w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
PREQUALIFICATION QUESTIONNAIRE
For
W.M. KECK BUILDING MRI INSTALLATION
UNIVERSITY OF CALIFORNIA, SAN DIEGO
W9938679/P4S-815
SUBMITTED BY:
<please enter your company name here>
UNIVERSITY OF CALIFORNIA, SAN DIEGO
FACILITIES DESIGN & CONSTRUCTION
10280 NORTH TORREY PINES ROAD
LA JOLLA, CA 92037
ISSUE DATE: TUESDAY, NOVEMBER 18, 2014
MANDATORY PREQUALIFICATION MEETING: TUESDAY, DECEMBER 2, 2014
SUBMITTALS DUE: MONDAY, DECEMBER 8, 2014
(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 Contractor must have the following California General Building Contractor’s License, License Code: 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.
Each prospective Contractor must answer all of the following questions and provide all requested information, where applicable. Any prospective Contractor 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. Each prospective Contractor must submit four (4) printed sets and one (1) flash drive with complete submittal of the questionnaire. All Contractors that have submitted a Prequalification Questionnaire will be notified in writing of either successfully or not successfully achieving prequalification status. The decision of the University is final and is not appealable within the University of California system.
All information submitted for Prequalification evaluation will be considered official information acquired in confidence, and the University will maintain its confidentiality to the extent permitted by law.
It is critical that the prospective Contractor fills out all information required accurately, completely, truthfully and to the best of their knowledge. Ambiguous or incomplete information may lead to an unfavorable rating and subsequent status as non-prequalified.
WHERE NECESSARY, COPY THE FORMS IN THIS PACKAGE. USE ONLY THESE FORMS.
1. PREQUALIFICATION DECLARATION
I, ________________________________________________, hereby declare that I am the
(Printed Name)
_________________________________ of ____________________________________
(Title) (Name of Firm)
submitting this Prequalification Questionnaire; that I am duly authorized to sign this Prequalification Questionnaire on behalf of the above-named firm; and that all information set forth in this Prequalification Questionnaire and all attachments hereto are, to the best of my knowledge, true, accurate and complete as of its submission date.
The undersigned declares under penalty of perjury that all of the prequalification information submitted with this form is true and correct and that this declaration was executed in
________________________________ (County), __________________________, (State)
on ______________________________ (Date).
____________________________________
(Signature)
2. ATTENDANCE AT MANDATORY PREQUALIFICATION CONFERENCE
Did a representative of your firm attend the Mandatory Prequalification Conference at the University of California, San Diego, La Jolla?
YES NO
General Contractor Page 1 of 23 Prequalification Questionnaire
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w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
Name/names of those attending: _________________________________________
Date of Meeting Attended:____________________________________________
3. LICENSE
A. Does your firm hold the following California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?
License Code: B
License Classification: General Building Contractor
YES NO
1. If the entity submitting this prequalification questionnaire is a Joint Venture, does the Joint Venture entity itself currently hold a (B – General Building Contractor) California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?
YES NO N/A
B. Provide the following information about your firm's contractor's license:
1. Name of license holder exactly as on file with the California Contractor's State License Board:
__________________________________________________________________
2. License Classification: _______________________________________________
3. License Code: ______________________________________________________
4. License Number: _____________________________________________________
5. Date Issued: _______________________________________________________
6. Expiration Date: ____________________________________________________
C. Can you truthfully state that your firm's contractor's license hasn’t been suspended or revoked by the California Contractor's State License Board within the last five (5) years?
YES NO
If answer is “No,” explain on attached additional sheets.
If the entity submitting this prequalification questionnaire is a Joint Venture, can the Joint Venture entity truthfully state that no member of the Joint Venture has ever had their firm's contractor's license suspended or revoked by the California Contractor's State License Board?
YES NO N/A
If answer is “No,” explain on attached additional sheets.
D. Has a complaint ever been filed with the Contractor’s State License Board against your company that required a formal hearing or inquiry?
YES NO
4. SURETY
Prospective Contractor desiring to be prequalified are informed that they will be subject to and must fully comply with all bid conditions including 100% payment and 100% performance bonds.
Prospective Contractor shall submit the below form, signed by representative of surety and notarized. If firm has used current surety for less than ten years, list surety(ies) previously used and indicate number of years used to demonstrate ten (10) complete years of surety history.
A. Is the surety to be used listed in the latest published State of California Department of Insurance list of Insurance Organizations Authorized by the Insurance Commissioner to Transact Business of Insurance in the State of California?
YES NO
B. Is the prospective Contractor able to obtain bonding up to and including the cost for this construction contract estimated at $380,000 of which no more than 50% is currently committed to other projects?
YES NO
1. If the entity submitting this prequalification questionnaire is a Joint Venture, is the Joint Venture entity itself able to obtain bonding up to and including the cost for this construction contract estimated at $380,000 of which no more than 50% is currently committed to other projects?
YES NO N/A
C. Is it true that the surety has not paid out any monies for the construction activities of the prospective Contractor whatsoever within the last ten (10) years?
YES NO
If answer is “No,” explain on attached additional sheets.
1. If the entity submitting this prequalification questionnaire is a Joint Venture, is it true that the surety has not paid out any monies for the construction activities of any member of the Joint Venture within the last ten (10) years?
YES NO N/A
D. How long has the Prospective Contractor been with this surety? years
E. Surety Declaration:
Provide this Declaration of your surety(ies) for completion. Do not have the surety submit this information directly to the University.
The undersigned declares under penalty of perjury that all of the above surety information is true and correct and that this declaration was executed in
County, California, on (date).
(Signature)
(Name and Title - Printed or Typed)
(Representing [Surety Name])
(Surety License Number)
(Firm Name)
(Address) (City, State, Zip Code)
________________________________________________________________________________________________________
(Telephone Number) (Facsimile Number)
(Email Address)
(ATTACH NOTARIZATION of SURETY REPRESENTATIVE’S SIGNATURE)
General Contractor Page 1 of 23 Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 07/2014)
w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
5. INSURER
Prospective Contractor desiring to be prequalified are informed that they will be subject to and must fully comply with all bid conditions including the following insurance coverage and associated limits.
Prospective Contractor shall submit the below form, signed by representative of insurer and notarized. If firm has used current insurer for less than ten years, list insurer(s) previously used and indicate number of years used to demonstrate ten (10) complete years of insurer history.
A. Is the insurer to be used listed by Best with a rating of A- or better and a financial classification of VIII or better (or an equivalent rating by Standard & Poor’s or Moody's)?
YES NO
Indicate Best Rating:
Indicate Best Financial Classification:
B. Is the prospective Contractor able to obtain insurance in the following limits for each of these construction contracts?
YES NO
1. If the entity submitting this prequalification questionnaire is a Joint Venture, is the Joint Venture entity itself able to obtain insurance in the following limits for each of these construction contracts?
YES NO N/A
Minimum
Comprehensive or Commercial Form General Liability Insurance - Limits of Liability Requirement
Each Occurrence - Combined Single Limit for Bodily Injury and Property Damage $1,000,000
Products - Completed Operations Aggregate $2,000,000
Personal and Advertising Injury $1,000,000
General Aggregate - Not Applicable to Comprehensive Form $2,000,000
Business Automobile Liability Insurance - Limits of Liability
Each Accident - Combined Single Limit for Bodily Injury and Property Damage $1,000,000
C. How long has the Prospective Contractor been with this insurer? years
General Contractor Page 1 of 23 Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 07/2014)
w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
D. Insurance Declaration:
Provide this Declaration to your insurance carrier for completion. Do not have the carrier submit this information to the University.
The undersigned declares under penalty of perjury that all of the above insurer information is true and correct and that this declaration was executed in
County, California, on (date).
(Signature)
(Name and Title - Printed or Typed)
(Representing [Insurer Name])
(Insurer’s License Number)
(Firm Name)
(Address) (City, State, Zip Code)
(Telephone Number) (Facsimile Telephone Number)
(Email Address)
(ATTACH NOTARIZATION of INSURER REPRESENTATIVE’S SIGNATURE)
General Contractor Page 1 of 23 Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 07/2014)
w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
6. CONSTRUCTION EXPERIENCE
Submit Project Data on a minimum of two (2) and a maximum of five (5) comparable projects successfully completed within the last ten (10) years constructed in the United States of America one of which was constructed in the State of California.
A comparable project is defined as having a construction cost at the bid date of at least $400,000 or a total of $1.2M for the projects submitted, and the following example building types:
· Commercial or institutional research laboratory
· Hospital or clinical medical facility
· Office building combined with one of the above
· Addition to an existing commercial or institutional research laboratory, hospital or clinical medical facility while the facility remains in full operation
· Other facilities that contain a high degree of technical/aesthetic complexity and
Such projects should have possessed the following construction challenges:
· Institutional renovation work with limited construction and staging areas
· Repair of buildings requiring proactive and innovative solutions due to noise, dust, and pedestrian traffic while building is occupied and research is ongoing
· Renovations/expansions requiring proactive and innovative solutions due to unknown and/or unforeseen field conditions.
· Project complexity requiring critical path construction scheduling to complete on time.
Such projects should include these specific components:
· Radio Frequency (RF) shielding with integration of ductwork and nonferrous components.
· Skylight systems
· Relocation of electrical circuits and panels while research is ongoing
· Rooftop chiller and associated piping to technical electronic equipment.
A. If the entity submitting this prequalification questionnaire is a Joint Venture, the Joint Venture entity itself must demonstrate adequate previous construction experience. Joint Venture teams newly-formed to pursue this prequalification opportunity are not eligible for prequalification.
B. Listed projects must have been managed and constructed under the business name submitted for prequalification. Projects completed by employees for former employers are not acceptable.
C. Submit the following Project Data Sheets for each project submitted as evidence of your firm's Contractor expertise.
General Contractor Page 1 of 23 Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 07/2014)
w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
PROJECT DATA SHEET
(A separate sheet must be prepared for each project submitted.)
1. Project Name: _________________________________________________________________
2. Project Location: ___________________________________________________________
3. Project Description: ___________________________________________________________
4. Constr. Type:
5. Size (gross square feet): ____________
6. What was your company’s role on this project?
Prime (General) Contractor
Subcontractor to GC
2nd Tier Subcontractor
3rd Tier Subcontractor
Prime Subcontractor to Owner
Other: _________
List the Business Entity (name) your company used to perform work for this project: ____________________________________________________________________________________
7. If the entity submitting this prequalification questionnaire is a Joint Venture, did the Joint Venture entity itself construct and manage this project?
YES NO N/A
8. How is this project comparable to the W.M. Keck Building MRI Installation project? ______________________________________________________________________________
______________________________________________________________________________
9. Was the project completed within budget?
Cost At Bid: $
Cost At Completion: $
Explanation: ____________________________________________________________________
General Contractor Page 1 of 23 Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 07/2014)
w.m. keck building mri installation PROJECT NO. w9938679/p4s-815
university of california, san diego
10. For any differing amount between cost at completion and cost at bid, distribute the sources and/or causes of these changes into the following categories:
Document Problems: $
Unforeseen Conditions: $
Owner Generated Scope: $
Regulatory Agency: $
Other: $
11. Was construction begun and completed within the last ten (10) years?
YES NO
12. Was the project completed within the original contract time or the adjusted contract time?
YES NO
If completion did not occur within the original or the adjusted contract time, indicate elapsed time in whole calendar days between original or adjusted contract time and actual final completion. For projects that have not reached final completion, indicate current status with respect to contract time:
______________________________________________________________________________
13. Did the project include occupied facilities?
YES NO
14. What communications strategies were used by your firm to assist the project team in mitigating the impacts of construction on the occupied facilities? ______________________________________________________________________________
15. What Infection Control measures were carried out on the project? Describe Infection Control means and methods, types of containment barriers, ICRA Permit process, monitoring and maintenance of containment barriers for the project. Include whether infection control specialty subcontractor was used, or whether in-house personnel performed infection control.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
16. Was the project for a university or public institution?
YES NO
17. What strategic decisions did your firm contribute to the project which supported the project’s success (e.g. value engineering, phasing, innovation, new technology, etc.)? ______________________________________________________________________________