Thornton Ep Lab Equipment Replacementproject No. 4916/A4l-447/965020

THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

university of california, san diego

PREQUALIFICATION QUESTIONNAIRE

For

B -GENERAL BUILDING CONTRACTOR

THORNTON EP LAB EQUIPMENT REPLACEMENT

UCSD MEDICAL CENTER – LA JOLLA

PROJECT NO.: 4916/A4L-447/965020

SUBMITTED BY:

please enter your company name here

UNIVERSITY OF CALIFORNIA, SAN DIEGO

CAPITAL PROGRAM MANAGEMENT

10280 NORTH TORREY PINES ROAD

LA JOLLA, CA 92037

ISSUE DATE: July 5, 2017

MANDATORY PREQUALIFICATION MEETING: July 13, 2017

MANDATORY MEETING LOCATION: CPM, Large Conference Room, Suite 466

SUBMITTALS DUE: July 20, 2017

PREQUALIFICATION QUESTIONNAIRE

For

THORNTON EP LAB EQUIPMENT REPLACEMENT

UCSD MEDICAL CENTER – LA JOLLA

(Where a time period is given, such as the last ten [10] years, the period is to be measured backwards from the date this Level I 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 Classification: 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 andone (1) flashdrive 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

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

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 Classification: B - General Building Contractor

YESNO

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?

YESNON/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:

______

1. License Classification: ______

1. License Number: ______

4.Date Issued: ______

5.Expiration Date: ______

C.Is your firm registered with the State of California Department of Industrial Relations (DIR)?

YESNO

Public Works Contractor Registration Number: ______

D.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.

E.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

F.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.

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 $1,482,000of 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 $1,482,000 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)

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

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 LiabilityRequirement

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

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

university of california, san diego

1. 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)

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GC P/Q Quest

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

university of california, san diego

6.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 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 $1,000,000 or a total of $4,200,000 for the projects submitted, and the following example building types:

• Hospital or clinical medical/treatment facilities
• Other facilities that contain a high degree of technical complexity and

Such projects should have possessed the following construction challenges:

• Urban site 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 work 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.
• Coordination of the installation of medical equipment.
• Review, approval, and compliance with California State Fire Marshal and California Division of State Architect Handicapped Accessibility.
• Governance under OSHPD 1 or OSHPD 3 jurisdiction.

Such projects should include these specific components:

• Interventional diagnostic and/or treatment room(s)
• Phased construction of underground utilities adjacent to existing underground utilities
• Infection control, monitoring and maintenance.

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.

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

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): ______

1. 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 Thornton EP Lab EquipmentReplacementproject? ______

______

9.Was the project completed within budget?

Cost At Bid:$

Cost At Completion:$

Explanation: ______

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

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.Was the project a hospital or a clinical medical/ treatment facilities?

YES NO

14.Was the project for a university or public institution?

YES NO

15.Did the project include occupied facilities?

YES NO

16.What communications strategies were used by your firm to assist the project team in mitigating the impacts of construction on the occupied facilities? ______

17.Did the project include coordination of medical equipment and utilities installation?

YES NO

“If yes,” what were the specific utilities and medical equipment? ______

18.Did the project involve urban site work with limited construction and staging areas?

YES NO

19.Did the project require proactive and innovative solutions due to noise, dust, and pedestrian traffic while building was occupied and work was on going?

YES NO

20.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.)? ______

21.Did the project include adherence to critical path scheduling?

YES NO

22.Did the project include a quality control/quality assurance program?

YES NO

If “Yes,” explain: ______

23.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.

______

______

______

24.Did the project include interventional diagnostic and/or treatment rooms?

YES NO

25.Was the project OSHPD 1 or OSHPH 3 jurisdiction?

YES NO

26.Did the project include California State Fire Marshal review and approval (planning, scheduling and obtaining State Fire Marshal approval of materials, shop drawings, and systems testing)?

YES NO

27.Did the project include California Division of State Architect Handicapped Accessibility Compliance review and approval?

YES NO

28.Did the Owner assess any back-charges?

YES NO

If answer is “Yes,” explain: ______

29.Did the Owner assess any liquidated damages?

YES NO

If answer is “Yes,”explain: ______

30.Name of Project Executive:______

Qualifications of this Project Executive:______

31.Name of Project Manager: ______

Qualifications of this Project Manager: ______

______

32.Name of Project Superintendent: ______

Qualifications of this Project Superintendent: ______

______

33.Name of Project Engineer: ______

Qualifications of this Project Engineer: ______

______

34.Did your firm self-perform any of the work?

YES NO

If “Yes,”please specify the trades you self-performed or have the capability to self-perform:

______

______

______

General ContractorPage 1 of 26Prequalification Questionnaire

GC P/Q Quest

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THORNTON EP LAB EQUIPMENT REPLACEMENTPROJECT NO. 4916/A4L-447/965020

UCSD MEDICAL CENTER – LA JOLLA

university of california, san diego

(Attach additional pages with other pertinent project information as necessary.)

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