PQ Quetionnaire Price Center HVAC W10015323
PRICE CENTER hvac phase IV ahu 3-1 & 3-2PROJECT NO.
W10015323 / P4L-212
university of california, san diego
PREQUALIFICATION QUESTIONNAIRE
For
C-20 - Warm-Air Heating, Ventilating and Air-Conditioning
Contractor
PRICE CENTER HVAC PHASE IVAHU 3-1 & 3-2 REPLACEMENT
W10015323 / P4L-212
SUBMITTED BY:
UNIVERSITY OF CALIFORNIA, SAN DIEGO
CAPITAL PROGRAM MANAGEMENT
10280 NORTH TORREY PINES ROAD
LA JOLLA, CA 92037
ISSUE DATE: May 19, 2020
INTENT TO SUBMIT & REI DUE: Tuesday, May 26, 2020 by 4:00
p.m.
SUBMITTALS DUE: Friday, June 12, 2020 by 2:00 p.m.
(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)
FORMCHECKBOX CHECK this box if the entity submitting this
prequalification questionnaire is a JOINT VENTURE
Each prospective Contractor must have the following California
license C-20 - Warm-Air Heating, Ventilating and Air-Conditioning
Contractor, 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. This
Prequalification Questionnaire with all portions completed,
including required attachments must be submitted.
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 non
responsive and not responsible with respect to this
Prequalification at the sole discretion of the University. Each
prospective Contractor must email the questionnaire in PDF format
to Hiroko Wilson at [email protected] cc: Kimberly Santiago
([email protected]). 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 complete all
information required herein 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.INTENT TO SUBMIT
Did your firm send Intent to Submit in writing via email?
YES FORMCHECKBOX
NO FORMCHECKBOX
Date and time of email:
Name and email:
3.LICENSE AND REGISTRATION
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: C-20 - Warm-Air Heating, Ventilating and
Air-Conditioning Contractor
YES FORMCHECKBOX
NO 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(s):
_______________________________________________
3. License Number:
_____________________________________________________
4.Date Issued:
_______________________________________________________
5.Expiration Date:
____________________________________________________
C.Is your firm currently registered with the California
Department of Industrial Relations
pursuant to California Labor Code Section 1725.5 and 1771.1?
YES FORMCHECKBOX
NO FORMCHECKBOX
If Yes, provide Public Works Contractor Registration Number:
______________________
If currently not registered, it will be required that Contractor
and all Subcontractors,
regardless of tier be registered at time of bid.
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 FORMCHECKBOX
NO FORMCHECKBOX
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 FORMCHECKBOX
NO FORMCHECKBOX
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 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.
G.Did your firm complete and submit the UC San Diego Capital
Program Management Company Registration form located on our website
(http://rmp-web.ucsd.edu/CompanyEvaluation)?
YES FORMCHECKBOX
NO FORMCHECKBOX
4.SURETY
Prospective Contractor desiring to be prequalified is 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
$775,000 of which no more than 50% is currently committed to other
projects?
YES FORMCHECKBOX
NO 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
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 with a minimum rating of A.M.
Best as A+ or better and a financial classification of XII 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 this construction contract?
YES FORMCHECKBOX
NO 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 three (3) 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 $775,000 or a total of $3,000,000 or more
for projects submitted, and the following example building
types:
· Commercial or institutional facility
· Addition to an existing commercial or institutional 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:
· Renovation work requiring complex phasing solutions to
maintain egress and utilities to adjacent occupied areas
· Renovations/expansions 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 tracking of multiple functions
and phases
· Project complexity requiring critical path construction
scheduling to complete on time.
· Complex phasing plan development and execution.
Such projects should include these specific components:
· Renovation work requiring coordination of creative nuisance
control solutions to allow for protection of adjacent occupied
areas during construction.
· Demolition in an occupied facility.
· Overhead install work in an occupied facility.
· Temporary utility – Power.
· Major Facility system shut downs that required extensive
coordination with end user.
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.Contract Delivery Method:
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.How is this project comparable to the PRICE CENTER - HVAC
PHASE IV AHU 3-1 AND 3-2
project?
________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
8.Was the project completed within budget?
Cost At Bid:
$
Cost At Completion:$
Explanation:
____________________________________________________________________
9.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:
$
10.Was construction begun and completed within the last ten (10)
years?
YES FORMCHECKBOX
NO FORMCHECKBOX
11.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:
_________________________________________________________________________________
12.Was work performed within and adjacent to occupied
facilities?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
13.What communications strategies were used by your firm to
assist the project team in mitigating the impacts of construction
on the occupied facilities?
______________________________________________________________________________
14.Was the project for a university or public institution?
YES FORMCHECKBOX
NO FORMCHECKBOX
15.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.)?
______________________________________________________________________________
16.Did the project include adherence to critical path
scheduling?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
17.Did project contain Medium Voltage electrical work?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
18.Did the project include a quality control/quality assurance
program?
YES FORMCHECKBOX
NO FORMCHECKBOX
If “Yes,” explain:
_______________________________________________________________
19.Did the project take place in an occupied facility?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
20. Did the project include construction within sensitive
occupied spaces that would be impacted by noise, vibration, or
dust?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
21. Did the project include working directly with occupants in
the facility without a construction barricade?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
22.Did the project include major utility shut downs within the
facility?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” describe:
______________________________________________________________________________
23.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 FORMCHECKBOX
NO FORMCHECKBOX
24.Did the project include California Division of State
Architect Handicapped Accessibility Compliance review and
approval?
YES FORMCHECKBOX
NO FORMCHECKBOX
25.Did the project include USGBC LEED requirements/certification
or their equivalent?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” explain:
_________________________________________________________
26.Did the Owner assess any back-charges?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” explain:
__________________________________________________________
27.Did the Owner assess any liquidated damages?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “Yes,” explain:
_________________________________________________________
28.Name of Project
Executive:_____________________________________
Qualifications of this Project
Executive:__________________________
______________________________________________________________________________
29.Name of Project Manager:
___________________________________________________
Qualifications of this Project Manager:
_________________________________________
______________________________________________________________________________
30.Name of Project Superintendent:
___________________________________________________
Qualifications of this Project Superintendent:
_________________________________________
______________________________________________________________________________
31.Name of Project Engineer:
________________________________________________________
Qualifications of this Project Engineer:
______________________________________________
______________________________________________________________________________
32.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:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Owner/GC Firm Name:
Owner/GC Contact:
Title:
Owner/GC Address:
City, State Zip
Owner/GC Phone:
Client Fax:
Owner/GC E-mail Address:
Architect/Engineer/
Consultants:
Architect/Engineer
Contact Name:
Phone:
Architect/Engineer
E-mail Address:
(Attach additional pages with other pertinent project
information as necessary.)
7. Not Used
8. Not Used
9.STAFF EXPERIENCE AND PROJECT SAFETY
It is preferred that the Project Manager and Project
Superintendent have successfully completed one or more of the
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 Prime 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 (as needed) 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 or 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 $5,000 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: PRICE CENTER HVAC PHASE IV AHU 3-1
AND 3-2
1.The name of the specific Project Executive to be committed to
this project part-time 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: PRICE CENTER HVAC PHASE IV AHU 3-1
AND 3-2
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 PRICE CENTER HVAC PHASE IV
AHU 3-1 AND 3-2
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.As-Needed Project Engineer: PRICE CENTER HVAC PHASE IV AHU 3-1
AND 3-2
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 PRIME CONTRACTOR REQUIREMENTS
A.If fully prequalified and a successful fee bidder, the Prime
Contractor will be required to use the following computer software
programs: Microsoft Word Processing, Microsoft Excel Cost Analysis,
Primavera Project Planner Project Scheduling, e-Builder Project
Management and Control, Outlook Email, and Internet Explorer Web
Browser.
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 Workers Compensation Experience
Modification Rate (EMR) equal to 1.15 or less?
YES FORMCHECKBOX
NO FORMCHECKBOX
Provide your California Workers Compensation Modifier for each
of the last three (3) years.
G.Provide EMR verification (regardless of whether EMR is under
or over 1.15) 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
If the answer is “Yes,” please explain.
________________________________________________________________________
________________________________________________________________________
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 average
annual business construction revenue of at least $5,000,000
(excluding any and all legal awards) over the last five (5)
consecutive years?
YES FORMCHECKBOX
NO FORMCHECKBOX
B.Can you provide audited financial statements (if requested)
for the last ten (10) years?
YES FORMCHECKBOX
NO FORMCHECKBOX
If answer is “No,” what type of statements will you
provide?_______________________
DO NOT INCLUDE FINANCIAL STATEMENTS WITH THIS PREQUALIFICATION
QUESTIONNAIRE.
C.List average yearly volume of work for each of the past 5
years (revenue and amount of reinvestment income).
YEAR
REVENUE/VOLUME
REINVESTED INCOME
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
D.List value of work currently on backlog, with percent
complete, as appropriate.
WORK
VALUE %COMPLETE
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
14.Not Used
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
If the answer is “Yes,” please explain.
________________________________________________________________________
________________________________________________________________________
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 21 of 28Prequalification
Questionnaire
GC P/Q Quest
(UCSD Rev. 09/25/18)
