ENGINEERING VI - PHASE 2 University of California, Los ...CM).pdfCM/Contractor Prequalification Questionnaire ... ENGINEERING VI - PHASE 2 Project Number ... regardless of whether

ENGINEERING VI - PHASE 2 University of California, Los Angeles Project No. 940252.01

02/24/12 CM/Contractor: PQ CM/Contractor Prequalification Questionnaire - 1

CM/CONTRACTOR PREQUALIFICATION QUESTIONNAIRE (Utilizing Best Value Selection Methodology)

for ENGINEERING VI - PHASE 2 Project Number 940252.01

(Email Address)

(Telephone Number) (License Number)(Fax Number)

(Full Address)

(Contact Name)

SUBMITTED BY:

(Entity Name. If a Joint Venture, state name of JV Entity)

As used herein, the term “entity” means the prospective CM/Contractor Bidder submitting this Prequalification Questionnaire regardless of whether the entity is an individual company, joint venture, or partnership. Please note that the term “prospective CM/Contractor Bidder” may sometimes be used interchangeably with the term “entity” or “Bidder.”

Each prospective Bidder must answer all of the following questions and submit all requested information, where applicable. Any prospective Bidder failing to do so will be deemed to be not responsive and not responsible with respect to this Prequalification at the sole discretion of the University of California. In addition, bidder must list accurate names and telephone numbers of applicable contact references. If University is unable, after reasonable efforts, to confirm the past project information submitted by bidder, said project will not be accepted as a qualifying project. All Bidders that have submitted a Prequalification Questionnaire will be notified in writing of whether or not they have successfully achieved Prequalification status. Prospective Bidders that affirmatively respond (i.e. answer YES) to all questions, submit all required information and supporting data, and are determined to have accurately responded to the questions will be prequalified. Only those Bidders that have been determined to be prequalified will be eligible to submit a bid for this Project.

If the prospective Bidder is determined by the University not to be prequalified, the prospective Bidder may request a review by the Facility. Any such request must be received by the Facility within 3 calendar days after receipt by the prospective Bidder of the determination. The decision resulting from such review is final and is not appealable within the University of California. Any person or entity not satisfied with the outcome of the prequalification must file a writ challenging the outcome within 10 calendar days from the date of the University's written notice regarding prequalification determination. Any assertion that the outcome of the prequalification process was improper will not be a ground for a bid protest.

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.

CM/Contractor selection will be based upon a Best Value methodology.

WHERE NECESSARY, COPY THE FORMS IN THIS PACKAGE. USE ONLY THESE FORMS.



1. CALIFORNIA CONTRACTOR LICENSE

Entity (or if entity is a joint venture, the joint venture entity and each member of the joint venture) must be a licensed contractor in California with a B License (General Building) classification. Additionally, Bidder (or if Bidder is a joint venture, the joint venture entity and each member of the joint venture) must never had its license revoked by the State of California Contractors State License Board (CSLB).

A. Submit a copy the current contractor license held by Bidder (or if Bidder is a joint venture, the joint venture entity and each member of the joint venture).

B. Can the entity truthfully state that the CSLB has never revoked its contractor license (or, if entity is a joint venture, of joint venture entity or any joint venture member)?

NO YES

2. SURETY

Prospective Bidder shall obtain and submit the Surety Declaration in the form shown on the next page, signed by an authorized representative of the surety proposed to be used for this project and notarized.

A. Is the surety to be used for this project authorized by the Insurance Commissioner to transact business in the State of California as an admitted surety insurer (as defined in the California Code of Civil Procedure Section 995.120)?

NO YES

B. Is the entity able to obtain bonding for $55,000,000? NO YES

C. Can the entity truthfully state that no surety has paid out any monies on claims on the performance bond issued by a surety for the benefit of the Owner arising out of the construction activities of the entity since January 1, 2007?

NO YES

D. Can the entity truthfully state that no surety has paid out any monies on claims on the payment bond issued by a surety for the benefit of the Owner arising out of the construction activities of the entity since January 1, 2007?

NO YES



SURETY DECLARATION:

FURNISH THIS DECLARATION TO YOUR SURETY(IES) FOR COMPLETION. DO NOT HAVE THE SURETY SUBMIT THIS INFORMATION DIRECTLY TO THE UNIVERSITY.

(ATTACH NOTARIZATION OF SURETY REPRESENTATIVE'S SIGNATURE)

(Representing [Surety Name])

(Address)

(City, State, Zip Code)

(Facsimile Number)

(Signature)

(State) on (Date).

The undersigned declares under penalty of perjury that the bonding capacity indicated above is true and

correct and that this Declaration was executed in (County)

(Name and Title - Printed or Typed)

(Entity Name)

(Telephone Number)



3. FINANCIAL STATEMENT

Entity must have a Current Assets to Current Liabilities ratio of at least 1.

A. Complete and submit (1) copy of the Contractor's audited Statement of Financial Condition (attached at the end of this Prequalification Questionnaire), and all information required with said document.

(NOTE: If Bidder is a joint venture, a statement must be filed for the joint venture entity itself.)

B. Can the entity truthfully state that it meets the minimum financial requirements set forth above? NO YES

4. OCCUPATIONAL SAFETY AND HEALTH QUALIFICATIONS

The minimum occupational safety and health qualifications for Bidder are as follows:

A. Bidder has no serious and willful violations of Part 1 (commencing with Section 6300) of Division 5 of the Labor Code during the five (5)-year period prior to execution of this certification.

B. Bidder has maintained a Workers' Compensation Experience Modification Rate (EMR) that averages below 1.15 for the past five years. If Bidder has been in business for less than five years, then it must have maintained a workers' compensation Experience Modification Rate (EMR) that averages below 1.15 for all years they have been in business.

C. Bidder has instituted an injury prevention program pursuant to Section 3201.5 or 6401.7 of the Labor Code and will furnish University with a complete copy upon request.

Has the entity attached a copy of its EMR for the lesser of the past five years or for all years it has been in business? NO YES

Can the entity truthfully state that it meets the minimum occupational safety and health qualifications set forth above? NO YES



5. PRIOR CONSTRUCTION EXPERIENCE

Entity must have the minimum experience described below. Submit, on this form only (see Construction Experience Information Form on next two pages), proof of the following prior construction experience:

A. Bidder successfully completed (1) project meeting all of the following criteria: 1. Fully completed by Bidder in the United States since January 1, 2002; and 2. Work included the construction of new building or structure classified as Type I

construction; and 3. The building or structure was three or more stories in height; and 4. The building or structure was used for occupancy groups Type A and B; and 5. The total area of work performed by Bidder was at least 70,000 gross square

feet.

B. Bidder successfully completed (1) project meeting all of the following criteria: 1. Fully completed by Bidder in the United States since January 1, 2002; and 2. Work included construction of an auditorium or performing arts theater containing

at least 160 fixed seats; and 3. Work included the installation of audio visual components and specialty lighting

where specialty lighting is defined as lighting for broadcast, lecture or theatrical functions; and

4. The value of the work was at least $750,000.

C. Bidder successfully completed (1) project meeting all of the following criteria: 1. Fully completed by Bidder in the United States since January 1, 2002; and 2. Work included the construction of a new Type I building or structure of at least

70,000 gross square feet; and 3. Bidder prepared a Building Information Modeling (BIM) model for constructability,

coordination and clash detection; and 4. Bidder organized and implemented the use of the model in its entirety.

D. Bidder successfully completed (1) project meeting all of the following criteria: 1. Bidder submitted general contractor (GC) portion of LEED® NC or CI Certification

documentation to the U.S. Green Building Council (USGBC); and 2. The construction cost of said project was at least $40,000,000.

E. Bidder successfully completed (2) projects, meeting all of the following criteria: 1. Fully completed by Bidder in the United States since January 1, 2002; and 2. The work included construction of a new Type I building delivered as a CM at

Risk project; and 3. The preconstruction work scope included subcontractor procurement schedules,

construction schedules, cost estimating, constructability review, value engineering, preparation of subcontractor bid packages and a quality management program; and

4. The construction cost of said project was at least $40,000,000.

F. Bidder successfully completed (1) project meeting all of the following criteria: 1. Fully completed by Bidder in the United States since January 1, 2002; and 2. The work included construction of a new Type I building; and 3. The work included procurement of design build subcontractors for mechanical

electrical and plumbing trades; and 4. The construction cost of said project was at least $40,000,000.

NOTES: 1. "Fully completed" shall be defined as Bidder having completed all on-site work,

including punch list, and submitted all required close-out documentation to project owner or general contractor, as applicable.



2. Bidder, the licensed entity listed on Page 1 of this Questionnaire, must have been the contractor on each project submitted for consideration. Bidder may not use experience performed by a parent company, a sister subsidiary company, or a subsidiary to the Bidder. Additionally, Bidder may not use experience where Bidder was one member of a separately licensed joint venture entity.

3. If Bidder is a joint venture, all construction experience must have been performed by the joint venture entity itself.



Project Name Project Location (City & State)

Owner's Name & Telephone Owner's Contact Person's Name & Telephone

Design Professional's Contact Person's Name & Telephone

Design Professional's Name & Telephone

Project Start Date

CONSTRUCTION EXPERIENCE INFORMATION FORM (Copy Additional Pages as Needed)

1. Is all work, including punch list work, complete, and has all required close-out documentation been submitted to project owner? NO YES

Project Completion Date

2. Did work include the construction of a new building or structure classified as Type I construction? NO YES

NO YES

NO YES

NO YES

9. Did the work include the construction of a new Type I building or structure of at least 70,000 gross square feet? NO YES

4. Was the building or structure used for occupancy groups Type A and B? NO YES

5. Was the total area of work performed by Bidder at least 70,000 gross square feet? NO YES

3. Was the building or structure three or more stories in height?

6. Did the work include construction of an auditorium or performing arts theatre containing at least 160 fixed seats? NO YES

7. Did the work include the installation of audio visual components and specialty lighting where specialty lighting is defined as lighting for broadcast, lecture or theatrical functions?

8. Was the value of the work at least $750,000?

10. Did the Bidder prepare a Building Information Modeling (BIM) model for constructability, coordination and clash detection? NO YES

11. Did the Bidder organize and implement the use of the model in its entirety? NO YES



(BALANCE OF PAGE INTENTIONALLY LEFT BLANK)

NO YES

12. Did Bidder submit the general contractor (GC) portion of LEED® NC or CI Certification documentation to the U.S. Green Building Council (USGBC)?

NO YES

NO YES

NO YES

14. Did the work include construction of a new Type I building delivered as a CM at Risk project? NO YES

18. Did the work include procurement of design build subcontractors for mechanical, electrical and plumbing trades? NO YES

NO YES

NO YES

13. Was the construction cost of said project at least $40,000,000?

15. Did the preconstruction work scope include subcontractor procurement schedules, construction schedules, cost estimating, constructability review, value engineering, preparation of subcontractor bid packages and a quality management program?


17. Did the work include construction of a new Type I building?








Project Start Date





NO YES

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Email Address

Firm's Phone # Firm's License #Firm's Fax #

Firm Name and Full Address

Signed:

Printed Name and Title

PREQUALIFICATION DECLARATION

I, (Printed Name), hereby declare that I am

the (Title)

of (Name of Entity) submitting this Prequalification Questionnaire; that I am duly authorized to sign this Prequalification Questionnaire on behalf of the above named entity; 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).


06/12/12 Statement of Financial Condition (CM/Contractor) - 24

STATEMENT OF FINANCIAL CONDITION (CM/Contractor)

Email

Telephone Number

City, State, Zip Code

Address

SUBMITTED BY:

Firm Name

INSTRUCTIONS For Filing the

Contractor's Statement of Financial Condition

1. The Statement is used to give the University a financial record of the Contractor.

2. All questions contained in the Statement must be answered in complete detail.

3. Age of Financial Information: The Statement of Financial Condition required herein must show the condition of the business at the end of the Contractor's fiscal year immediately preceding the deadline for receipt of Qualification Documents. If Contractor's fiscal year ended more than 90 days prior to the deadline for receipt of qualification Documents, Contractor may, at its option, or if requested by University, Contractor shall be required to submit subsequent quarterly statements for consideration with the fiscal year statement. University's consideration of said quarterly statements shall be at its sole determination. Notwithstanding the foregoing, if the Contractor's immediately preceding fiscal year end occurs within 90 days prior to the deadline for receipt of Qualification Documents, and the required Statement of Financial Condition for the immediately preceding fiscal year has not been completed, then the Contractor shall submit the required Statement of Financial Condition showing the condition of the business at the end of the most recent date available, but not earlier than the end of the fiscal year immediately prior to the fiscal year preceding the deadline for receipt of Qualification Documents.

4. Number of copies required to be submitted: One.

5. Data Required: All applicable portions of the Statement must be completed, with schedule attached if the spaces provided in the Statement are not sufficient. In lieu of completing the specific schedules in the Statement of Financial Condition, the customary accountant's report and appropriate schedules must be submitted, provided they include all the information specifically requested in the Statement of Financial Condition.

Full financial statements shall be submitted for the last two (2) fiscal years of the Bidder.

6. Accounting Requirements of the Statement of Fiscal Condition: Audited Financial Statements prepared by a Certified Public Accountant are required for this project.

Fax Number



7. Contractor's Declaration (Corporation, Partnership, Individual, or Joint Venture, as applicable): The declaration appropriate to the nature of the Contractor's organization shall be fully completed and signed in the spaces provided.

8. If the Bidder is a joint venture, a Statement must be filed for each party of the joint venture. A full history of experience as this joint venture must be provided along with a proposed division of responsibilities and operations plan for this project.

9. The Contractor's Statement of Financial Condition shall be substantially in the form on Pages 3 and 4, and shall include items referenced in Paragraph 6 above. The Certified Public Accountant's report shall be included in the Financial Statement.

10. Any Contractor who fails to submit this Contractor's Statement of Financial Condition, including required attachments as stated above, with the Prequalification Statement will be considered ineligible to submit a bid for the Project.

END OF INSTRUCTIONS




STATEMENT OF FINANCIAL CONDITION

Email


Address

Banker

Firm Name

Telephone

Fax

Email


Address

Surety Company

Firm Name

Telephone

Fax

dateFinancial condition at close of business on:

1. Cash

2. Notes receivable

3. Accounts receivable from completed contracts

4. Sums earned on complete contracts

ASSETS Detail Total

Current Assets

5. Other accounts receivable

6. Advances to construction joint ventures

7. Material in stock not included in Item 4

8. Negotiable securities

9. Other current assets

Total Current Assets

10. Real Estate

11. Construction plant and equipment

12. Furniture and fixtures

13. Investment of a non-current nature

Fixed and Other Assets

14. Other non-current assets

Total Fixed and Other Assets

Total Assets



15. Current portion of notes payable, exclusive of equipment obligations and real estate encumbrances

16. Accounts payable

17. Other current liabilities

LIABILITIES AND CAPITAL Detail Total

Current Liabilities

Total Current Liabilities

22. Capital stock paid up

Capital and Surplus

23. Surplus (or net worth)

Total Capital and Surplus

Total Liabilities and Capital

18. Real estate encumbrances

19. Equipment obligations secured by equipment

20. Other non-current liabilities and non-current notes payable

21. Reserves

Other Liabilities and Reserves

Total Other Liabilities and Reserves

24. Liability on notes receivable, discounted or sold

25. Liability on accounts receivable, pledged, assigned or sold

26. Liability on bondsman

27. Liability on guarantor on contractor on accounts of others

CONTINGENT LIABILITIES

28. Other contingent liabilities

Total Contingent Liabilities

Notes: 1. Enter sums for numbered items 1 through 28 in shaded spaces in Detail column. Then enter total sums of main headings in shaded spaces in Total column.

2. A copy of the accountant's opinion or report must be attached to the Statement of Financial Condition. See Instruction 6 on Page 1.



DECLARATION For Individual, Partnership or Corporation)

(If an individual, doing business as:

declares: That I am (capacity) of the (entity) submitting the Contractor's Statement of Experience and Financial Condition; that I have read the Statement of Experience and all of the information furnished in it is true, and correct of my own knowledge; that I have read the Statement of Financial Condition and am familiar with the accounting records from which it was prepared; and that the Statement of Financial Condition is a true and accurate statement of (my or the) financial condition (of the partnership or firm) as of its date (any other representations deemed appropriate).

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was subscribed at:

State of on

For partnership only:

The foregoing declaration is hereby affirmed

(Remaining partners of firm sign here)

Name (name of Individual, Partner, or Officer)

(City) (County)

(Date)

(Individual, Partner or Officer must sign here)