien)
Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to
backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2
does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an
individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the
Certification, but you must provide your correct TIN (See the attached instructions.)
SIGNATURE OF U.S. PERSON
DATE


Payee Data Record
PART 7
TYPE OF
BUSINESS
ENTERPRISE
CHECK IF APPLICABLE AND PROVIDE A COPY OF CERTIFICATION
Disabled Veteran Business Enterprise
Minority Business Enterprise
Woman Owned Business Enterprise
Rev. 1/12
PAYEE DATA RECORD
MCCD RFQ#01-14 Energy Services Companies
Page 28
MiraCosta Community College District
PAYEE DATA RECORD
(Required in lieu of IRS W-9)
Purpose of Form
1.
You do not furnish your TIN to the requester, or
A person who is required to file an information return with the IRS must obtain your
2.
You do not certify your TIN when required (see the Part 6 instructions given
below for details), or
3.
The IRS tells the requester that you furnished an incorrect TIN, or
4.
The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for reportable
interest and dividends only), or
5.
You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts
opened after 1983 only).
correct taxpayer identification number (TIN) to report, for example, income paid to
you, real estate transactions, mortgage interest you paid, acquisition or abandonment
of secured property, cancellation of debt, or contributions you made to an IRA.
U.S. Person. Use Form W-9 only if you are a U.S. person (including a resident alien),
to provide your correct TIN to the person requesting it (the requester) and, when
applicable, to:
1.
Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued,
2.
Certify that you are not subject to backup withholding, or
3.
Claim exemption from backup withholding if you are a U.S. exempt payee.
Certain payees and payments are exempt from backup withholding. See the Part 4
instructions and the separate Instructions for the Requester of Form W-9.
Penalties
Note: If a requester gives you a form other than Form W-9 to request your TIN, you
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
must use the requester’s form if it is substantially similar to IRS Form W-9.
subject to a penalty of $50 for each such failure unless your failure is due to
Foreign Person. If you are a foreign person, use the appropriate Form W-8 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a
false statement with no reasonable basis that results in no backup withholding, you are
subject to a $500 penalty.
certain types of income. However, most tax treaties contain a provision known as a
Criminal penalty for falsifying information. Willfully falsifying certifications or
“saving clause.” Exceptions specified in the saving clause may permit an exemption
affirmations may subject you to criminal penalties including fines and/or imprisonment.
from tax to continue for certain types of income even after the recipient has otherwise
Misuse of TINs. If the requester discloses or uses TINs in violation of Federal law,
become a U.S. resident alien for tax purposes.
the requester may be subject to civil and criminal penalties.
If you are a U.S. resident alien who is relying on exception contained in the saving
Specific Instructions
clause of a tax treaty to claim an exemption from U.S. tax on certain types of income,
you must attach a statement that specified the following five items:
PART 1—PAYEE DATA (NAME)
1.
The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
If you are an individual, you must generally enter the name shown on your social
2.
The treaty article addressing the income.
marriage without informing the Social Security Administration of the name change,
3.
The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
enter your first name, the last name shown on your social security card, and your new
4.
The type and amount of income that qualifies for the exemption from tax.
5.
Sufficient facts to justify the exemption from tax under the terms of the treaty
article.
security card. However, if you have changed your last name, for instance, due to
last name.
If the account is in joint names, list first, and then circle the name of the person or
entity whose number you enter in Part 3 of the form.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax
Sole proprietor. Enter your individual name as shown on your social security card in
for scholarship income received by a Chinese student temporarily present in the United
the “Name” box of Part 1. You may enter your business, trade, or “doing business as
States. Under U.S. law, this student will become a resident alien for tax purposes if his
(DBA)” name in the “Business Name” box. You may not enter only the business
or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of
name.
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions
of Article 20 to continue to apply even after the Chinese student becomes a resident
alien of the United States. A Chinese student who qualifies for this exception (under
paragraph 2 of the first protocol) and is relying on this exception to claim an exemption
Limited liability company (LLC). If you are a single-member LLC (including a
foreign LLC with a domestic owner) that is disregarded as an entity separate from its
owner under Treasury regulations section 301.7701.3, enter the owner’s name in
the “Name” box. Enter the LLC’s name in the “Business Name” box.
from tax on his or her scholarship or fellowship income would attach to Form W-9 a
statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to backup
withholding, give the requester the appropriate completed Form W-8.
What is backup withholding? Persons making certain payments to you must
withhold and pay to the IRS 30% of such payments (29% after December 31, 2003;
Other entities. Enter your business name as shown on required Federal tax
documents in the “Name” box. This name should match the name shown on the
charter or other legal documents creating the entity. You may enter any business,
trade, or DBA name in the “Business name” box.
PART 2—PAYEE ENTITY TYPE. Please check appropriate box.
28% after December 31, 2005). This is called “backup withholding.” Payments that
Note: You are requested to check the appropriate box for your status (individual/sole
may be subject to backup withholding include interest, dividends, broker and barter
proprietor, corporation, etc.).
exchange transactions, rents, royalties, nonemployee pay, and certain payments from
PART 3—PAYEE’S TAXPAYER IDENTIFICATION NUMBER (TIN)
fishing boat operators. Real estate transactions are not subject to backup withholding.
Enter your TIN in the appropriate box. If you are a resident alien and you do
You will not be subject to backup withholding on payments you receive if you give the
not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
requester your correct TIN, make the proper certifications, and report all your taxable
identification number (ITIN). Enter it in the social security number box. If you do not
interest and dividends on your tax return.
have an ITIN, see How to get a TIN below.
Payments you receive will be subject to backup withholding if:
If you are a sole proprietor, the District and the IRS prefer that you enter your
MCCD RFQ#01-14 Energy Services Companies
Page 29
MiraCosta Community College District
PAYEE DATA RECORD
(Required in lieu of IRS W-9)
or
social security number. The State of California Employment Development
15.
Department requires your SSN on the DE542 report.
If you are a single-owner LLC that is disregarded as an entity separate from its owner
A trust exempt from tax under section 664 or described in section 4947.
The chart below shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt recipients listed above, 1 through 15.
(see Limited liability company (LLC) in Part 1), enter your SSN. If the LLC is a
corporation, partnership, etc., enter the entity’s EIN.
Note: See the chart on page 4 for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your local
Social Security Administration office or get this form on-line at
If the payment is for…
THEN the payment is exempt for…
Interest and dividend payments
All exempt recipients except for 9
Broker transactions
Exempt recipients 1 through 13. Also, a
www.ssa.gov/online/sst.html. You may also get this form by calling 1-800-772-
person registered under the Investment
1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number,
Advisers Act of 1940 who regularly acts
as a broker
to apply for an ITIN or Form SS-4, Application for Employer Identification Number, to
apply for an EIN. Your can get Forms W-7 and SS-4 from the IRS by calling 1-800-
Barter exchange transactions and
TAX-FORM (1-800-829-3676) or from the IRS’s internet Web Site at www.irs.gov.
patronage dividends
If you are asked to complete Form W-9 but do not have a TIN, write “Applied For” in
Payments over $600 required to be
the space for the TIN, sign and date the form, and give it to the requester. For
reported and direct sales over $5,000
Exempt recipients 1 through 5
Generally, exempt recipients 1 through
1
72
interest and dividend payments, and certain payments made with respect to readily
tradable instruments, generally you will have 60 days to get a TIN and give it to the
requester before you are subject to backup withholding on payments. The 60-day rule
1
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
However, the following payments made to a corporation (including gross proceeds
does not apply to other types of payments. You will be subject to backup withholding
paid to an attorney under section 6045(f), even if the attorney is a corporation) and
on all such payments until you provide your TIN to the requester.
reportable on Form 1099-MISC are not exempt from backup withholding: medical and
Note: Writing “Applied For” means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner must use the
appropriate Form W-8.
health care payments, attorneys’ fees; and payments for services paid by a Federal
executive agency.
PART 5—RESIDENCY STATUS
Each corporation, individual, sole proprietor, partnership, estate or trust doing
PART 4—EXEMPT FROM BACKUP WITHHOLDING
If you are exempt, enter your name as described above and check the appropriate box
for your status, then check the “Exempt from backup withholding” box in Part 4.
business with the MiraCosta Community College District must indicate their
residency status along with their taxpayer identification number.
A corporation will be considered a “resident” if it has a permanent place of
business in California. The corporation has a permanent place of business in
Generally, individuals (including sole proprietors) are not exempt from backup
California if it is organized and existing under the laws of this state or, if a foreign
withholding. Corporations are exempt from backup withholding for certain payments,
corporation, has qualified to transact intrastate business. A corporation that has
such as interest and dividends.
not qualified to transact intrastate business (e.g., a corporation engaged
Note: If you are exempt from backup withholding, you should still complete this form
exclusively in interstate commerce) will be considered as having a permanent place
to avoid possible erroneous backup withholding.
of business in this state only if it maintains a permanent office in this state that is
permanently staffed by its employees.
Exempt payees. Backup withholding is not required on any payments made to the
For individuals/sole proprietors, the term “resident” includes every individual
following payees:
who is in California for other than a temporary or transitory purpose and any
1.
An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2);
2.
The United States or any of its agencies or instrumentalities;
extend over a long or indefinite period, will be considered a resident. However, an
3.
A state, the District of Columbia, a possession of the United States, or any of
their political subdivisions or instrumentalities;
individual who comes to perform a particular contract of short duration will be
4.
A foreign government or any of its political subdivisions, agencies, or
instrumentalities; or
For withholding purposes, a partnership is considered a resident partnership if it
5.
An international organization or any of its agencies or instrumentalities;
has a permanent place of business in California. An estate is considered a
6.
A corporation;
California estate if the decedent was a California resident at the time of death and
7.
A foreign central bank of issue;
8.
A dealer in securities or commodities required to register in the United States,
the District of Columbia, or a possession of the United States.
More information on residency status can be obtained by calling the Franchise Tax
Board at the numbers listed below:
9.
A futures commission merchant registered with the commodity Futures
Trading Commission;
From within the United States, call ......................................... 1-800-338-0505
10.
A real estate investment trust;
For hearing impaired with TDD, call ........................................ 1-800-822-6268
11.
An entity registered at all times during the tax year under the Investment
Company Act of 1940;
Are You Subject To Nonresident Withholding?
12.
A common trust fund operated by a bank under section 584(a);
Payments made to nonresident payees, including corporations, individuals,
13.
A financial institution;
partnerships, estates and trusts, are subject to withholding. Nonresident payees
14.
A middleman known in the investment community as a nominee or custodian;
performing services in California or receiving rent, lease or royalty payments from
individual domiciled in California who is absent for a temporary or transitory
purpose. Generally, an individual who comes to California for a purpose, which will
considered a nonresident.
a trust is considered a California trust if at least one trustee is a California resident.
From outside the United Sates, call......................................... 1-916-845-6600
MCCD RFQ#01-14 Energy Services Companies
Page 30
MiraCosta Community College District
PAYEE DATA RECORD
(Required in lieu of IRS W-9)
property (real or personal) located in California will have 7% of their total payments
5.
Mortgage interest paid by you, acquisition or abandonment of secured
withheld for state income taxes. However, no withholding is required if total payments
property, cancellation of debt, qualified state tuition program
to the payee are $1500 or less for the calendar year.
payments (under section 529), IRA or Archer MSA contributions or
distributions, and pension distributions. You must give your correct TIN,
A nonresident payee may request that income taxes be withheld at a lower rate or
but you do not have to sign the certification.
waived by sending a completed form FTB 588 to the address below. A waiver will
generally be granted when a payee has a history of filing California returns and making
timely estimated payments. If payee activity is carried on outside of California or
partially outside of California, a waiver or reduced withholding rate may be granted.
PART 7—TYPE OF BUSINESS ENTERPRISE
Please check every box that applies and attach appropriate certification.
For more information, contact:
What Name/Number to Give the Requester
Franchise Tax Board
1
List first and circle the name of the persons whose number you furnish. If only one
person on a joint account has an SSN, that person’s number must be furnished.
Nonresident Withholding Section
2
Attention: State Agency Withholding Coordinator
Circle the minor’s name and furnish the minor’s SSN.
PO Box 651 Sacramento, CA 95812-0651
You must show your individual name, but you may also enter your business or
“DBA” name. The District and the IRS prefer that you provide your SSN. The
Telephone: (916) 845-4900
For this type of account:
Give name and SSN of:
1.
Individual
The individual
2.
Two or more individuals (joint
account)
The actual owner of the account or, if
combined funds, the first individual on
the account 1
3.
Custodian account of a minor
(Uniform Gift to Minors Act)
The minor
4.
a.
The usual revocable savings
trust (grantor is also trustee)
The grantor-trustee
b.
So-Called trust account that is
not a legal or valid trust under
state law
The actual owner
FAX: (916) 845-4831
If the Franchise Tax Board has authorized a reduced rate of withholding or
3
waiver, attach a copy to this form.
PART 6—CERTIFICATION
To establish to the withholding agent that you are a U.S. person, or resident alien, sign
the PAYEE DATA RECORD Form. The withholding agent may request you to sign even
if items 1, 3, and 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in PART 2 should sign (when
required). Exempt recipients, see Exempt from backup withholding on page 2.
Signature requirements. Complete the certification as indicated in 1 through 5
2.
The owner—See Footnote 3
6.
Sole proprietorship or single-owner
LLC
The owner—See 5 above and
Footnote 3.
and broker accounts considered active during 1983. You must give your
7.
A valid trust, estate, or pension trust
Legal entity
correct TIN, but you do not have to sign the certification.
8.
Corporate or LLC electing corporate
status on Form 8832
The corporation
9.
Association, club, religious,
charitable, educational, or other taxexempt organization
Interest, dividend, and barter exchange accounts opened before 1984
Interest, dividend and barter exchange accounts opened after 1983
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4.
1
Give name and EIN of:
and broker accounts considered inactive during 1983. You must sign the
3.
Sole proprietorship or single-owner
LLC
1
For this type of account:
below.
1.
5.
2
Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. “Other payments” include payments made in the course of the
requester’s trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments to certain
fishing boat crew members and fishermen, and gross proceeds paid to attorneys
(including payment to corporations).
10. Partnership or multi-member LLC
11. A broker or registered nominee
12. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
4
The organization
The partnership
The broker or nominee
The public entity
District needs your SSN for State of California EDD DE542 reporting
purposes. You may provide both you SSN and your EIN. The SSN will only
be used for State of California EDD DE542 reporting; your EIN will be used
for IRS 1009MISC reporting
4
List first and circle the name of the legal trust, estate, or pension trust. (Do not
furnish the TIN of the personal representative or trustee unless the legal entity itself is
not designated in the account title.)
Note: If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain
other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or Archer MSA. The
IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and
criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, or to Federal
and state agencies to enforce Federal nontax criminal laws and to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments to a payee who does not give a
TIN to a payer. Certain penalties may also apply.
MCCD RFQ#01-14 Energy Services Companies
Page 31