GENERAL CONTRACTOR / DESIGN BUILDER
PREQUALIFICATION QUESTIONNAIRE
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
VARIOUS PROJECTS
DESIGN-BUILD DELIVERY
ISSUE DATE:
MAY 14, 2015 @ 4:00 P.M.
MANDATORY PREQUALIFICATION
CONFERENCE:
MAY 21, 2015 @ 10:00 A.M.
SUBMITTAL DUE DATE:
MAY, 28, 2015 @ 4:00 P.M.
University of California, San Diego
Facilities Design & Construction
10280 N. Torrey Pines Rd. Ste. 465
La Jolla, CA 92037
Rhonda Mitchell
UCSD FD&C Contracts Manager
(858) 822-3126
rcmitchell@ucsd.edu
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
(Where a time period is given, such as the last ten [10] years, the period is to be measured backwards from the
date this prequalification questionnaire is required to be submitted to the University of California at San Diego.)
Note: Submission of an incomplete and/or unclear Prequalification Questionnaire may result in the determination
of the prospective Contractor as NON-PREQUALIFIED.
SUBMITTED BY:
(Name and Title) Printed or Typed
(Signature)
(Firm Name. If a Joint Venture, state name if JV Entity)
(Contact Name for all notices and correspondence)
(Address)
(City, State, Zip Code)
(Telephone Number)
(Facsimile Number)
(E-mail Address)
Each prospective Proposer must have the following California Contractor’s License, License Code: General
Building Contractor, B, current, active and in good standing with the California Contractor’s State License
Board on the date and time of the Prequalification Questionnaire submittal is due and must submit this
Prequalification Questionnaire with all portions completed, including required attachments.
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
Each prospective Proposer must answer all of the following questions and provide all requested
information, where applicable. Any prospective Proposer failing to do so may be deemed to be
not responsive and not responsible with respect to this prequalification at the sole discretion of the
University of California. All information submitted for prequalification evaluation will be considered
official information acquired in confidence, and the University of California will maintain its
confidentiality to the extent permitted by law. Any prospective Proposer found to be not
prequalified as a result of the Proposer's answers to this Prequalification Questionnaire will
receive written response from the University Facility explaining the Facility's decision. If the
Proposer can refute some of the facts upon which the decision was based, the Proposer can
request a hearing at the Facility to appeal the decision. The appeal shall state the basis of the
appeal and must be submitted in writing within three (3) working days of receipt of notification and
must request a hearing or a written response from University. The decision of the Facility is final
and not appealable within the University of California.
Each prospective Proposer must submit five (5) printed sets and one (1) flash drive with
complete submittal of the questionnaire.
The Design Build contracts will require the successful Proposers to provide both design and
construction services. The entity that provides these services is the Proposer, but the actual
structure of the entity is up to each Proposer. The Proposer may, as an example, be a
construction company with a design firm as a subcontractor or it may be a joint venture between a
construction company and a design firm. In such cases, each member of the Proposer shall
submit project experience as required below and such design firms shall comply with the laws of
the State of California, applicable to such firms. However, all information required herein shall be
submitted within the following parameters:
1. The Proposer shall hold all required licenses.
2. The Proposer shall be the financially responsible entity for bonding and insurance.
Prequalification approval will remain valid for one (1) calendar year from the date of the first RFP
advertisement. However, the University reserves the right during that calendar year to adjust,
increase, limit, suspend or rescind the prequalification status based on subsequently learned
information. University shall notify Proposer of their change in prequalification status in writing.
Upon receipt of said notice, Proposer has the opportunity to request a hearing consistent with the
hearing procedures described below for appealing a prequalification determination.
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
PREQUALIFICATION QUESTIONNAIRE, POINT SYSTEM
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
VARIOUS PROJECTS
DECLARATION
Each prospective Proposer must have a current and active California contractor's license at the time of the
proposal opening and must submit this Prequalification Questionnaire with all portions completed, including
any required attachments.
I,
hereby declare that I am the
Printed Name
Title
of
submitting this Prequalification Questionnaire; that I
Company Name
am duly authorized to execute this Questionnaire on behalf of Contractor; and that all information set forth
in this Questionnaire and all attachments hereto are, to the best of my knowledge, current, accurate, and
complete as of its submission date. I declare, under penalty of perjury, that all of the prequalification
information submitted with this form is true and correct and that this declaration was executed
at:
County of
Location and City
State of
County
on
State
.
Date
Signature
Printed Name
If signed by other than the sole proprietor, a general partner, or corporate
officer, attach original notarized power of attorney or corporate resolution.
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
1.
W4806
VARIOUS PROJECTS
License (Total Points Available = PREREQUISITE)
Proposer must be a licensed contractor in California with a B – GENERAL BUILDING CONTRACTOR
classification. Submit license number, classification, date issued, and expiration date.
Does your firm have the required California State Contractors license?
Yes
No
(Name of Licensee as it appears on record with the California Contractors State License Board)
License No.
Issue Date:
Expiration Date:
License Classification(s):
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
2.
W4806
VARIOUS PROJECTS
Surety (Total Points Available = PREREQUISITE)
A.
List below all Surety companies used by your company for the past ten (10) years and state
whether the Surety had to complete any part of your work including, but not limited to warrantyrelated repairs or other defective workmanship on any contract within the past ten years:.
Surety Company #1:
Surety’s Name
Street Address:
,
Street Address
Period Covered
Telephone
,
City & State
Has listed Surety Company #1 completed work
for your Company within the past ten years?
Zip Code
Yes
No
Surety Company #2:
Surety’s Name
Street Address:
,
Street Address
Period Covered
Telephone
,
City & State
Has listed Surety Company #2 completed work
for your Company within the past ten years?
Zip Code
Yes
No
Surety Company #3:
Surety’s Name
Street Address:
,
Street Address
Period Covered
Telephone
,
City & State
Has listed Surety Company #3 completed work
for your Company within the past ten years?
Zip Code
Yes
No
Surety Company #4:
Surety’s Name
Street Address:
,
Street Address
Period Covered
Telephone
,
City & State
Has listed Surety Company #4 completed work
for your Company within the past ten years?
Zip Code
Yes
No
(If more space is needed, provide the information on your company’s letterhead
with reference to the project name and number and attach it to this Questionnaire.)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
B.
Attach a notarized declaration from surety or sureties (sureties must be listed in the latest
published State of California, Department of Insurance list of “Insurers Admitted to Transact
Surety Insurance in this State”) proposed to be used on the LABORATORY REPURPOSING
PROJECTS certifying that Proposer's bonding capacity available for these projects is
$25,000,000. Attach a copy of the surety's power of attorney.
C.
Has Proposer had a surety finish work on a contract in the last ten (10) years?
YES
NO
If “Yes,” explain: _______________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
3.
W4806
VARIOUS PROJECTS
Insurance (Total Points Available = PREREQUISITE)
The successful Proposer for this project will be required to furnish certificates of insurance on the
University’s form in the amounts below.
COMMERCIAL FORM GENERAL LIABILITY INSURANCE – Limits of Liability
Minimum
Requirements
Each Occurrence - Combined Single Limit for Bodily Injury and Property Damage:
$2,000,000
Products-Completed Operations Aggregate:
$5,000,000
Personal and Advertising Injury:
$2,000,000
General Aggregate:
$5,000,000
PROFESSIONAL (ERRORS AND OMISSIONS) LIABILITY – Limits of Liability
Minimum
Requirement
Contractor’s Professional Liability (Each Occurrence & Aggregate)
$2,000,000
BUSINESS AUTOMOBILE LIABILITY INSURANCE – Limits of Liability
Minimum
Requirement
Each Accident - Combined Single Limit for Bodily Injury and Property Damage:
$1,000,000
WORKERS’ COMPENSATION – As required by Federal and State of California law
EMPLOYER’S LIABILITY – Limits of Liability
Minimum
Requirement
Each Employee:
$1,000,000
Each Accident:
$1,000,000
Policy Limit:
$1,000,000
EXCESS/UMBRELLA – Limits of Liability
Minimum
Requirement
Each Occurrence:
N/A
Aggregate:
N/A
1.
Is your firm able to obtain the insurance in the required limits and ratings from companies that
meet the criteria stated above? Yes
No
2.
If “yes,” provide notarized declaration(s) from your insurance agent/broker/carrier stating that
your firm is able to obtain insurance coverage in the limits and ratings stated above from the
insurance companies required for this Project.
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
4.
W4806
VARIOUS PROJECTS
Construction Experience (Total Points Available = 100)
Provide information concerning your firm’s experience with design-build contracts. Complete the
following information for LAB RENOVATION projects completed within the last ten (10) years. A
maximum of five (5) projects will be evaluated. (Copy additional sheets as needed.)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
CONSTRUCTION EXPERIENCE – TYPE OF PROJECT
Verify all contacts prior to submittal.
Do not leave any spaces blank. Responses such as “N/A” are not acceptable.
If not applicable, state “Not Applicable” and explain why. If none, state “NONE.”
Project Name:
Project or Contract Number:
Project Location:
,
Street Address
Owner Information:
,
City & State
Zip Code
Contact Person:
Owner’s Name
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Address of Contractor’s Office that Performed the Work:
,
,
Street Address
City & State
Contact Person:
Zip Code
Telephone:
Name & Title
Email:
Name of Contractor’s Project Manager for project:
Name of Contractor’s Superintendent for project:
Design Firm:
Contact Person:
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Name of Design Firm’s Project Manager for project:
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
CONSTRUCTION EXPERIENCE (Cont.)
Contract Time:
Initial Contract
Time (days):
Time Extensions (days):
Start Date:
Scheduled Completion Date:
Month/Day/Year
Month/Day/Year
Actual Completion Date:
Days Extended due to Unexcused Delays:
Month/Day/Year
Contract Amount:
$
Base Amount
Project Information:
Type of Project: New
Type of Facility: Commercial
$
Adjustment Due to Change Orders
$
Final Contract Amount
Remodel/Renovation
Industrial
Public Agency
Was a Design Build Contract Delivery used for this project?
Institutional
Yes
No
Yes
No
If not, what delivery method was used on this project?
Was this Project designed and constructed within the past ten (10) years?
Project Description: (Provide a brief description & insert representative photograph)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
5.
W4806
VARIOUS PROJECTS
Design Experience (Total Points Available = 100)
Provide information concerning your firm’s experience with design-build contracts. Complete the
following information for LAB RENOVATION projects completed within the last ten (10) years. A
maximum of five (5) projects will be evaluated. (Copy additional sheets as needed.)
Provide a list of all design professionals who were used on the Projects, including but not limited to the
following categories:
Architect
Landscape Architect
Other(s)
The following information shall be provided for each design professional:
Name and Title
Firm Name
Address
City, State and Zip Code
Telephone Number
Experience on projects of type/scope of this Project
Specific experience on Design Build projects
Complete a Type of Project form (see next page) for each of your firm's five (5) comparable laboratory
renovation projects that were designed and constructed in less than one (1) year in the last ten (10)
years. If the design for this Project will be by a separate entity (subcontractor, joint venture partnership,
etc., the experience should so indicate.
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
DESIGN EXPERIENCE – TYPE OF PROJECT
Verify all contacts prior to submittal.
Do not leave any spaces blank. Responses such as “N/A” are not acceptable.
If not applicable, state “Not Applicable” and explain why. If none, state “NONE.”
Complete the following information for laboratory renovation projects. (Copy additional sheets as needed.)
Project Name:
Project or Contract Number:
Project Location:
,
Street Address
Owner Information:
,
City & State
Zip Code
Contact Person:
Owner’s Name
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Address of Design Firm’s Office that Performed the Work:
,
,
Street Address
City & State
Contact Person:
Zip Code
Telephone:
Name & Title
Email:
Name of Design Firm’s Project Manager for project:
Contractor:
Contact Person:
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Name of Contractor’s Project Manager for project:
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
DESIGN EXPERIENCE – TYPE OF PROJECT (Cont.)
Contract Time:
Initial Design
Contract Time
(days):
Time Extensions (days):
Start Date:
Scheduled Completion Date:
Month/Day/Year
Month/Day/Year
Actual Completion Date:
Days Extended due to Unexcused Delays:
Month/Day/Year
Contract Amount:
$
Base Amount
Project Information:
Type of Project: New
Type of Facility: Commercial
$
Adjustment Due to Change Orders
Remodel/Renovation
Industrial
$
Final Design Contract
Amount (with your firm)
Public Agency
Was a Design Build Contract Delivery used for this project?
If not, what delivery method was used on this project?
Was this Project designed and constructed within the past ten (10) years?
Institutional
Yes
No
_____________________
Yes
No
Project Description: (Provide a brief description & insert representative photograph)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
6.
W4806
VARIOUS PROJECTS
Design-Build Experience (Total Points Available = 100)
Provide information concerning your firm’s experience with design-build contracts. Complete the following
information for LAB RENOVATION projects completed within the last ten (10) years. A maximum of five
(5) projects will be evaluated. (Copy additional sheets as needed.)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
DESIGN-BUILD EXPERIENCE
Verify all contacts prior to submittal.
Do not leave any spaces blank. Responses such as “N/A” are not acceptable.
If not applicable, state “Not Applicable” and explain why. If none, state “NONE.”
Project Name:
Project or Contract Number:
Project Location:
,
Street Address
Owner Information:
,
City & State
Zip Code
Contact Person:
Owner’s Name
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Address of Contractor’s Office that Performed the Work:
,
,
Street Address
City & State
Contact Person:
Zip Code
Telephone:
Name & Title
Email:
Name of Contractor’s Project Manager for project:
Name of Contractor’s Superintendent for project:
Design Firm:
Contact Person:
Name & Title
Address:
,
Street Address
Telephone:
,
City & State
Zip Code
Email:
Name of Design Firm’s Project Manager for project:
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
DESIGN-BUILD EXPERIENCE (Cont.)
Contract Time:
Design Duration:
Construction Duration:
Weeks
Weeks
Start Date:
Scheduled Completion Date:
Month/Day/Year
Month/Day/Year
Actual Completion Date:
Days Extended due to Unexcused Delays:
Month/Day/Year
Contract Amount:
$
Base Amount
Project Information:
Type of Project: New
Type of Facility: Commercial
$
Adjustment Due to Change Orders
$
Final Contract Amount
Remodel/Renovation
Industrial
Public Agency
Was this Project designed and constructed within the past ten (10) years?
Institutional
Yes
No
Design Description: (Provide a brief description & insert representative photograph)
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
7.
W4806
VARIOUS PROJECTS
Proposed Design-Build Team Members (Total Points Available = 100)
Provide the following information concerning each of the listed personnel. If the title/job function
envisioned differs from the listed title provide the closest match and an explanation of the differences.
Résumés shall be submitted in addition to this form. Résumés shall NOT be submitted in lieu of this
form. If more space is needed, provide the information using the format below and attach it to this
Questionnaire.
Providing résumés of typical superintendents and project managers who will be made available when
required. Résumés of superintendents and project managers will be requested with the request for
proposal for each project.
NOTE: We require staffing information for:




Design-Build Executive
Design Manager
Preconstruction Manager
Construction Manager
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
NAME OF PROPOSED
DESIGN-BUILD TEAM EXECUTIVE:
NAME AND TITLE:
COMPANY:
ADDRESS:
RELATIONSHIP TO DESIGN BUILDER
(e.g. employee, consultant, etc.):
List and briefly describe five (5) previous projects of similar size and complexity for this individual giving
scope, name and point of contact for Owner:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
_____________________________________________________________________________________________
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UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
NAME OF PROPOSED
DESIGN MANAGER:
NAME AND TITLE:
COMPANY:
ADDRESS:
RELATIONSHIP TO DESIGN BUILDER
(e.g. employee, consultant, etc.):
List and briefly describe five (5) previous projects of similar size and complexity for this individual giving
scope, name and point of contact for Owner:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
_____________________________________________________________________________________________
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UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
NAME OF PROPOSED
PRECONSTRUCTION MANAGER:
NAME AND TITLE:
COMPANY:
ADDRESS:
RELATIONSHIP TO DESIGN BUILDER
(e.g. employee, consultant, etc.):
List and briefly describe five (5) previous projects of similar size and complexity for this individual giving
scope, name and point of contact for Owner:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
_____________________________________________________________________________________________
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UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
NAME OF PROPOSED
CONSTRUCTION MANAGER:
NAME AND TITLE:
COMPANY:
ADDRESS:
RELATIONSHIP TO DESIGN BUILDER
(e.g. employee, consultant, etc.):
List and briefly describe five (5) previous projects of similar size and complexity for this individual giving
scope, name and point of contact for Owner:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
Project Name & Location:
Contract
Amount:
Owner:
Point of Contact
Role Responsibilities:
Telephone:
$
Project Description:
_____________________________________________________________________________________________
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
8.
W4806
VARIOUS PROJECTS
Financial Data (Total Points Available = PREREQUISITE)
For the purposes of this prequalification questionnaire, "business construction revenue" shall be defined
as payments to prospective contractor’s license holder.
A.
Can you truthfully state that your firm has had an average annual business construction revenue
of at least $25,000,000 (excluding any and all legal awards) over the last five (5) consecutive
years?
YES
B.
NO
Can you provide audited financial statements for the last ten (10) years?
YES
NO
DO NOT INCLUDE FINANCIAL STATEMENTS WITH THIS PREQUALIFICATION
QUESTIONNAIRE. The University reserves the right to request and require approval of
acceptable financial statements.
9.
Arbitration and Litigation Claims History (all Owners) (Total Points Available = 100)
A.
List any and all CURRENT AND/OR PENDING disputes with project owners.
B.
Have there been any claims between any entity of proposed Design-Build team and University of
California?
YES
C.
NO
Is Proposer presently disqualified from performing work for the University of California or another
Contract Entity?
YES
NO
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LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
10.
W4806
VARIOUS PROJECTS
Prior Disqualification (Total Points Available = 100)
Provide the following information if your firm has ever been disqualified from performing work for any
contracting entity:
Name of Contracting Entity:
Telephone No. of Contracting Entity:
Project name:
Date of Disqualification:
Duration of Disqualification:
Reason for Disqualification:
(Repeat items above for each disqualification.)
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
24
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
11.
W4806
VARIOUS PROJECTS
Provide Proposed Rates for Additional Design Services for the following categories
(Total Points Available = PREREQUISITE):
Labor Category
Direct Hourly Rate
Overhead/Profit Percentage
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
25
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
12.
W4806
VARIOUS PROJECTS
SAFETY PROGRAM
A.
Does your firm have a written Injury and Illness Prevention Program (IIPP) that complies with
California Code of Regulations, Title 8, Sections 1509 and 3203?
YES
NO
Brief Description: _________________________________________________________
B.
Does your firm have a written safety program that meets CAL/OSHA requirements?
YES
C.
NO
Will your firm have personnel permanently assigned and dedicated to Safety on this project?
YES
D.
NO
If “Yes,” state the names of all such personnel who will be assigned and individually list their
specific duties:
Name, Title
Specific Duties
Attach résumés (include certification and safety related training received.)
E.
Have you had accidents, which resulted in a construction fatality on any of your projects over the
last 2 years?
YES
NO
If the answer is “Yes,” please explain.
F.
Is your firm’s current Workers’ Compensation Experience Modification Rate (EMR) equal to 1.0
or less?
YES
NO
Provide your California Workman’s Compensation Modifier for each of the last three (3) years.
G.
Provide EMR verification (regardless of whether EMR is under or over 1) from State of California
or from insurance company for the most recently completed year.
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
26
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
H.
W4806
VARIOUS PROJECTS
Has your firm been cited by OSHA in the past 5 years?
YES
NO
If the answer is “Yes,” please explain.
________________________________________________________________________
________________________________________________________________________
I.
Does your firm have a Small Business/Underutilized Business Outreach Program?
YES
NO
If “Yes,” please include a summary of your efforts (up to one [1] page).
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
27
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
13.
W4806
VARIOUS PROJECTS
Proposer's Comments
The following space is provided for further explanations of the answers to any questions asked in this
Prequalification Questionnaire.
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
28
LABORATORY REPURPOSING PROJECTS
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W4806
VARIOUS PROJECTS
Rating Information
Up to eight of the highest scoring proposers, based on an established scoring system, will be invited to participate
in the Level II Interview step. A Proposer who falls under any of the following categories, will be excluded from
further consideration in the prequalification process and from participating in the Level II Interview:
1.
2.
3.
4.
5.
6.
7.
Proposer does not have the proper license.
Proposer does not meet established minimum standards for bonding capacity (as described in the
Prequalification Questionnaire).
Proposer is not able to obtain required insurance.
Proposer does not have the required financial information.
Proposer has had a surety finish work on a contract in the last ten (10) years.
Proposer is presently disqualified from performing work for the University of California or another
Contract Entity.
Proposer did not submit required information.
Prequalification Categories/Tentative Points
CATEGORY
POINTS
1.
California Contractor’s License
Prerequisite
2.
Surety and Bonding Capacity
Prerequisite
3.
Insurance
Prerequisite
4.
Construction Experience
100
5.
Design Experience
100
6.
Design-Build Experience
100
7.
Design-Build Team Members
100
8.
Financial Data
9.
Arbitration and Litigation Claims History
100
10.
Prior Disqualification
100
11.
Rates for Additional Design Services
Prerequisite
12.
Safety Record
Prerequisite
Prerequisite
_____________________________________________________________________________________________
__
April 11, 2002
Prequalification Questionnaire
Rev. 5/14/15 FDC
DB:PQ
29