MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
UNIVERSITY OF CALIFORNIA, SAN DIEGO
PREQUALIFICATION QUESTIONNAIRE
For
MAIN OPERATING ROOMS HVAC UPGRADE
UCSD MEDICAL CENTER HILLCREST
UNIVERSITY OF CALIFORNIA, SAN DIEGO
Project Number: 4346/A4L-363/966248
SUBMITTED BY:
please enter your company name here
TRADE (please indicate your trade (s))
[ ] Final Cleaning [ ] Acoustic Ceilings/Accessories/Wall Protection
BSD BUILDERS
8825 REHCO ROAD, SUITE 100
SAN DIEGO, CA 92121
ISSUE DATE: February 6, 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)
Note: Submission of an incomplete and/or unclear Prequalification Questionnaire may result in the determination of the prospective Subcontractor as NON-PREQUALIFIED.
SUBMITTED BY:
(Name and Title) Printed or Typed
(Trade)
(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 Subcontractor shall have California Contractor’s License(s), 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 Subcontractor must answer all of the following questions and provide all requested information, where applicable. Any prospective Subcontractor failing to do so may be deemed to be not responsive and not responsible with respect to this Prequalification at the sole discretion of BSD Builders. Each prospective Subcontractor must submit one (1) printed set of the questionnaire. All Subcontractors that have submitted a Prequalification Questionnaire will be notified in writing of either successfully or not successfully achieving prequalification status.
All information submitted for Prequalification evaluation will be considered official information acquired in confidence, and the BSD Builders will maintain its confidentiality to the extent permitted by law.
It is critical that the prospective Subcontractor 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. LICENSE
A. Does your firm hold a California Contractor's license(s), which is current, valid, and in good standing with the California Contractor's State License Board?
License Classification/Code: ______
YES NO
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.
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
E. Does your firm have experience utilizing CPM logic, Primavera Project Planner scheduling software on your projects and would you utilize this experience on this project?
YES NO
If “No,” name the software application(s) used or the software application you would propose for use on this project for scheduling. ______
3. SURETY
Prospective Subcontractor desiring to be prequalified are informed that they will be subject to and must fully comply with all bid conditions and may be asked to provide a 100% payment and 100% performance bonds.
Prospective Subcontractor 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 it true that the surety has not paid out any monies for the construction activities of the prospective Subcontractor 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
C. How long has the Prospective Subcontractor been with this surety? years
D. 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)
Page 15 of 15 Prequalification Questionnaire
MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
UNIVERSITY OF CALIFORNIA, SAN DIEGO
4. INSURER
Prospective Subcontractor desiring to be prequalified is informed that they will be subject to and must fully comply with all bid conditions including the following insurance coverage and associated limits.
Prospective Subcontractor 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 Subcontractor 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 Subcontractor been with this insurer? years
Page 15 of 15 Prequalification Questionnaire
MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
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
Page 15 of 15 Prequalification Questionnaire
MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
UNIVERSITY OF CALIFORNIA, SAN DIEGO
5. CONSTRUCTION EXPERIENCE
Submit Project Data on a minimum of three (3) and a maximum of five (5) comparable projects successfully completed within the last ten (10) years constructed in the State of California.
A comparable project is defined as having a trade cost at the bid date of at least (see below for each trades comparable cost) for the projects submitted:
Final Cleaning / $10,000
Acoustic Ceilings/Accessories/Wall Protection $130,000
A comparable project is further defined by the following building types:
· Acute Care Hospital (24/7 operational hospital)
· Renovations to an existing hospital while the facility remains in operation
· Acute care operating rooms, ICU, or clean rooms
Such projects should have possessed the following construction challenges:
· Urban site work with limited construction and staging areas
· Renovation of buildings requiring proactive and innovative solutions due to noise,
dust, and pedestrian traffic while building is occupied
· Level 4 infection control requirements
· Renovations/expansions requiring proactive and innovative solutions due to unknown
and/or unforeseen field conditions.
· Complex phasing plan development and execution
· Project complexity requiring critical path construction scheduling
· Project schedule requiring multiple phases of work
· Multiple crews and shift hand-offs for night and weekend work
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 Subcontractor expertise.
Page 15 of 15 Prequalification Questionnaire
MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
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. Project Dates (month and year) Start______Completion Date ______
5. Constr. Type:
6. Value of your firm’s contract amount: ______
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. Did the project include OSHPD review, approval, and inspections?
YES NO
9. How is this project comparable to the MAIN OPERATING ROOMS HVAC UPGRADE project? ______
______
10. Was this project constructed within an occupied facility?
YES NO
11. Did the project include working off hours and shift work?
YES NO
12. Did the project include multiple crews per shift? If yes, please describe.
YES NO
______
______
13. What was the specific scope of work your firm performed on this project?
______
14. Was the owner of the project a University or Public Institution?
YES NO
15. Did you subcontract any of the work?
YES NO
If yes, what percentage of the work? ______
16. Were any claims filed?
YES NO
17. Were any back-charges or liquidated damages assessed?
YES NO
General Contractor Firm Name:General Contractor Contact: / Title:
General Contractor Address: / City, State Zip
General Contractor Phone: / Client Fax:
General Contractor E-mail Address:
(Attach additional pages with other pertinent project information as necessary.)
Page 15 of 15 Prequalification Questionnaire
MAIN OPERATING ROOMS HVAC UPGRADE Project Number: 4346/A4L-363/966248
UCSD MEDICAL CENTER HILLCREST
UNIVERSITY OF CALIFORNIA, SAN DIEGO
6. PROJECT SAFETY
The safety of the Subcontractor employees, employees of the University and other visitors to the Project are of the utmost importance to the University. The Subcontractor shall take whatever steps are necessary to maintain a clean and safe work environment for their employees, the employees of their Subcontractors and vendors, and any other visitors to the project. Subcontractor shall have a written Injury and Illness Prevention Program (IIPP) that complies with California Code of Regulations, Title 8, Sections 1509 and 3203 and a written safety program that meets CAL/OSHA requirements
A. Can your firm comply with the above requirements?
YES NO
B. 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.
______
______
C. Is your firm’s current worker’s 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.
2012______
2011______
2010______
D. Provide EMR verification (regardless of whether EMR is under or over 1) from State of California or from insurance company for 2012.
E. Has your firm been cited by OSHA in the past 5 years?
YES NO
7. QUALITY CONTROL/QUALITY ASSURANCE PROGRAM (QC/QA)
A. Does your firm have a written quality control/quality assurance program?
YES NO
8. BUSINESS CONSTRUCTION REVENUE
For the purposes of this prequalification questionnaire, "business construction revenue" shall be defined as payments to prospective Subcontractor for construction services as a Subcontractor.
A. List average yearly volume of work for each of the past 5 years.
YEAR REVENUE/VOLUME
______
______
______
______
______