OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
PREQUALIFICATION QUESTIONNAIRE
For
A, GENERAL ENGINEERING CONTRACTOR
OPP PARKING & PATIENT DROP-OFF
UCSD MEDICAL CENTER – LA JOLLA
PROJECT NO. 4973/A4L-430/965080
SUBMITTED BY:
please enter your company name here
UNIVERSITY OF CALIFORNIA, SAN DIEGO
FACILITIES DESIGN & CONSTRUCTION
10280 NORTH TORREY PINES ROAD
LA JOLLA, CA 92037
ISSUE DATE: DECEMBER 20, 2016
MANDATORY PREQUALIFICATION MEETING: 10:00 A.M., JANUARY 5, 2017
MANDATORY MEETING LOCATION: FD&C LARGE CONFERENCE ROOM, SUITE 466
SUBMITTALS DUE: 4:00 P.M., JANUARY 13, 2017
(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 EngineeringContractor’s License, License Classification: 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 three (3)printed sets andone (1) flashdrive with complete submittal of the questionnaire. All Contractors that have submitted a Prequalification Questionnaire will be notified in writing of either successfully or not successfully achieving prequalification status. The decision of the University is final and is not appealable within the University of California system.
All information submitted for Prequalification evaluation will be considered official information acquired in confidence, and the University will maintain its confidentiality to the extent permitted by law.
It is critical that the prospective Contractor fills out all information required accurately, completely, truthfully and to the best of their knowledge. Ambiguous or incomplete information may lead to an unfavorable rating and subsequent status as non-prequalified.
WHERE NECESSARY, COPY THE FORMS IN THIS PACKAGE. USE ONLY THESE FORMS.
1.PREQUALIFICATION DECLARATION
I, ______, hereby declare that I am the
(Printed Name)
______of ______
(Title)(Name of Firm)
submitting this Prequalification Questionnaire; that I am duly authorized to sign this Prequalification Questionnaire on behalf of the above-named firm; and that all information set forth in this Prequalification Questionnaire and all attachments hereto are, to the best of my knowledge, true, accurate and complete as of its submission date.
The undersigned declares under penalty of perjury that all of the prequalification information submitted with this form is true and correct and that this declaration was executed in
______(County), ______, (State)
on ______(Date).
______
(Signature)
2.ATTENDANCE AT MANDATORY PREQUALIFICATION CONFERENCE
Did a representative of your firm attend the Mandatory Prequalification Conference at the University of California, San Diego, La Jolla?
YES NO
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
Name/names of those attending: ______
Date of Meeting Attended:______
3.LICENSE
A.Does your firm hold the following California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?
License Classification: A - General Engineering Contractor
YESNO
1.If the entity submitting this prequalification questionnaire is a Joint Venture, does the Joint Venture entity itself currently hold a (A- General Engineering Contractor) California contractor's license, which is current, valid, and in good standing with the California Contractor's State License Board?
YESNON/A
B.Provide the following information about your firm's contractor's license:
1.Name of license holder exactly as on file with the California Contractor's State License Board:
______
- License Classification: ______
- License Number: ______
4.Date Issued: ______
5.Expiration Date: ______
C.Is your firm registered with the State of California Department of Industrial Relations (DIR)?
YESNO
Public Works Contractor Registration Number: ______
D.Can you truthfully state that your firm's contractor's license hasn’t been suspended or revoked by the California Contractor's State License Board within the last five (5) years?
YES NO
If answer is “No,” explain on attached additional sheets.
If the entity submitting this prequalification questionnaire is a Joint Venture, can the Joint Venture entity truthfully state that no member of the Joint Venture has ever had their firm's contractor's license suspended or revoked by the California Contractor's State License Board?
YES NO N/A
If answer is “No,” explain on attached additional sheets.
E.Has a complaint ever been filed with the Contractor’s State License Board against your company that required a formal hearing or inquiry?
YES NO
F.Does your firm have experience utilizing CPM logic, Primavera Project Planner scheduling software on your projects and would you utilize this experience on this project?
YES NO
If“No,” name the software application(s) used or the software application you would propose for use on this project for scheduling.
4.SURETY
Prospective Contractor desiring to be prequalified are informed that they will be subject to and must fully comply with all bid conditions including 100% payment and 100% performance bonds.
Prospective Contractor shall submit the below form, signed by representative of surety and notarized. If firm has used current surety for less than ten years, list surety(ies) previously used and indicate number of years used to demonstrate ten (10) complete years of surety history.
A.Is the surety to be used listed in the latest published State of California Department of Insurance list of Insurance Organizations Authorized by the Insurance Commissioner to Transact Business of Insurance in the State of California?
YES NO
B.Is the prospective Contractor able to obtain bonding up to and including the cost for this construction contract estimated at $2,000,000of which no more than 50% is currently committed to other projects?
YES NO
1.If the entity submitting this prequalification questionnaire is a Joint Venture, is the Joint Venture entity itself able to obtain bonding up to and including the cost for this construction contract estimated at $2,000,000 of which no more than 50% is currently committed to other projects?
YES NO N/A
C.Is it true that the surety has not paid out any monies for the construction activities of the prospective Contractor whatsoever within the last ten (10) years?
YES NO
If answer is “No,” explain on attached additional sheets.
1.If the entity submitting this prequalification questionnaire is a Joint Venture, is it true that the surety has not paid out any monies for the construction activities of any member of the Joint Venture within the last ten (10) years?
YES NO N/A
D.How long has the Prospective Contractor been with this surety? years
E.Surety Declaration:
Provide this Declaration of your surety(ies) for completion. Do not have the surety submit this information directly to the University.
The undersigned declares under penalty of perjury that all of the above surety information is true and correct and that this declaration was executed in
County, California, on (date).
(Signature)
(Name and Title - Printed or Typed)
(Representing [Surety Name])
(Surety License Number)
(Firm Name)
(Address)(City, State, Zip Code)
______
(Telephone Number)(Facsimile Number)
(Email Address)
(ATTACH NOTARIZATION of SURETY REPRESENTATIVE’S SIGNATURE)
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
5.INSURER
Prospective Contractor desiring to be prequalified are informed that they will be subject to and must fully comply with all bid conditions including the following insurance coverage and associated limits.
Prospective Contractor shall submit the below form, signed by representative of insurer and notarized. If firm has used current insurer for less than ten years, list insurer(s) previously used and indicate number of years used to demonstrate ten (10) complete years of insurer history.
A.Is the insurer to be used listed by Best with a rating of A- or better and a financial classification of VIII or better (or an equivalent rating by Standard & Poor’s or Moody's)?
YES NO
Indicate Best Rating:
Indicate Best Financial Classification:
B.Is the prospective Contractor able to obtain insurance in the following limits for each of these construction contracts?
YES NO
1.If the entity submitting this prequalification questionnaire is a Joint Venture, is the Joint Venture entity itself able to obtain insurance in the following limits for each of these construction contracts?
YES NO N/A
Minimum
Comprehensive or Commercial Form General Liability Insurance - Limits of LiabilityRequirement
Each Occurrence - Combined Single Limit for Bodily Injury and Property Damage $1,000,000
Products - Completed Operations Aggregate $2,000,000
Personal and Advertising Injury $1,000,000
General Aggregate - Not Applicable to Comprehensive Form $2,000,000
Business Automobile Liability Insurance - Limits of Liability
Each Accident - Combined Single Limit for Bodily Injury and Property Damage $1,000,000
C.How long has the Prospective Contractor been with this insurer? years
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
- 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)
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
6.CONSTRUCTION EXPERIENCE
Submit Project Data on a minimum of two (2) 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 $2,000,000 or a total of $6,000,000 for the projects submitted, and the following example building types:
- Excavation, grading, paving and surface work for parking or roadways
- Irrigation, landscaping and underground utility installation.
- Other engineering projects that contain a high degree of technical complexity and
Such projects should have possessed the following construction challenges:
- Urban site work with limited construction and staging areas
- Construction requiring proactive and innovative solutions due to noise, dust, and pedestrian traffic while nearby buildingsare occupied
- Construction 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:
- Phased construction of underground utilities adjacent to existing 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.
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
PROJECT DATA SHEET
(A separate sheet must be prepared for each project submitted.)
1.Project Name:______
2.Project Location:______
3.Project Description:______
4.Constr. Type:
5. Size (gross square feet): ______
- What was your company’s role on this project?
Prime (General) Contractor
Subcontractor to GC
2nd Tier Subcontractor
3rd Tier Subcontractor
Prime Subcontractor to Owner
Other: ______
List the Business Entity (name) your company used to perform work for this project: ______
7.If the entity submitting this prequalification questionnaire is a Joint Venture, did the Joint Venture entity itself construct and manage this project?
YES NO N/A
8.How is this project comparable to the OPP PARKING & PATIENT DROP-OFFproject? ______
______
9.Was the project completed within budget?
Cost At Bid:$
Cost At Completion:$
Explanation: ______
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
10.For any differing amount between cost at completion and cost at bid, distribute the sources and/or causes of these changes into the following categories:
Document Problems:$
Unforeseen Conditions:$
Owner Generated Scope:$
Regulatory Agency:$
Other:$
11.Was construction begun and completed within the last ten (10) years?
YES NO
12.Was the project completed within the original contract time or the adjusted contract time?
YES NO
If completion did not occur within the original or the adjusted contract time, indicate elapsed time in whole calendar days between original or adjusted contract time and actual final completion. For projects that have not reached final completion, indicate current status with respect to contract time:
______
13.Did the project include occupied adjacent facilities?
YES NO
If “Yes,” explain: ______
______
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.Did the project contain any complex construction phasing requiring the continued operation of a facility?
YES NO
If “Yes,” explain: ______
______
16.Was the project for a university or public institution?
YES NO
17.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.)? ______
18.Did the project include adherence to critical path scheduling?
YES NO
19.Did the project include a quality control/quality assurance program?
YES NO
If “Yes,” explain: ______
20.Did the project include California Division of State Architect Handicapped Accessibility Compliance review and approval?
YES NO
21.Did the Owner assess any back-charges?
YES NO
If answer is “Yes,” explain: ______
22.Did the Owner assess any liquidated damages?
YES NO
If answer is “Yes,”explain: ______
23.Name of Project Executive:______
Qualifications of this Project Executive:______
______
24.Name of Project Manager: ______
Qualifications of this Project Manager: ______
______
25.Name of Project Superintendent: ______
Qualifications of this Project Superintendent: ______
______
26.Name of Project Engineer: ______
Qualifications of this Project Engineer: ______
______
27.Did your firm self-perform any of the work?
YES NO
If “Yes,”please specify the trades you self-performed or have the capability to self-perform:
______
______
______
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
Client Firm Name:Client Contact: / Title:
Client Address: / City, State Zip
Client Phone: / Client Fax:
Client 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.)
General ContractorPage 1 of 24Prequalification Questionnaire
GC P/Q Quest
(UCSD Rev. 01/26/2016)
OPP PARKING & PATIENT DROP-OFFPROJECT NO. 4973/A4L-430/965080
UCSD MEDICAL CENTER – LA JOLLA
university of california, san diego
If this project is UNDER $5M, delete thefollowing 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 one (1) comparable project.
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.