LEVEL 1

RECLAIMED WATER PIPELINE EXPANSION

PROJECT NO. 4794

university of california, san diego

PREQUALIFICATION QUESTIONNAIRE

For

RECLAIMED WATER PIPELINE EXPANSION

UNIVERSITY OF CALIFORNIA, SAN DIEGO

4794

SUBMITTED BY:

UNIVERSITY OF CALIFORNIA, SAN DIEGO

FACILITIES DESIGN & CONSTRUCTION

10280 NORTH TORREY PINES ROAD

LA JOLLA, CA 92037

ISSUE DATE: April 9, 2014

MANDATORY PREQUALIFICATION MEETING: April 16, 2014

SUBMITTALS DUE: April 30, 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 Engineer Contractor’s License, License Code: A, 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 5 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 FORMCHECKBOX

NO FORMCHECKBOX

Name/names of those attending: _________________________________________

Date of Meeting Attended: April 16, 2014

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/Code: A – General Engineering

YES FORMCHECKBOX

NO FORMCHECKBOX

1.If the entity submitting this prequalification questionnaire is a Joint Venture, does the Joint Venture entity itself currently hold a (Class A - General Engineering Contractor) California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?

YES FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

B.Is the prospective Contractor able to obtain bonding up to and including the cost for this construction contract estimated at $4,000,000 of which no more than 50% is currently committed to other projects?

YES FORMCHECKBOX

NO FORMCHECKBOX

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 $4,000,000 of which no more than 50% is currently committed to other projects?

YES FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

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)

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

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

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)

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 $4,000,000 for the projects submitted, and the following example pipeline installations:

· Trenched and horizontal directional drilled pressurized water pipeline and valve installation and testing; piping connections to existing water lines; deep boring pits; deep vault construction/installation;

Such projects should have possessed the following construction challenges:

· Urban site work with limited construction and staging areas

· Site conditions requiring proactive and innovative solutions to mitigate construction impacts such as noise, dust, vehicular and pedestrian traffic while campus is occupied and research is ongoing

· Pipe installations requiring proactive and innovative solutions due to unknown and/or unforeseen field conditions.

· Project complexity requiring tracking of multiple locations

· Project complexity requiring critical path construction scheduling to complete on time.

· Complex phasing plan development and execution

Such projects should include these specific components:

· Horizontal directional drilled pressure piping

· Construction on an occupied and operational campus (university, military base, airport, hospital, etc.)

· Construction of underground utilities adjacent to existing in-service underground utilities

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.

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 FORMCHECKBOX

Subcontractor to GC

FORMCHECKBOX

2nd Tier Subcontractor

FORMCHECKBOX

3rd Tier Subcontractor

FORMCHECKBOX

Prime Subcontractor to Owner FORMCHECKBOX

Other: _________

FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

8.How is this project comparable to the Reclaimed Water Pipeline Expansion project? ______________________________________________________________________________

______________________________________________________________________________

9.Was the project completed within budget?

Cost At Bid:

$

Cost At Completion:$

Explanation: ____________________________________________________________________

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 FORMCHECKBOX

NO FORMCHECKBOX

12.Was the project completed within the original contract time or the adjusted contract time?

YES FORMCHECKBOX

NO FORMCHECKBOX

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 FORMCHECKBOX

NO FORMCHECKBOX

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.Was the project for a university or public institution?

YES FORMCHECKBOX

NO FORMCHECKBOX

16.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.)? ______________________________________________________________________________

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

YES FORMCHECKBOX

NO FORMCHECKBOX

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

YES FORMCHECKBOX

NO FORMCHECKBOX

If “Yes,” explain: _______________________________________________________________

19.Did the Owner assess any back-charges?

YES FORMCHECKBOX

NO FORMCHECKBOX

If answer is “Yes,” explain: __________________________________________________________

20.Did the Owner assess any liquidated damages?

YES FORMCHECKBOX

NO FORMCHECKBOX

If answer is “Yes,” explain: _________________________________________________________

21.Name of Project Executive:_____________________________________

Qualifications of this Project Executive:__________________________

______________________________________________________________________________

22.Name of Project Manager: ___________________________________________________

Qualifications of this Project Manager: _________________________________________

______________________________________________________________________________

23.Name of Project Superintendent: ___________________________________________________

Qualifications of this Project Superintendent: _________________________________________

______________________________________________________________________________

24.Name of Project Engineer: ________________________________________________________

Qualifications of this Project Engineer: ______________________________________________

______________________________________________________________________________

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

YES FORMCHECKBOX

NO FORMCHECKBOX

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

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

If this project is UNDER $5M, delete the following section (“Current Projects for the Regents of the University of California”):

7.NOT USED

If this project is UNDER $5M, delete the following section (“Past Projects for the Regents of the University of California”):

8.NOT USED

9.STAFF EXPERIENCE AND PROJECT SAFETY

The Project Manager and Project Superintendent listed will be considered qualified only if he/she has successfully completed at least three (3) comparable projects.

A.Contractor hereby commits as a minimum to assignment of the specific field staff as outlined below. Contractor to submit a complete staffing chart as part of this package.

· One Project Executive part-time during construction.

The Project Executive will be on site part-time during construction and on site for construction meetings.

· One Project Manager part-time during construction

Contractor shall assign one Project Manager to oversee, manage and coordinate the project. The magnitude and complexity of the project will necessitate that this position manage the entire construction process. This position will need to be involved with all aspects of the project including but not limited to all scheduling and budgeting meetings, overall construction process development and execution, multi-staff operation management and coordination. The project manager will take the lead position in all Architect and University issues including overall contract administration, RFI, RFP and contract change order negotiations, campus and community relations. The project manager will be the main contact on behalf of the general contractor and will be responsible for guiding the construction development process to successful completion. The project manager will be responsible for budget, quality and schedule.

· One Project Superintendent full-time on site during construction

The Contractor will assign one Project Superintendent to manage, coordinate and facilitate the field supervision staff for each of the various components of the project construction process. The major function of this position will be in addition to the normal superintendent’s daily workload, subcontractor interaction and production, and various field related coordination issues.

· One Project Engineer part-time on site during construction

The Contractor will assign one Project Engineer to perform Quality Control duties, submittals, shop drawings and MEP coordination.

· One Project Clerk as needed during construction

B. At the time of bid, the successful Contractor will be required to reconfirm staff assignments to the project based on this submittal. If any of the named staff submitted are no longer employed by the firm at the time the project starts, or are otherwise unavailable, the firm's bid may be considered non-responsive. Substitution of other individuals with equivalent experience may be considered by the University, however resumes, comparable project history and other relevant information must be submitted to the University prior to the determination of the bid results.

C. Project Management -- This project may not require a project manager on site full time, but does require site visits and meetings as requested by the University Project Manager.

The Contractor shall keep on the job throughout its duration a competent Project Manager and Project Superintendent, all of whom must be satisfactory to the University. The Project Manager and Project Superintendent, shall be the same individuals proposed by the Contractor during the procurement process for this project. The Project Manager shall represent the Contractor, and all communication given to the Project Manager shall be as binding as if given to the Contractor. The Contractor shall not change either the Project Manager or the Project Superintendent on the project from those originally proposed for the project without the prior written consent of the University. The University will only grant written consent for such change in the case of undue hardship on the individual or if the Project Manager and Project Superintendent shall leave the employ of the Contractor.

By submitting a proposal for this project, the Contractor agrees to pay a training fee of $50,000 should they change Project Executive, Project Manager, or Project Superintendent without the written consent of the University.

D.Safety Program

The safety of the Contractor employees, employees of the University and other visitors to the Project are of the utmost importance to the University. The Contractor 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.

E.Part-Time Project Executive: Reclaimed Water Pipeline Expansion Project.

1.The name of the specific Project Executive to be committed to this project and continuously retained throughout this project is:

(Attach resume)

2.Total years of experience:

years

3.Years at this position:

years

4.Years with this firm:

years

5.The Project Executive named above was assigned to the following comparable projects for which data sheets have been included in this questionnaire:

Project:

Construction Cost:

a.

b.

c.

6.The Project Executive named above worked on the following similar projects that are described in the attached resume:

a.

b.

c.

F.Part-Time Project Manager: Reclaimed Water Pipeline Expansion Project

1.The name of the specific Project Manager to be committed to this project on a part-time basis and continuously retained throughout this project is:

(Attach resume)

2.Total years of experience:

years

3.Years at this position:

______years

4.Years with this firm:

years

5.The Project Manager named above was assigned to the following comparable projects for which data sheets have been included in this questionnaire:

Project:

Construction Cost:

a.

b.

c.

6.The Project Manager named above worked on the following similar projects that are described in the attached resume:

a.

b.

c._____________________________________________________________

G.Full-Time Project Superintendent: Reclaimed Water Pipeline Expansion Project

1.The name of the specific Project Superintendent to be committed to this project on a full-time basis and continuously retained throughout this project is:

(Attach resume)

2.Total years of experience:

years

3.Years at this position:

years

4.Years with this firm:

years

5.The Project Superintendent named above was assigned to the following comparable projects for which data sheets have been included in this questionnaire:

Project:

Construction Cost:

a.

b.

c.

6.The Project Superintendent named above worked on the following similar projects that are described in the attached resume:

a.

b.

c.

H.Full-Time Project Engineer: Reclaimed Water Pipeline Expansion Project

1.The name of the specific Project Engineer to be committed to this project on a full-time basis and continuously retained throughout this project is:

(Attach resume)

2.Total years of experience:

years

3.Years in this position:

years

4.Years with this firm:

years

5.The Project Engineer named above was assigned to the following comparable projects for which data sheets have been included in this questionnaire:

Project:

Construction Cost:

a.

b.

c.

6.The Project Engineer named above worked on the following similar projects that are described in the attached resume:

a.

b.

c.

10.ADDITIONAL GENERAL CONTRACTOR REQUIREMENTS

A.If fully pre-qualified and a successful fee bidder, the Contractor will be required to use the following computer software programs. Further, it shall be required that certain specific documents be submitted to the University and/or University’s Representative in such electronic format. Indicate computer program currently used by your firm:

Owner Standard

Your Firm

Word processing

(e.g. letters, memos, etc.)

Microsoft Word 6.0

Cost Analysis

Microsoft Excel

Project Scheduling

Project Management & Control

Email

Outlook

Web Browser

Internet Explorer

11.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 FORMCHECKBOX

NO FORMCHECKBOX

Brief Description: _________________________________________________________

B.Does your firm have a written safety program that meets CAL/OSHA requirements?

YES FORMCHECKBOX

NO FORMCHECKBOX

C.Will your firm have personnel permanently assigned and dedicated to Safety on this project?

YES FORMCHECKBOX

NO FORMCHECKBOX

D.If “Yes,” state the names of all such personnel who will be assigned and individually list their specific duties:

Name, Title

Specific Duties

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Attach resumes (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 FORMCHECKBOX

NO FORMCHECKBOX

If the answer is “Yes,” please explain.

________________________________________________________________________

________________________________________________________________________

F.Is your firm’s current worker’s Compensation Experience Modification Rate (EMR) equal to 1.0 or less?

YES FORMCHECKBOX

NO FORMCHECKBOX

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.

H.Has your firm been cited by OSHA in the past 5 years?

YES FORMCHECKBOX

NO FORMCHECKBOX

I. Does your firm have a Small Business/Underutilized Business Outreach Program?

YES FORMCHECKBOX

NO FORMCHECKBOX

If “Yes,” please include a summary of your efforts (up to one [1] page).

12.QUALITY CONTROL/QUALITY ASSURANCE PROGRAM (QC/QA)

A.Does your firm have a written quality control/quality assurance program?

YES FORMCHECKBOX

NO FORMCHECKBOX

B.Will your firm have personnel permanently assigned and dedicated to QC/QA on this project?

YES FORMCHECKBOX

NO FORMCHECKBOX

C.If “Yes,” state the names of all such personnel who will be assigned and individually list their specific duties:

Name, Title

Specific Duties

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

D.Provide brief description of your Quality Control/Quality Assurance Program:

_______________________________________________________________________

_______________________________________________________________________

E.Describe how your Program will be applied to this project:

_______________________________________________________________________

_______________________________________________________________________

13.BUSINESS CONSTRUCTION REVENUE

For the purposes of this prequalification questionnaire, "business construction revenue" shall be defined as payments to prospective Contractor for construction services as a General Contractor.

A.Can you truthfully state that your firm has had an annual business construction revenue of at least $4,000,000 (excluding any and all legal awards) for each and every one of the last five (5) consecutive years?

YES FORMCHECKBOX

NO FORMCHECKBOX

B.If the entity submitting this prequalification questionnaire is a Joint Venture, can the Joint Venture entity truthfully state that each member of the Joint Venture has had an annual business construction revenue of at least $4,000,000 (excluding any and all legal awards) for each and every one of the last five (5) consecutive years?

YES FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

C.Can you provide audited financial statements (if requested) for the last ten (10) years?

YES FORMCHECKBOX

NO FORMCHECKBOX

DO NOT INCLUDE FINANCIAL STATEMENTS WITH THIS PREQUALIFICATION QUESTIONNAIRE.

D.List average yearly volume of work for each of the past 5 years (Revenue and amount of reinvestment income).

YEAR

REVENUE/VOLUME

REINVESTED INCOME

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

E.List value of work currently on backlog, with percent complete, as appropriate.

WORK

VALUE %COMPLETE

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

If this project is UNDER $5M, delete the following section (“Mediation, Arbitration and Litigation History…”):

14.NOT USED

If this project is UNDER $5M, delete this following section (“Mediation, Arbitration and Litigation History With the Regents…”):

15.NOT USED

16.DISCIPLINARY MEASURES HISTORY

A.Can you truthfully state that your firm has not been disqualified or barred from doing business with a public agency (e.g., federal, state, county, city, University of California System, California State University System, etc.) within the last fifteen (15) years?

YES FORMCHECKBOX

NO FORMCHECKBOX

1.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 been disqualified or barred from doing business with a public agency (e.g., federal, state, county, city, University of California System, California State University System, etc.) within the last fifteen (15) years?

YES FORMCHECKBOX

NO FORMCHECKBOX

N/A FORMCHECKBOX

17.MISCELLANEOUS REQUIREMENTS

A. Has your Firm ever refused to perform change order or warranty work requested by an Owner?

YES FORMCHECKBOX NO FORMCHECKBOX

If the answer is “Yes,” please explain.

________________________________________________________________________

________________________________________________________________________

B. What is your Firm’s procedure for answering an Owner’s request to perform warranty work? Please describe:

________________________________________________________________________

________________________________________________________________________

C. Describe your firm's claim-avoidance strategy and/or philosophy:

________________________________________________________________________

________________________________________________________________________

General ContractorPage 20 of 25Prequalification Questionnaire

GC P/Q Quest

(UCSD Rev. 10/2012)