SUPPLEMENTARY PREQUALIFICATION FORM
JOB ORDER CONTRACT BID - #67971, #67972 AND #67973
CALIFORNIA STATE UNIVERSITY, CHICO
Bidders for the above contract must be prequalified with the Trustees, using the Prequalification of Prospective Bidders, Form 703.11, available online at
http://www.calstate.edu/cpdc/cm/contractor_prequal_bidders.shtml, and shall have a prequalification rating of at least {$1,000,000} to bid this contract.
Bidders must also meet the criteria contained in this Supplementary Prequalification Form in order to bid this contract. All bidders shall provide the
information requested hereon and submit to the Prequalification Coordinator at the California State University, Chancellor’s Office, 401 Golden Shore,
Long Beach, CA 90802-4210 or via e-mail to cocm@calstate.edu ten business days prior to bid opening date.
Firm Name:
CSLB License Number:
The undersigned declares under penalty of perjury under the laws of the State of California that the information provided on and attached to this form is
true and correct.
Executed on this
day of
, 20
Signature of Applicant
, at
, California.
Printed Name, Title
A. CONTRACTOR LICENSE HISTORY
Has your firm held, under the same company name, a valid contractor’s ‘B’ license issued by the California Contractors State License Board for the past
five years? (Check Yes or No) Yes  No 
If not, your firm will not be qualified to bid this project. We will confirm with the Contractors State License Board.
B. JOB ORDER CONTRACT PROJECT EXPERIENCE
If your firm has performed a job order contract anywhere in California, provide the following information for each job order contract held in the past five
years (use additional sheets if necessary).
Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Were claims filed? Yes  (attach explanation)
No 
*If actual amount is less than 80% of Max give reason for lower value:
Contract start date: mm/yyyy
Contract completion date: mm/yyyy
Minimum contract value: $
Maximum possible contract value: $
Actual amount of total contract*: $
Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Were claims filed? Yes  (attach explanation)
No 
*If actual amount is less than 80% of Max give reason for lower value:
Contract start date: mm/yyyy
Contract completion date: mm/yyyy
Minimum contract value: $
Maximum possible contract value: $
Actual amount of total contract*: $
Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Were claims filed? Yes  (attach explanation)
No 
*If actual amount is less than 80% of Max give reason for lower value:
Contract start date: mm/yyyy
Contract completion date: mm/yyyy
Minimum contract value: $
Maximum possible contract value: $
Actual amount of total contract*: $
Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Were claims filed? Yes  (attach explanation)
No 
*If actual amount is less than 80% of Max give reason for lower value:
Contract start date: mm/yyyy
Contract completion date: mm/yyyy
Minimum contract value: $
Maximum possible contract value: $
Actual amount of total contract*: $
Construction Mgmt.
703.11-JOC 5/14
Supplementary Prequalification Form
Job Order Contract – Bid No- #67971, #67972 AND #67973
Page 2
Firm Name:
C. CONCURRENT PROJECT EXPERIENCE (PART 1)
Your firm must demonstrate experience in performing five projects concurrently, each with a minimum value of $200,000 and completed in the past five
years. List five (5) new/renovation/repair projects in California that meet these requirements. One of the five projects must have been performed for a
public agency. If claims were filed on any project listed, attach an explanation. Provide all requested information on this form; if more space is needed hit
return to expand the cell. Ensure all contact information is current and correct; references will be secured.
Failure to provide this information will result in disqualification of your firm from bidding this contract.
1) Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Project name, description:
Completed contract value: $
Start date: mm/yyyy
Completed on time?
2) Owner/Agency name, location:
Owner’s contact name:
Project name, description:
Completed contract value: $
Contact current phone no.:
Contact current e-mail address:
Completion date: mm/yyyy
Were claims filed?
Start date: mm/yyyy
Completed on time?
Completion date: mm/yyyy
Were claims filed?
3) Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Project name, description:
Completed contract value: $
Start date: mm/yyyy
Completed on time?
Completion date: mm/yyyy
Were claims filed?
4) Owner/Agency name, location:
Owner’s contact name:
Contact current phone no.:
Contact current e-mail address:
Project name, description:
Completed contract value: $
Start date: mm/yyyy
Completed on time?
Completion date: mm/yyyy
Were claims filed?
5) Owner/Agency name, location:
Owner’s contact name:
Project name, description:
Completed contract value: $
Contact current phone no.:
Contact current e-mail address:
Start date: mm/yyyy
Completed on time?
Completion date: mm/yyyy
Were claims filed?
C. CONCURRENT PROJECT EXPERIENCE (PART 2)
The five projects listed in above Section C, Concurrent Project Experience Part 1, are required to be performed concurrently. List each project below and
highlight or mark each box for the month of construction start under the year it started, and continue highlighting or marking until you reach the year and
month of completion. At some point in construction, all five projects must have been under construction at the same time. You may change the years or
add years, if necessary. Failure to provide this information will result in disqualification of your firm from bidding this contract.
Construction Duration
Dec
Nov
Oct
Sep
Aug
Jul
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
20__
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Project / Month
20__
Jun
Year
Project
1
2
3
4
5
Page 2
Construction Mgmt.
703.11-JOC 5/14