PREQUALIFICATION DOCUMENTS by A2u4DNV

VIEWS: 25 PAGES: 22

									Faculty Club - Flat Roofs                                                            PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




                                  ROOFING CONTRACTOR
                             PREQUALIFICATION QUESTIONNAIRE



                                                  FOR

                                          Faculty Club
                                       PROJECT NO. 12527A




                                    University of California, Berkeley
                                         CAPITAL PROJECTS
                                   1936 University Avenue, 2nd Floor
                                      Berkeley, CA 94704-7027


                                               April, 2012




MANDATORY PREQUALIFICATION CONFERENCE:
April 12, 2012, at 2:00pm - Faculty Club south entry

SECOND MANDATORY PREQUALIFICATION CONFERENCE:
April 19, 2012, at 10:30am - Faculty Club south entry

SUBMITTAL DATE:
MAY 3, 2012, by 2:00pm – Capital Projects Contract Administration office, 1936 University
Avenue, Room 250, Berkeley, CA 94704




                    Page 1 of 21                                    Revised 041612
Faculty Club - Flat Roofs                                                                                          PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




                                                        TABLE OF CONTENTS




0. ADVERTISEMENT ............................................................................................................... 3

I.   GENERAL ............................................................................................................................ 5

II. PREQUALIFICATION QUESTIONNAIRE ............................................................................ 6

III. CONSTRUCTION EXPERIENCE ....................................................................................... 17

IV. KEY PERSONNEL ............................................................................................................. 22

V. FALSE CLAIMS HISTORY ................................................................................................ 22

VI. REQUIRED COMPLETED ATTACHMENTS ..................................................................... 22

VII. DECLARATION ................................................................................................................. 23

VIII.PREQUALIFICATION CHECKLIST/ANALYSIS ................................................................ 24




                              Page 2 of 21                                                      Revised 041612
Faculty Club - Flat Roofs                                                                     PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY


                  ADVERTISEMENT FOR ROOFING CONTRACTOR PREQUALIFICATION

Subject to conditions prescribed by the undersigned, responses to University’s prequalification documents are
sought from Contractors for the following work:

                                           Faculty Club - Flat Roofs
                                           Berkeley, Alameda County
                                             PROJECT NO. 12527A

PREQUALIFICATION OF PROSPECTIVE ROOFING CONTRACTORS:                              University has determined that
contractors who submit bids on this Project must be prequalified.

LICENSES: To become prequalified, interested contractors must possess a current California
contractor’s license, C-39 Roofing License Classification.

DESCRIPTION OF THE WORK:
The proposed project will reroof the majority of the flat roofs on the Faculty Club, a historic structure on the
Berkeley campus of the University of California. The work will involve substantial reframing of the existing roof
and restoration of existing historic finishes.

Interested firms may obtain Prequalification Documents on April 10, 2012 at:

                                            CAPITAL PROJECTS
                           UNIVERSITY OF CALIFORNIA, BERKELEY CAMPUS
            Contract Administration, 1936 University Avenue, Room 250, Berkeley, CA 94704-7027
                                         Telephone: (510) 642-6273.

                  Or to obtain an electronic copy of the Prequalification Documents, please see
                                   http://www.cp.berkeley.edu/AdsForBids.html

A MANDATORY Prequalification Conference will be conducted on April 12, 2012, at 2:00 pm, at the Faculty
Club, on the central UCB campus. Attendance at the Prequalification Conference is mandatory for Contractors
attempting to become prequalified to bid on this project.


A SECOND MANDATORY Prequalification Conference will be conducted on April 19, 2012, at 10:30 am, at the
Faculty Club, on the central UCB campus. Attendance at the Prequalification Conference is mandatory for
Contractors attempting to become prequalified to bid on this project. Those who attended the April 12, 2012
meeting need not attend.

Contractors may find that parking may be difficult. The Owner recommends that you allow ample time to drive
to the area of College Avenue and Bancroft Way, Berkeley, find a parking space, and walk to the building
(approx. 3 minute walk from College & Bancroft), and locate the building’s south entry, at which the mandatory
Prequalification Conference will be held. (Note: Public parking is available on the street, in the south of campus
area.) Contractors arriving late after the mandatory Prequalification Conference has commenced (i.e., more
than 15 minutes after the published starting time) will not be allowed to submit a Prequalification Questionnaire
for this project. Contractors must be present for the entire Prequalification Conference.

Submittal of Prequalification Submittals to permit a contractor to bid the project will be received at:

                                            CAPITAL PROJECTS
                           UNIVERSITY OF CALIFORNIA, BERKELEY CAMPUS
            Contract Administration, 1936 University Avenue, Room 250, Berkeley, CA 94704-7027
                                         Telephone: (510) 642-6273

until 2:00 pm, May 3, 2012.
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Faculty Club - Flat Roofs                                                                   PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY


No Prequalification Submittals will be received after 2:00 pm, May 3, 2012.

Confidentiality of the information provided will be respected to the extent permitted by law.

QUESTIONS: Only written inquiries will be permitted. Questions must be submitted in writing, and received by
5:00 pm, April 26, 2012, and will be acceptable by US Mail, email or fax to the Project Manager. Project
                                                                                                           nd
Manager and Owner contact is Richard Larson, UC Berkeley Capital Projects, 1936 University Avenue, 2
Floor,  Berkeley,    CA      94704-7027,      telephone:   510-643-5434,   fax:     510-642-7271,      email:
rlarson@cp.berkeley.edu.

All information requested in these forms must be provided in order to be considered "responsive" to the
requirements of prequalification.

THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Revised April 16, 2012




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Faculty Club - Flat Roofs                                                                   PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



GENERAL DESCRIPTION OF WORK

Project Description

The proposed project will reroof the majority of the flat roofs on the east side of the Faculty Club, a historic
structure on the Berkeley campus of the University of California. The work will involve substantial reframing of
the existing roof and restoration of existing historic finishes. Work includes, but is not restricted to, roof beam
structural repairs, a cold-applied SBS-modified bitumen roofing system and a liquid-applied reinforced
polymethylmethacrylate (PMMA) coating and flashing system. The contractor must be approved and certified
by the manufacturer that can provide both systems.

Wiss Janey Elsner is the Architect for this project.

The successful Proposer will be required to show evidence of the following lines of insurance at the time of
award: General Liability, Auto Liability, Worker’s Compensation.




                        Page 5 of 21                                       Revised 041612
Faculty Club - Flat Roofs                                                                PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY

I.     PROCESS

       The prequalification process is as follows:
     A. Questionnaire
        Provide all requested information, as applicable, on the questionnaire. Any prospective contractor
        failing to do so may be deemed non-responsive with respect to the prequalification process for this
        project. 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.

        Availability of Prequalification Questionnaires:
        On April 10, 2012, Prequalification Questionnaires will be issued to interested contractors at
        University of California, Berkeley, Capital Projects Contract Administration, 1936 University Avenue,
        Room 250, Berkeley, CA 94704-7027. Prequalification documents may be downloaded from our
        website: http://www.cp.berkeley.edu/AdsForBids.html#Prequalification.
        For information, contact Pam Sasagawa - Contract Administrator at (510) 643-9116 or
        psas@berkeley.edu.
     B. Mandatory Prequalification Conference
        Contractors interested in prequalifying to propose on this project are required to attend the
        Mandatory Prequalification Conference scheduled on April 12, 2012, beginning promptly at 2:00
        P.M. Contractor’s failing to sign in on the official attendance sheet at the prequalification
        conference will not be eligible to participate in the prequalification process.
        A second Mandatory Prequalification Conference will be held on April 19, 2012, beginning
        promptly at 10:30 A.M. Contractor’s failing to sign in on the official attendance sheet at the
        prequalification conference will not be eligible to participate in the prequalification process.
        Contractors who attended the April 12, 2012 meeting need not attend.
        Participants shall meet at: the Faculty Club, on the campus of the University of California,
        Berkeley, CA 94704-7027. Meet just outside the south entry to the Club.
     C. Submittal Procedures and Deadline
        Contractors interested in prequalifying to propose on this project must submit a completed
        Prequalification Questionnaire. The University is not responsible for any costs that contractors
        may incur to complete the prequalification process. All applicable portions of the attached forms
        shall be completed with attachments if the space provided on the questionnaire is not sufficient.
        QUESTIONNAIRES FAILING TO CLEARLY PRESENT ALL OF THE REQUESTED
        INFORMATION, OR THAT ARE NOT IN THE FORMAT REQUESTED MAY BE CONSIDERED
        NON RESPONSIVE AND REJECTED ON THAT BASIS. Each copy of the submittal must be
        complete and fully responsive to the requirements of the Prequalification Questionnaire.




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Faculty Club - Flat Roofs                                                              PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



       Prequalification Questionnaires must be received at: University of California, Berkeley, Capital
       Projects Contract Administration, 1936 University Avenue, Room 250, Berkeley, CA 94704-7027.
       Attention: Pam Sasagawa, Contract Administrator
       Provide one (1) original and two (2) copies of the Prequalification Questionnaire. Submittals must
       be received at the above address no later than 2:00pm, on MAY 3, 2012.

       Prequalification Questionnaire submittals must indicate the contractor’s name and address
       using the following format:
      PREQUALIFICATION QUESTIONNAIRE
      Company Name and Address:
      Project Name: Faculty Club - Flat Roofs
      Due Date and Time: MAY 3, 2012, at 2:00pm.




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Faculty Club - Flat Roofs                                                               PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



      Contractors shall assume full responsibility for timely delivery at the location designated for receipt
      of Prequalification Questionnaires. ORAL, TELEPHONIC, FACSIMILE, TELEGRAPHIC, OR E-
      MAILED PREQUALIFICATION QUESTIONNAIRES ARE INVALID AND WILL NOT BE
      ACCEPTED. NO PREQUALIFICATION DOCUMENTS WILL BE ACCEPTED AFTER THE DUE
      DATE AND TIME.
   D. Rating and Evaluation Procedures
       Prospective Roofing Contractors are advised that construction experience and key personnel will be
       scored. To become prequalified to bid, Contractors must achieve at least 85 points out of 100. See
       attached Prequalification Analysis sample.

      1. To be selected to bid, a prospective Contractor must:
         a) CONSTRUCTION EXPERIENCE: Have demonstrated sufficient project experience as roofing
             contractor. The projects submitted will receive points based on the extent to which they meet the
             listed criteria. Contractors must demonstrate experience with both cold-applied SBS-modified
             bitumen and PMMA coating and flashing systems.
         b) KEY PERSONNEL: Demonstrate experience by contractor’s Key Personnel – see Section
             IV, Key Personnel (information submitted will receive points based on experience).
             Proposed staff members must be current employees of the proposing firm.
         c) LICENSE: Hold the proper license, current and active.
         d) SURETY: Submit a notarized statement from the proposed surety(ies) that states:
                  i.   Contractor’s current available bonding capacity meets or exceeds the minimum
                       capacity described in the Questionnaire.
                 ii.   Contractor’s total bonding capacity.
                iii.   Surety(ies) proposed to be used on the project is an admitted surety insurer as
                       defined in the California Code of Civil Procedure Section 995.120.
                iv.    Surety (ies) acknowledges its intent to provide bonding of the Project in the event
                       Contractor is awarded the Project.
         e) INSURANCE: Submit a written declaration from its insurance agent/broker/carrier stating
             that the Contractor is able to obtain insurance that meets or exceeds the limits and ratings
             required for this project. Submit a copy of Contractor’s insurance certificate.
         f) ANNUAL REVENUE: Submit financial statements including annual revenue for the years
             2009 through 2011 and schedule indicated contracts awarded to you.
         g) Submit all requested information that is current, accurate, and complete.
      2. To be prequalified, a prospective contractor must not have:
          a) EXPERIENCE MODIFIER RATE: An Experience Modifier Rate (EMR: Workers’ Comp) injury
              rating above 1.0 for 3 or more of the past five years.
          b) SURETY: A surety complete work on any contract within the past ten years.
          c) CONTRACTOR LICENSE BOARD DISCIPLINARY PROCEEDINGS: A Contractors State
             License Board disciplinary action in the past ten years.
          d) FALSE CLAIMS HISTORY: Contractor must not have submitted a false or fraudulent claim
             within the past ten years.

      After review of the Prequalification Questionnaire, the University may request clarifying
      information. The Questionnaire must be complete and address all the stated requirements.




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Faculty Club - Flat Roofs                                                              PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



      Contractors will be notified of their prequalification status after evaluation of the Prequalification
      Questionnaires.
      Prospective contractors that do not prequalify as a result of their response to the Questionnaire
      will receive written notice from the University. If the bidder can refute some of the facts upon
      which the above determinations were based, the bidder may request a review by the Facility. The
      decision resulting from such review is final and is not appealable within the University of California.
      The University reserves the right to reject any or all responses to Prequalification Questionnaires
      and any or all proposals and to waive any non-material irregularities in any response or proposal
      received.

      Contractors that successfully prequalify will be invited to bid the project. Additional information
      and details regarding bids will be provided to prequalified contractors.




                                [THIS SPACE LEFT INTENTIONALLY BLANK]




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Faculty Club - Flat Roofs                                                             PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



II. PREQUALIFICATION QUESTIONNAIRE

       All information requested must be furnished on the forms provided below and must be
                                 completed in order to prequalify.

   A. COMPANY NAME AND ADDRESS

        Company
          Name:


                                  Telephone                           Facsimile

  Street Address:                                               ,                               ,
                                  Street Address                     City & State                     Zip Code



   B. CONTACT INFORMATION

   Contact Person
        #1:
                                         Name, Title                Telephone                       Email
   Contact Person
        #2:
                                         Name, Title                Telephone                       Email


   C. ENTITY SUBMITTING THIS PREQUALIFICATION QUESTIONNAIRE

  Parent Company:                 Subsidiary:          Other:
                                                                                (Please list)
   Branch Office:                    Division:


   D. TYPE OF BUSINESS ORGANIZATION

  Corporation:                     State of Incorporation:
  Partnership:
  Sole Proprietorship:                           Other:
                                                                         (Please list)

    President’s Name:
    Vice President’s Name:
    Secretary’s Name:
    Treasurer’s Name:



   E. YEAR COMPANY WAS ESTABLISHED

    Year established:
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Faculty Club - Flat Roofs                                                             PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



   F. PARENT COMPANY INFORMATION (if applicable)

          Company
            Name:


                                   Telephone                            Facsimile

    Street Address:                                          ,                               ,
                                   Street Address                      City & State                Zip Code
    Contact Person:
                                             Name, Title                                 Telephone

   G. LIST ALL FORMER COMPANY NAMES




   H. LICENSE

      Contractor must have a current and active California State Contractors license with a “C-39”
      Roofing Contractor Classification for this Project.

               ALL LICENSES MUST BE CURRENT AND ACTIVE THROUGHOUT THE PROJECT.

      Does your firm have the required current and active California State Contractors
      license?                                                                               Yes       No


           (Name of Licensee as it appears on record with the California Contractors State License Board)

      License No.                         Issue Date:             Expiration Date:
      License Class/Classes:
      Description of Classification(s):
      Description of Certification(s):



      Has the above contractor license(s) been suspended or revoked by the California Contractors
      State License Board within the past ten years?
                                                                     Yes          No
        If yes, please explain:




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Faculty Club - Flat Roofs                                                                       PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY


   I.   CONTRACTORS LICENSE BOARD DISCIPLINARY PROCEEDINGS

        Has your company, during the past ten years, received any disciplinary action from the California
        Contractors State License Board?    Yes           No

         If yes, give details including dates:

   J. DEBARMENT

        Is your company currently debarred by any Federal, State or local agency?                 Yes          No

         If yes, give details including dates:


   K. SURETY

        List below all Surety companies used by your company within the past ten years (2002 – 2012)
        and state whether the Surety had to complete any part of your work including, but not limited to
        warranty-related repairs or other defective workmanship on any contract within the past ten years:

   Current Surety
   Company:
                                                          Surety’s Name                                   Telephone

        Street Address:                                                    ,                               ,
                                         Street Address                              City & State              Zip Code

                                                Has listed Surety Company completed work
                                                                                                        Yes         No
             Period Covered                    for your Company within the past ten years?


                     (If more space is needed, provide the information your company’s letterhead
                  with reference to the project name and number and attach it to this Questionnaire.)

   L. FINANCIAL CAPABILITY
        Attach a notarized statement from the surety (ies) that states: (i) current available bonding
        capacity meets or exceeds $1 million; (ii) total bonding capacity; (iii) Surety(ies) proposed to be used
        on the project is an admitted surety insurer as defined in the California Code of Civil Procedure
        Section 995.120; and (iiii) Surety(ies) acknowledges its intent to provide bonding of the Project in the
        event contractor is awarded the Project.

   M. FINANCIAL DATA
        Specify your company’s total and current available bonding capacity. Contractor may include 2012
        fiscal year data if available.


                                     Provide copies of audited Profit and Loss Statements for the past
          Financial Statement(s):
                                     three years of operation.




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Faculty Club - Flat Roofs                                                                     PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY

   N. INSURANCE
      The successful Contractor for this Project will be required to furnish certificates of insurance on
      University’s form evidencing that it shall furnish and maintain Commercial Form of General Liability,
      Excess Liability (if applicable), Business Automobile Liability, Pollution Liability, and Workers’
      Compensation insurance in the amounts below.
      The insurance required for Commercial Form General Liability, Excess Liability, Business Automobile
      Liability, and Pollution Liability Insurance shall be issued by companies with a Best rating of A- or better,
      and a financial classification of VIII or better (or an equivalent rating by Standard & Poor or Moody’s)
      written for not less than the following:
                                                                                                    Minimum
             COMMERCIAL FORM GENERAL LIABILITY INSURANCE – Limits of Liability                    Requirements
               Each Occurrence – Combined Single Limit for Bodily Injury and Property Damage:       $3,000,000
                                                   Products-Completed Operations Aggregate:         $5,000,000
                                                               Personal and Advertising Injury:     $1,000,000
                                                                           General Aggregate:       $5,000,000

                                                                                                   Minimum
                    BUSINESS AUTOMOBILE LIABILITY INSURANCE – Limits of Liability                 Requirement
                  Each Accident – Combined Single Limit for Bodily Injury and Property Damage:      $2,000,000

                                                                                                   Minimum
                                 POLLUTION LIABILITY INSURANCE – Limits of Liability              Requirement
                                                                            Each Occurrence:        $1,000,000
                                                  Products-Completed Operations Aggregate:          $1,000,000
                                                                          General Aggregate:        $1,000,000

                         WORKERS’ COMPENSATION – As required by Federal and State of California law
                                                                                                   Minimum
                                             EMPLOYER’S LIABILITY – Limits of Liability           Requirement
                                                                              Each Employee:        $1,000,000
                                                                               Each Accident:       $1,000,000
                                                                                  Policy Limit:     $1,000,000
      Insurance required for Workers’ Compensation and Employer’s Liability Insurance shall be issued by
      companies that have a (i) Best rating of B+ or better, and a financial classification of VIII or better (or an
      equivalent rating by Standard & Poor or Moody’s) or (ii) that are acceptable to the University. Such
      insurance shall be written to be not less than (as required by Federal and State of California law).

      1.   Is your firm able to obtain the insurance in the required limits and ratings from companies that
           meet the criteria stated above? Yes         No

      2.   If “yes,” provide declaration(s) from your insurance agent/broker/carrier stating that your firm is
           able to obtain insurance coverage in the limits and ratings stated above from the insurance
           companies required for this Project.
      3.   Provide a copy of your company’s insurance certificate.




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Faculty Club - Flat Roofs                                                                     PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY



   O. EXPERIENCE MODIFICATION RATE

      List your company’s Workers’ Compensation Experience Modifier Rate for the past five years:


           2007:             2008:               2009:              2010:               2011:

      Submit a letter from your Workers’ Compensation carrier showing your Experience
      Modification rate for the past ten years.

       If the Modification Rate has been above 1.0 for more than one year, provide an explanation,
       including dates:


   P. UNSETTLED WARRANTIES OR CLAIMS

      Provide the following information if contractor has unsettled/pending claims, demands or notices of
      default issued by the University of California for University projects:

                UC Campus Name:
         Facility’s Contact Person:
                      Project Name:
                    Project Number:
                  Recorded Date of
                       Claim/Notice:
                  Type of Warranty:
                     Basis of Claim:



      Status of Unsettled Warranty:




                   (If more space is needed, provide the information your company’s letterhead
                with reference to the project name and number and attach it to this Questionnaire.)




    If the Contractor does not have any unsettled/pending claims, demands or notices of default,
    please indicate “None” in the space provided:




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Faculty Club - Flat Roofs                                                                        PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




III.      CONSTRUCTION EXPERIENCE

       A. PROJECT COMPLETION

          Has your company failed to complete a Contract or been removed from a project within the past ten
          years? Yes     No

           If yes, give details including dates:



                         (If more space is needed, provide the information your company’s letterhead
                      with reference to the project name and number and attach it to this Questionnaire.)

       B. LIQUIDATED DAMAGES

          Has contractor been assessed liquidated damages for failing to complete a contract within the time
          specified in the contract documents since within the past ten years? Yes   No

           If yes, give details including dates:



                         (If more space is needed, provide the information your company’s letterhead
                      with reference to the project name and number and attach it to this Questionnaire.)




                                [THIS SPACE LEFT INTENTIONALLY BLANK]




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Faculty Club - Flat Roofs                                                                  PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY


   C. COMPLETED CONSTRUCTION PROJECT EXPERIENCE

      1. Contractor Construction Experience:
              a. Submit a minimum of 3 and maximum of 7 projects completed, or substantially
                 completed, in the past 5 years that meet the criteria listed below and demonstrate
                 the contractor’s ability to successfully complete the project with respect to project size,
                 cost, use, complexity, etc.

              b. Projects presented for consideration must be submitted on the forms attached to this
                 section.


           All projects presented for consideration must be completed for commercial, industrial, public
           agency or institutional clients. All projects should be performed in the State of California.
                   Three (3) roofing projects installing SBS-modified bitumen roofing membrane, and
                    SBS-modified/fluid applied roofing membrane.

                   One (1) project should include a liquid-applied reinforced
                    polymethylmethacrylate (PMMA) coating and flashing system.

                   For the cold-applied SBS-modified bitumen system, the contractor should have
                    10 years of experience applying cold-applied SBS-modified roofing systems.

                   For the PMMA system, the contractor should have 5 years of experience
                    applying liquid-applied PMMA flashings.

                   One (1) project should be on a historic wood frame structure and have included
                    the replacement of historic finishes.

                   One (1) project located within the greater San Francisco Bay Area for which the
                    construction cost exceeded $300,000.

                   One (1) project should include significant carpentry work as part of the roofing
                    project

                   One (1) project should include restricted site access and staging space.




              c. In addition, submit a comprehensive list, including University’s Representative contact
                 information, of all projects completed for The Regents of the University of California
                 (including LBNL, LLNL) within the past seven (7) years. Provide name, date of
                 completion and University’s Representative name and current phone number.
              d. If your firm provides inaccurate or incomplete information, your firm will be found non-
                 responsive. If your firm receives negative project references, your firm may be found
                 non-responsive.
              e. Use the Project Data sheets for all submitted projects




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   Faculty Club - Flat Roofs                                                                             PROJECT NO.: 12527A
   UNIVERSITY OF CALIFORNIA, BERKELEY



                                                   PROJECT DATA SHEET
                                               Verify all contacts prior to submittal.
                             Do not leave any spaces blank. Responses such as “N/A” are not acceptable.
                          If not applicable, state “Not Applicable” and explain why. If none, state “NONE.”


      Project Name:
Project or Contract Number:

     Project Location:                                                       ,                           ,
                                          Street Address                             City & State                Zip Code



Owner Information:                                                   Contact Person:
                                   Owner’s Name                                                         Name & Title
    Address:                                                                 ,                           ,
                                      Street Address                                 City & State                Zip Code

   Telephone:                                   Facsimile:                                Email:



                                 Address of Contractor’s Office that Performed the Work:

                                                                 ,                                  ,
                         Street Address                                          City & State                   Zip Code


 Contact Person:                                                       Telephone:
                                                                 Name & Title

Facsimile:                                             Email:

     Name of Contractor’s Project Manager for project:

     Name of Contractor’s Superintendent for project:



   Design Firm:                                                        Contact Person:
                                                                                                         Name & Title
    Address:                                                             ,                               ,
                                     Street Address                                  City & State                Zip Code

   Telephone:                                   Facsimile:                                 Email:

    Name of Design Firm’s Project Manager for project:




                                                                                                                Data Sheet P. 1 of 2



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    Faculty Club - Flat Roofs                                                                          PROJECT NO.: 12527A
    UNIVERSITY OF CALIFORNIA, BERKELEY


                                                       PROJECT DATA SHEET


Contract Time:

                                                             Scheduled Completion
          Start Date:                                               Date:
                                  Month/Day/Year                                                  Month/Day/Year

Actual Completion Date:                                            Days Extended due to Unexcused Delays:
                                            Month/Day/Year


Contract Amount:
                    $                                          $                                        $
                    Base Amount                     Adjustment Due to Change Orders             Final Contract Amount


Project Information:
Type of Project:         New                          Remodel/Renovation
Type of Facility:        Commercial                   Industrial              Public Agency                 Institutional
Did this project include SBS-modified bitumen roofing membrane, and
SBS-modified/fluid applied roofing membrane?

Firm’s years’ experience applying this system:

If yes, please describe the process.

Did this project include PMMA coating and flashing system?

Firm’s years’ experience applying this system:

If yes, please describe the process.
Was this project located in the SF Bay Area with a construction
                                                                                          Yes                  No
value greater than $300,000?
If yes, please describe the scope.

Was this project for a historic structure?                                                Yes                  No

If yes, please describe your firm’s activities and responsibilities in each phase

Did this project include restricted site access and staging space?                        Yes                  No

If yes, please describe your firm’s methods for managing both
Did this project include significant carpentry as part of the roofing
                                                                                          Yes                  No
project?
If yes, please describe the scope.



                                   Provide a brief description and photos of the project if possible.
                        Verification of all submitted material may be requested from the contacts provided.


                                                                                                               Data Sheet P. 2 of 2
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Faculty Club - Flat Roofs                                                                        PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




   D. SUPPLEMENTAL COMPANY INFORMATION

      1. Safety Program

          a. Does your company have a written Injury and Illness Prevention Program (IIPP) that
               complies with California Code of Regulations, Title 8 Sections 1509 and 3203?
               Yes      No

          b. Does your company have personnel permanently assigned to safety?
               Yes       No

          If yes, state the names of all personnel who are assigned and list their specific duties:

           Name:                                                       Title:


           Specific Duties:



           Name:                                                       Title:


           Specific Duties:

          c.   Have you had accidents, which resulted in a construction fatality, on any of your projects
               within the last five (5) years? Yes    No
               If yes, please provide additional information.


          d. Have you had Cal-OSHA fines in the Serious, Repeat or Willful categories?
             Yes     No     If yes, please provide additional information.


                     (If more space is needed, provide the information your company’s letterhead
                 with reference to the project name and number and attach it to this Questionnaire.)




                      Page 19 of 21                                             Revised 041612
Faculty Club - Flat Roofs                                                                 PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




IV.   KEY PERSONNEL
      List all key personnel who will be assigned to this project and their relevant experience.
      Proposed staff members must be current employees of the proposing firm. Additional staff
      may be requested at the time of bid.

             Project Manager
             Project Superintendent



V.    FALSE CLAIMS HISTORY

      Can you truthfully state that your firm has not been found in a final decision of a court to have
      submitted a false or fraudulent claim to a public agency (e.g., federal, state, county, city, University of
      California System, California State University System, etc. within the last ten years ?      Yes        No


      If NO, please provide additional information.




VI.   REQUIRED COMPLETED ATTACHMENTS

      1. Notarized Statement from Surety stating:
         a. current available bonding exceeds $1 million;
         b. total bonding capacity;
         c. Surety(ies) proposed to be used on the project is an admitted surety insurer as defined in
            the California Code of Civil Procedure Section 995.120;
         d. Surety (ies) acknowledges its intent to provide bonding of the Project in the event
            Contractor is awarded the Project.
      2. Audited Profit and Loss Statements.
      3. Written declaration from your insurance agent/broker/carrier stating that your firm can obtain
         insurance coverage in the required limits and ratings for the project.
      4. Insurance Certificate.
      5. Letter from Workers’ Compensation carrier evidencing your EMR for the past five years.
      6. Project Data Sheets for projects managed, constructed, and completed in the past five (5)
         years.
      7. Staff resumes of all proposed Key Personnel.




                     Page 20 of 21                                       Revised 041612
Faculty Club - Flat Roofs                                                                     PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




                                                DECLARATION


I,                                             hereby declare that I am the
                  Printed Name                                                                    Title
of                                                          submitting this Prequalification Questionnaire; that I
                        Company Name
am duly authorized to execute this Questionnaire on behalf of Contractor; and that all information set forth in
this Questionnaire and all attachments hereto are, to the best of my knowledge, true, accurate, and
complete as of its submission date.

I declare, under penalty of perjury, that the foregoing is true and correct and that this declaration was executed
at                                                                County of
                          Location and City                                                    County

State of                                          on                                                    .
                            State                                          Date




                                                                                     Signature




                                                                                   Printed Name
     If signed by other than the sole proprietor, a general partner, or corporate officer, attach
                   original notarized power of attorney or corporate resolution.




                        Page 21 of 21                                        Revised 041612
Faculty Club - Flat Roofs                                                                                                                                                                                                         PROJECT NO.: 12527A
UNIVERSITY OF CALIFORNIA, BERKELEY




Construction Experience Checklist
      Instructions: List Projects below. Check off applicable experience for each project. Each Relevant Construction Experience column should have at
      least one check.


                                                                                                                                                                               Relevant Construction Experience

           Maximum Attainable Points    10                       10                       10                      10                5                5                          5                        10                       10               5                         5                                        5                 10                               100




                                                                                                                                                     Historic Wood Structure
                                         SBS-modified biument1

                                                                  SBS-modified biument2

                                                                                          SBS-modified biument3




                                                                                                                                                                                                         10 yrs SBS-mod bit exp
                                                                                                                                                                                Restricted Site Access




                                                                                                                                                                                                                                                                             All UC work submitted
                                                                                                                                                                                                                                                   Significant carpentry
                                                                                                                  PMMA system exp

                                                                                                                                    >$300K in SFBA




                                                                                                                                                                                                                                                                                                                      Project Manager
                                                                                                                                                                                                                                  5 yrs PMMA exp




                                                                                                                                                                                                                                                                                                     Key Personnel:




                                                                                                                                                                                                                                                                                                                                        Superintendent




                                                                                                                                                                                                                                                                                                                                                                         Points
               Project Name                                                                                                                                                                                                                                                                                                                              NOTES

  1

  2

  3

  4

  5

  6

  7
                                                                                                                                                                                                                                                                                                                                                          Total Points
                                                                                                                                                                                                                                                                                                                                                            Achieved


                                                                 Page 22 of 21                                                                                                                                                                                             Revised 041612

								
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