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SEMI ANNUAL PREQUALIFICATION FOR CPD VARIOUS PROJECTS PROJECT NO. MCH8867UC SAN DIEGO HEALTH SYSTEM (MEP CONTRACTORS)UNIVERSITY OF CALIFORNIA, SAN DIEGO

SEMI ANNUAL PREQUALIFICATION QUESTIONNAIRE

For

VARIOUS CONSTRUCTION PROJECTSUC SAN DIEGO HEALTH SYSTEM

UNIVERSITY OF CALIFORNIA, SAN DIEGO(Mechanical, Electrical & Plumbing)

Please check which package(s) you are submitting on.Please Note: If submitting more than one trade, please submit separate packages for each trade.

Mechanical

Electrical

Plumbing

MCH8867

UC SAN DIEGO HEALTH SYSTEMUNIVERSITY OF CALIFORNIA, SAN DIEGOCONSTRUCTION PROJECTS DEPARTMENT326 DICKINSON STREET (MAIL CODE 8867)

SAN DIEGO, CA 92103-8867

JULY 2014

Part II of 20 Semi Annual Prequalification QuestionnaireUCSD 10/14/03 (MEP Contractors)GC P/Q Quest(UCSD Rev. 01/2011) 7/2014


(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 Contractor’s License, depending on your trade, License Code: C-10, Electrical Contractor, C-20, HVAC Contractor, or C-36 Plumbing 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 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 three (3) copies 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 PREQUALIFICATION CONFERENCE

Did a representative of your firm attend the Prequalification Conference at the University of California, San Diego Medical Center in Hillcrest?

YES NO

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?

(Select applicable license).

License Classification/Code: C-10 YES NO

C-36 YES NO

C-20 YES NO

1. If the entity submitting this prequalification questionnaire is a Joint Venture, does the Joint Venture entity itself currently hold a Class C-10, C-36 or C-20 depending on your trade and the package you’re submitting, California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?

YES NO N/A

B. Provide the following information about your firm's contractor's license:

1. Name of license holder exactly as on file with the California Contractor's State License Board:__________________________________________________________________

2. License Classification: _______________________________________________

3. License Code: ______________________________________________________

4. License Number: _____________________________________________________



5. Date Issued: _______________________________________________________

6. Expiration Date: ____________________________________________________

C. Can you truthfully state that your firm's contractor's license has never 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. Has your firm in the past five (5) years ever refused to perform change order work or to honor warranty work?

YES NO

If yes, please explain on attached additional sheets.

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 NO

B. BONDING

1. Is the prospective Contractor able to obtain bonding up to and including the cost for various Construction Projects for the UC San Diego Health System estimated at $100,000 of which no more than 50% is currently committed to other projects?



YES NO

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.

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])

(Firm Name)

(Address) (City, State, Zip Code)

________________________________________________________________________________________________________Telephone Number) (Facsimile Number)

(Email Address)

(ATTACH NOTARIZATION of SURETY REPRESENTATIVE’S SIGNATURE)


5. INSURER

Prospective Subcontractors 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 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 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

MinimumComprehensive or Commercial Form General Liability Insur ance - Limits of Liability RequirementEach Occurrence - Combined Single Limit for Bodily Injury and Property Damage $1,000,000Products - Completed Operations Aggregate

$2,000,000Personal and Advertising Injury $1,000,000General Aggregate - Not Applicable to Comprehensive Form $2,000,000

Business Automobile Liability Insurance - Limits of Liabil ity 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

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])

(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 five (5) and a maximum of ten (10) comparable projects successfully completed as a Subcontractor within the last ten (10) years constructed in the United States of America, two of which were constructed in the State of California.

A comparable project is defined as having a construction cost at the bid date of at least $100,000 to $250,000 or a total of $500,000 for the projects submitted, and the following building types:

Hospital or clinical medical facility Medical office building combined with one of the above Remodel to an existing hospital or clinical medical facility while the facility remains

in full operation and includes MEP systems replacement

Such projects should have possessed the following construction challenges: Urban site with limited construction and staging areas Repair/Replacement of functioning building systems requiring coordination with in

house facility’s personnel for shutdowns. Renovations/expansions requiring proactive and innovative solutions due to unknown

and/or unforeseen field conditions. Project constraints requiring off hour work.

Such projects should include these specific components: Phased construction of underground utilities adjacent to existing underground utilities Fume hood ventilation and fire protection systems Work with fire protection system Medical gas Mechanical & electrical utility distribution system Preparation & installation of medical equipment Work within confined spaces adjacent to occupied spaces requiring innovative

solutions due to noise, dust, and pedestrian traffic Emergency power

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. Construction Type: _____________________________________________________________

5. Size (gross square feet) _________________________________________________________

6. Business name of entity which constructed this project: _______________________________

7. Was the project completed within budget?

Original Contract Amount: ______________________________________________________

Final Contract Amount: ________________________________________________________

Explanation: _______________________________________________________________________

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

YES NO

9. Was the project OSHPD 1 permitted and inspected?

YES NO

10. Did the project include the renovation of an operational hospital?

YES NO

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

YES NO

12. Did the project include modification to a functioning mechanical, electrical and plumbing system?

YES NO

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

YES NO

If “Yes”, please explain: ____________________________________________________________________________________________________________________________________________________.

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

YES NO

15. Did the project include off hour work?

YES NO

If “yes”, please explain: ________________________________________________________________________________________________________________________________________________.

16. Did the project require solutions due to unknown field conditions?

YES NO

If “yes”, please explain: ______________________________________________________________________________________________________________________________________________.

17. Did the project include coordination with in-house facility personnel to facilitate utility shut downs?

YES NO

If “yes”, please explain: ______________________________________________________________________________________________________________________________________________.

18. Did the owner assess any back-charges?

YES NO

19. Did the owner asses any liquidated damages?

YES NO

20. Did your firm Subcontract out any work in your contract?

YES NO

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________.

21. Name of Project Superintendent/ Foreman: _______________________________

Qualifications of this Project Superintendent/ Foreman: ______________________________________________________________________________

______________________________________________________________________________

Client Firm Name:

Client Contact: Title:

Client Address:

Client City: State: _____Zip:

Client Phone: ( ) Fax: ( )

Client E-mail Address:

Architect/Engineer/Consultants:

Architect/EngineerContact Name: Phone:

Architect/EngineerE-mail Address:

Did the Owner assess any back-charges or liquidated damages? YES NO

If yes, explain: _____________________________________________________________________________

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

7. STAFF EXPERIENCE AND PROJECT SAFETY

The Project Executive and Project Superintendent resumes submitted with this questionnaire shall demonstrate their experience with the types of project specifics as stated above in Section 6, “Construction Experience” based on their respective levels of participation outlined below.

A. Contractor hereby commits as a minimum to assignment of the specific field staff as outlined below.

One Project Executive (5% as needed) during construction. The Project Executive will be on-site, as needed for construction meetings.

One Project Superintendent/Foreman (full-time on site) during constructionThe Contractor will assign one Project Superintendent/Foreman 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.

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.

The Contractor shall keep on the job throughout its duration for that trade, a competent Project Superintendent, all of whom must be satisfactory to the University. The Project Superintendent shall be the same individual proposed by the Contractor during the procurement process for this project. The Project Superintendent/Foreman shall represent the Contractor, and all communication given to the Project Superintendent/Foreman shall be as binding as if given to the Contractor. The Contractor shall not change the Project Superintendent/Foreman 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 Superintendent shall leave the employ of the Contractor.

By submitting a proposal for this project, the Contractor agrees to pay a training fee of $10,000 should Contractor change Project Executive or Project Superintendent without the written consent of the University.

C. Part-Time Project Executive: CPD Construction Projects.

1. The name of the specific Project Executive to be committed to various CPD projects and continuously retained throughout the 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:

a.

b.

c.

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

Project: Construction Cost:

a.

b.

c.

D. Full - Time Project Superintendent/Foreman: (during work of that trade) CPD Construction Projects.

1. The name of the specific Project Superintendent/Foreman to be committed to various CPD projects on a full-time basis and continuously retained throughout the Work of the particular trade 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:

a.

b.

c.

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

Project: Construction Cost:

a.

b.

c._____________________________________________________________

8. ADDITIONAL 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 FirmWord processing(e.g. letters, memos, etc.) Microsoft Word 6.0 ____________

Cost Analysis Microsoft Excel

Email Outlook ____________

Web Browser Internet Explorer ____________

9. CONTRACTOR INFORMATION

A. Describe the scheduling method used by your firm to commit to the schedule and deadlines are met.________________________________________________________________________________________________________________________________________________

B. How is creativity of reworking a schedule implemented when problems occur to ensure a successful project?__________________________________________________________________________________________________________________________________________________

C. Describe your Firm’s claims advocating strategy and critical timing of projects.________________________________________________________________________________________________________________________________________________

D. Describe your Firm’s Quality Control procedure to ensure that the work is installed correctly the first time.________________________________________________________________________________________________________________________________________________

10. SAFETY PROGRAM

The safety of the Contractor employees, employees of the University and other visitors to the CPD Construction Projects 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.

A. Does your firm have a written safety program that meets CAL/OSHA requirements:

YES NO

B. Have you had accidents which resulted in a construction fatality on any of your projects over the last two (2) years?

YES NO

If the answer is “yes”, please explain: _______________________________________________________________________________________________________________________________________________________________________________________

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

YES NO

Provide your California Workman’s Compensation Experience Modifier for each of the last five (5) years: ______________________________________________________________________________________________________________________________________________________________________________________________________

D. 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.

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

YES NO

If the answer is “yes”, please explain: _______________________________________________________________________________________________________________________________________________________________________________________

F. 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 NO

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

YES NO

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

11. 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 Subcontractor.

A. Can you truthfully state that your firm has had annual business construction revenue of at least $500,000 (excluding any and all legal awards) for each and every one of the last five (5) consecutive years?

YES NO

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

YES NO

If the answer is “no”, please explain:___________________________________________

________________________________________________________________________

________________________________________________________________________

Prequalification approval will remain valid for one (1) calendar year from the date of notice. However, the University reserves the right during that calendar year to adjust, increase, limit, suspend or rescind the prequalification status based on subsequently learned information. University shall notify Contractor of their change in prequalification status in writing. Upon receipt of said notice, Contractor has the opportunity to request a hearing consistent with the hearing procedures described below for appealing a prequalification determination.

12. RESOLUTION OF PREQUALIFICATION CONTROVERSY

If a prequalification is rejected or rescinded by the Facility, and such rejection/rescission is not in response to a Prequalification protest, any Contractor, person or entity may dispute that rejection by filing a Prequalification Protest (limited to the rejection) not later than 5:00 pm on the 3rd business day following the rejected Contractor’s receipt of the notice of rejection.

Facility will investigate the basis for the Prequalification protest and analyze the facts. Facility will notify Contractor whose Prequalification Status is the subject of the protest of evidence presented in the protest and evidence found as a result of the investigation, and, if deemed appropriate, afford Contractor an opportunity to rebut such evidence, and permit Contractor to present evidence that it should be allowed to participate. If deemed appropriate by Facility, an informal hearing will be held. Facility will issue a written decision within 15 days following receipt of the Prequalification protest, unless factors beyond Facility's reasonable control prevent such a resolution, in which event such decision will be issued as expeditiously as circumstances reasonably permit. The decision will state the reasons for the action taken by Facility. A copy of the decision will be furnished to the protestor, the Contractor whose Prequalification Status is the subject of the protest, and any Contractors affected by the decision. The University’s decision will be final and is not appealable.

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