University of Colorado Colorado Springs
Standing Order Contract
Pre-qualification Form
April 1, 2011 to March 31, 2012
Section 1 – Firm Identification
Firm Name:
Address:
Phone:
Contact:
Email:
[Firm’s name here]
[Firm’s address here]
[Firm’s phone number here]
[Name of responsible person]
[Email address of responsible person]
Signature:
_______________________________
[Type title of responsible person here]
Section 2 – Licensing
Contractors must be licensed to do business in the City of Colorado Springs and the State of Colorado.
Licenses, where applicable, shall match work to be performed.
Provide a list of jurisdictions and trade categories in which your firm is legally qualified to do business in
the City of Colorado Springs.
Jurisdictions
[List jurisdictions with registration or license numbers here]
Employee Licenses
[List individual employees with licenses held]
Section 3 – Personnel
Please provide qualifications and a brief resume for the following personnel who will be assigned to work
at UCCS.
Project Manager
[Project manager information here]
Superintendent
[Superintendent information here]
UCCS SOC Pre-qualification Form
January 2011
Section 4 – Project References
Please provide the following information for five (5) projects you have completed in the last five years or
are currently in progress, that incorporate the trade(s) in which you are seeking pre-qualification. The
projects must be constructed in an education, research or similar type facility with adjacent occupancy
that is not disrupted by the construction and with a minimum contract value of $100,000.
Project No. 1
Project Name:
Contact Name:
Contact Phone:
Superintendent:
Project Description:
Bid Amount:
[Project name here]
[Contact name here]
[Phone number of contact person here]
[Project’s superintendent’s name here]
[Project description here]
[Bid amount here]
Project No. 2
Project Name:
Contact Name:
Contact Phone:
Superintendent:
Project Description:
Bid Amount:
[Project name here]
[Contact name here]
[Phone number of contact person here]
[Project’s superintendent’s name here]
[Project description here]
[Bid amount here]
Project No. 3
Project Name:
Contact Name:
Contact Phone:
Superintendent:
Project Description:
Bid Amount:
[Project name here]
[Contact name here]
[Phone number of contact person here]
[Project’s superintendent’s name here]
[Project description here]
[Bid amount here]
Project No. 4
Project Name:
Contact Name:
Contact Phone:
Superintendent:
Project Description:
Bid Amount:
[Project name here]
[Contact name here]
[Phone number of contact person here]
[Project’s superintendent’s name here]
[Project description here]
[Bid amount here]
Project No. 5
Project Name:
Contact Name:
Contact Phone:
Superintendent:
Project Description:
Bid Amount:
[Project name here]
[Contact name here]
[Phone number of contact person here]
[Project’s superintendent’s name here]
[Project description here]
[Bid amount here]
UCCS SOC Pre-qualification Form
January 2011
Section 5 – Firm’s Experience
Firms must be in business, operating in the proposed trade, in the State of Colorado, for a minimum of
three (3) years.
How many years has your firm been in business in the State of Colorado under your present business
name? [Number of years here]
How many years experience has your firm had in the trade, which you are requesting pre-qualification?
[Number of years here]
Section 6 – Claims and Law Suits
Has your firm ever failed to complete a contract? ___ No; If yes, please provide details.
[Provide details here if appropriate]
Has your firm been in litigation, judgements, claims, arbitration proceedings or law suits? ___ No; If yes,
please provide details.
[Provide details here if appropriate]
[State the current status]
Section 6 – Asbestos Training
All contractors shall ensure that their employees who work at UCCS are trained at a minimum to, OSHA
29, CFR 1926.1101 2-hour Asbestos Awareness. Documentation of training may be required at any time.
Failure to provide such information may result in a stop work order. Penalties are at the contractor’s
expense.
What level of OSHA training for asbestos does your company have? ____ Class; ___ None
Section 7 – Special Requirements
Some projects may have special requirements.
Does your firm have a respiratory program? ___ No; If yes, please describe.
[Describe respiratory program here]
Does your firm have a confined space program? ___ No; If yes, please describe.
[Describe confined space program here]
Does your firm have a lock-out/tag-out program? ___ No; If yes, please describe.
[Describe lock-out/tag-out program here]
Section 8 – Insurance
Provide a certificate of Insurance per the requirements of General Conditions:
www.uccs.edu/facsrvs/site/soc-rfp.htm
providing the information as shown in the insurance certificate samples found at:
www.uccs.edu/facsrvs/site/soc-rfp.htm
Section 9 – W-9 Form
UCCS SOC Pre-qualification Form
January 2011
Attach to the email response a copy of the University of Colorado W-9 form www.uccs.edu/facsrvs/site/socrfp.htm
Section 10 – Illegal Aliens
Attach to the email response a completed Certification and Affidavit Regarding Illegal Aliens form. The
form is at www.uccs.edu/facsrvs/site/soc-rfp.htm
Section 11 – For Carpet Contractors Only
UCCS is soliciting services to furnish and install carpets from the following manufacturer’s brands:
 Collins and Aikman
 Mohawk
 Shaw
 Interface
Identify which brands your firm represents:
___ Collins and Aikman
___ Mohawk
___ Shaw
___ Interface
Include in your email response, a letter from the manufacturer stating that you are authorized to the sell
and install the brands you check marked above.
Section 12 – Asbestos and Lead Abatement Contractors Only
All asbestos/lead abatement contractors are required to have a DOT Security Plan. The DOT Security
Plan is referenced in 49 CFR 172.800 and 172.704.
Does your firm have a DOT Security Plan? ___ Yes; ___ No
All asbestos/lead abatement contractors are required to have transportation standard operating procedures,
appropriate DOT training and demonstrate placarding requirements per DOT.
Does your firm have transportation standard operating procedures? ___ Yes; ___ No.
Does your firm have Hazardous Materials Transportation permits? ___ Yes; ___ No.
Section 13 – Asbestos and Lead Monitoring & Analysis Firms Only
Provide copies as an attachment to your email response of all appropriate certificates/licensing.