GENERAL CONTRACTOR · Web viewThe selected Design-Builder will provide Schematic Design including...

DESIGN-BUILDER(General Contractor/Design Firm)

PREQUALIFICATION QUESTIONNAIRE

PROGRESSIVE DESIGN-BUILD DELIVERY

PROJECT NO. M050782OUTPATIENT CLINIC RENOVATIONS

IN THE AMBULATORY CARE CENTER (ACC)

MANDATORY PREQUALIFICATION CONFERENCE: 11:00 AM THURSDAY, JUNE 11, 2020

PREQUALIFICATION QUESTIONNAIRE DUE DATE: 4:00 PM THURSDAY, JULY 2, 2020

Facilities Design & Construction Questions to FD&C Contracts:4800 2nd Avenue, Suite 3010 Leila Couceiro, Contracts ManagerSacramento, CA 95817 lccouceiro @ucdavis.edu https://health.ucdavis.edu/facilities/contractors/OUT-TO-BID.html

Project No. M050782 of 29 Design-BuilderOutpatient Clinic Renovations in the Ambulatory Care Center Prequalification Questionnaire

https://health.ucdavis.edu/facilities/contractors/OUT-TO-BID.html

mailto:[email protected]

TABLE OF CONTENTS

I. GENERAL............................................................................................................................................................................................... 1

A. Progressive Design-Builder Prequalification............................................................................................................................. 1

B. Project Description................................................................................................................................................................... 1

C. Project Delivery........................................................................................................................................................................ 1

D. Interested Parties..................................................................................................................................................................... 1

E. Design-Build Subcontractors.................................................................................................................................................... 2

F. Target Cost............................................................................................................................................................................... 2

G. Project Timing.......................................................................................................................................................................... 2

H. Prequalification Process........................................................................................................................................................... 2

I. Anticipated Selection Process Schedule.................................................................................................................................. 3

J. Prequalification Questionnaire Availability................................................................................................................................ 3

K. Questions................................................................................................................................................................................. 3

L. Mandatory Prequalification Conference.................................................................................................................................... 3

M. Submittal Procedures and Deadline......................................................................................................................................... 4

N. Rating and Evaluation Procedures........................................................................................................................................... 4

O. Joint Ventures.......................................................................................................................................................................... 5

P. University Controlled Insurance Program (UCIP)..................................................................................................................... 5

Q. Content of Prequalification Submission.................................................................................................................................... 5

II. PREQUALIFICATION QUESTIONNAIRE – REQUIRED ELEMENTS.................................................................................................... 9

A. Proposer Company Name and Address................................................................................................................................... 9

B. Contact Information.................................................................................................................................................................. 9

C. Entity Submitting this Prequalification Questionnaire............................................................................................................... 9

D. Type of Business Organization................................................................................................................................................. 9

E. Year Company was Established............................................................................................................................................. 10

F. Parent Company Information.................................................................................................................................................. 10

G. List All Former Company Names............................................................................................................................................ 10

H. License and Registration with California DIR......................................................................................................................... 10

I. Design Firm (Architect)........................................................................................................................................................... 11

J. Debarment.............................................................................................................................................................................. 12

K. Labor Code Violations............................................................................................................................................................ 12

L. Surety..................................................................................................................................................................................... 12

M. Financial Capability................................................................................................................................................................ 12

N. Financial Data........................................................................................................................................................................ 12

O. Insurance................................................................................................................................................................................ 13

P. Experience Modification Rate................................................................................................................................................. 14

Project No. M050782 ~ 2 ~ Design-BuilderOutpatient Clinic Renovations in the Ambulatory Care Center Prequalification Questionnaire

Q. Qualification History............................................................................................................................................................... 15

R. Unsettled Warranties or Claims.............................................................................................................................................. 15

III. CONSTRUCTION EXPERIENCE.......................................................................................................................................................... 16A. Years of Experience............................................................................................................................................................... 16

B. Local Preference.................................................................................................................................................................... 16

C. Project Completion................................................................................................................................................................. 16

D. Liquidated Damages............................................................................................................................................................... 16

E. Supplemental Company Information...................................................................................................................................... 16

F. Comparable Project Experience............................................................................................................................................. 17

G. Proposed Key Personnel........................................................................................................................................................ 17

IV. EVALUATION SCORING...................................................................................................................................................................... 18

A. Scoring Criteria....................................................................................................................................................................... 18

B. Local Preference.................................................................................................................................................................... 18

C. Comparable Project Experience............................................................................................................................................. 18

D. Proposed Key Personnel........................................................................................................................................................ 18

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

A. Owner Against Contractor Claim............................................................................................................................................ 22

B. Contractor Against Owner Claim............................................................................................................................................ 22

C. Owner Against Design Firm Claim.......................................................................................................................................... 22

VI. DECLARATION..................................................................................................................................................................................... 26

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Project No. M050782 ~ 3 ~ Design-BuilderOutpatient Clinic Renovations in the Ambulatory Care Center Prequalification Questionnaire

I. GENERAL

A. Progressive Design-Builder PrequalificationThis prequalification is for a general contractor and design team who after selection will assume the role of Design-Builder. The University intends to use the Progressive Design-Build delivery method for this Project. The Progressive Design-Build contract will require the successful Proposer to enter into the contract and to provide both design and construction services. The University's primary objectives in utilizing the Progressive Design-Build approach is to bring the best available integrated design expertise and construction experiences to this Project.

The University has determined that proposers on this project must be prequalified. Prequalified proposers will be required to hold the following licenses: 1. California Contractor’s License: B – General Building Contractor and 2. California Architect’s License

B. Project Description The Outpatient Clinic Renovations in the Lawrence J. Ellison Ambulatory Care Center (ACC) will transform the existing ACC building in order to facilitate the strategy of UC Davis Health to consolidate and improve the operational efficiency of hospital-based outpatient services at the University of California Davis Medical Center.

The renovation will enable the ACC to be the leading destination for ambulatory care in the Sacramento area, with spaces that promote patient-centered care, staff satisfaction, and support the teaching and research mission of UC Davis Health. Transformation of the 375,000 gross square foot building will also provide state-of-the art and innovative spaces that will meet projected outpatient demand, lower operating costs, and increase patient satisfaction.

Planned improvements include a central check-in and waiting area, increased number of flexible exam rooms scaled to address changes in acute care service-line ebbs and flows, and improved patient access. The project will be completed in a phased manner, in order to achieve UC Davis Health’s operational goals within an occupied clinical environment and will require mitigation planning to minimize impacts to existing ACC clinical operations. All clinical space will meet OSHPD 3 Clinic requirements.

A space and functional program has been completed by the University and will be included with the Request for Proposals issued to the successful qualified proposers. Design is planned to commence late 2020 and the targeted completion date for the project is 2027. The estimated construction cost, inclusive of design and pre-construction services fees, ranges from $200 to 250 million. The Project Target Value will be established at the onset of the project and will be the maximum amount the University will spend on the Project. The planning and design of the ACC Outpatient Clinic Renovation Project must meet the Target Value Cost of the project and the project team must follow the Target Value Design approach.

The project will meet UC Sustainable Practice Policy (UCSPP) and will be a minimum of LEED Silver.

C. Project DeliveryThe selected Design-Builder will provide Schematic Design including Program Validation, Design Development and Construction Documents for the project, including but not limited to architectural, structural, civil, geotechnical, mechanical, plumbing, electrical, telecommunication, landscape, interdisciplinary construction coordination drawings as well as engineering calculations, including site, utilities, structural, mechanical and electrical systems necessary for a complete Project. Additionally, the successful Proposer shall be responsible for performing all work required to construct the Project as described and specified in the Contract Documents, including but not limited to, permitting, inspections, site preparation, site utilities, utility connections, hardscape and landscape, and surface improvements.

The Project will require the Design-Builder’s team, including the Design-Builder, all design consultants, design-build subcontractors and other subcontractors working on the Project (Design-Build Team) to be partially co-located (2-3 days a week) at minimum, for the duration of their work at the UC Davis Health Project Big Room.

UC Davis Health will use the Best Value Selection process based on price and qualifications. The price elements will include percentages for overhead and profit and rates for professional services and general conditions personnel. Qualifications will be determined by the information given in the attached Level 1 Qualification Forms.

D. Interested PartiesConsultants to the University who are participants or advisors to the University with respect to this project, including the preparation of criteria documents, are exempt from participating as a Design-Build team member or as a Subconsultant, of any Tier, to a Design-Builder. Therefore, for this project, the following firm is not eligible to participate in this project:

NBBJ LP

E. Design-Build SubcontractorsOnly Key Engineers of Record shall be included in this Prequalification Questionnaire as members of the Design-Builder team (refer to Section III-G). Subsequent to the Design-Builder being contracted with the University, Design-Build, Design-Assist, subconsultants and

Project No. M050782 Page 1 of 29 Design-BuilderOutpatient Clinic Renovations in the Ambulatory Care Center Prequalification Questionnaire

specialty consultants shall be selected with participation and agreement by the University. The University will contract directly with the Medical Equipment consultant.

F. Target Cost The Target Cost ranges from $200 to 250 million (inclusive of preconstruction, design and construction cost). The Target Cost will be included in the Request for Proposal (RFP) and will be the maximum amount the University will spend on the project.

G. Project TimingThe Project will proceed in four phases:

Phase 1: Schematic Design (including Program Validation) and Design Development Documents (Entire Scope)Phase 2: Construction Documents (Phased)Phase 3: Construction (Phased)Phase 4 Commissioning and Operations Monitoring

The Project will commence with an Intent to Award and Notice to Proceed (NTP) for Phase 1 immediately upon selection and award of the Contract. The University Milestone Schedule shows 24 months for the completion of Phases 1 and 2, between 48 and 60 months for Phase 3 (concurrent phases expected) and 24 months for Phase 4.

H. Prequalification ProcessThe purpose of this Prequalification process is to establish a shortlist of highly qualified Design-Build Teams to receive the RFP for the project. The Design-Builder Prequalification is a two-step process: Level 1 – Submittal of Prequalification documents, and Level 2 – an Interview. This process will result in the selection of a prequalified shortlist of teams receiving the Request for Proposals (RFP) and commencement of Level 3 – Submittal of Technical and Cost proposal.

Level 1 (Submittal of Prequalification Documents): Prospective proposers must meet the minimum prequalification requirements and will be scored based on the pre-established rating system described on this Questionnaire. The top five (5) scorers will be deemed prequalified to proceed to Level 2, the Interview, and will be notified via email. The University may interview more than five (5) proposers at its discretion.

Level 2 (Interview): Proposers will be notified whether they have been selected for a Level 2 Prequalification Interview and if submission of any additional clarifying information is required. The results of the Level 2 Interview and materials submitted in Level 1 will be separately scored. The top three (3) scoring teams established at the completion of Level 2 will be invited to participate in the Level 3 RFP competition. Proposers will be notified by email whether or not they are prequalified to move on to Level 3.

Level 3 (RFP competition and presentation): Prequalified proposers receive the RFP and will then submit cost and technical proposals. The cost submittal that is part of the RFP will consist of a percentage for fee for the construction work, and rates for professional services during design and preconstruction, including rates for all General Contractor Personnel for all four phases of work. The design competition, the final presentation, as well as the technical proposals, will be scored according to an established scoring system. The price will be divided by the score to determine a price per point. The prequalified proposer with the lowest price per point will be the apparent low proposer for the Project.

In an effort to help defray the cost for the development of the RFP submittal, UC Davis Health has agreed to compensate each unsuccessful prequalified Proposer that submits a responsive proposal. This amount (stipend) is $30,000.

There is no appeal process once the University has determined a team is not prequalified. Only those Proposers who pass Level 2 prequalification of the RFQ process and are among the top three (3) scorers will be eligible to participate in Level 3.

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I. Anticipated Selection Process Schedule

LEVEL 1: SchedulePrequalification Documents Available Mandatory Prequalification Conference

Wednesday - May 20, 2020 Thursday - June 11, 2020 at 11:00 AM

Last day to submit questions (RFIs) Thursday - June 18, 2020 Last day Clarifications Issued (if required)Last day to request Electronic Upload Link

Thursday - June 25, 2020Monday – June 29, 2020

Prequalification Documents Due Thursday – July 02, 2020 at 4:00 PM

LEVEL 2: ScheduleShortlist notified Thursday - July 16, 2020Interviews Day 1 Wednesday – July 22, 2020 andInterviews Day 2 Thursday – July 23, 2020

LEVEL 3: ScheduleShortlist Notified Friday - July 24, 2020RFP distributed to shortlistLevel 3 Mandatory Meeting

Monday - August 3, 2020Wednesday – August 5, 2020

Confidential Meeting #1 Week of August 17, 2020Confidential Meeting #2 Week of August 31, 2020Last day to submit questions (RFIs) Monday – September 7, 2020Last day clarifications issued (if required) Thursday – September 10, 2020RFP Submittals Due Thursday, - September 17, 2020 at 4:00 PM Final Interview Thursday - September 22, 2020Notice of Intent to Award Friday – October 9, 2020Notice to Proceed November 2020

The University reserves the right to change any and/or all of the dates stated above. Any changes to the schedule for the Design-Builder selection process will be issued by addenda.

J. Prequalification Questionnaire AvailabilityProvide all requested information, as applicable, on the questionnaire. Any prospective Proposer 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.

Editable copies of the Prequalification Questionnaire will be available starting Wednesday, May 20, 2020, and can be downloaded directly from our website at: https://health.ucdavis.edu/facilities/contractors/OUT-TO-BID.html.

K. QuestionsAll questions and issues regarding the Prequalification Process, requirements, criteria, and/or information, must be submitted electronically by emailing [email protected]. All questions must be submitted no later than the due date indicated in the Anticipated Selection Process Schedule. Questions received after the due date will not be considered.

L. Mandatory Prequalification ConferenceProposers must attend a MANDATORY Prequalification Conference, which will be held online, at 11:00 AM on Thursday, June 11, 2020. A Zoom meeting link will be distributed to Proposers who request it by 5:00 PM, June 9, 2020. Only Proposers who participate in the Prequalification Conference, in its entirety, will be allowed to propose on the project. Participants must join the virtual meeting before 11:00 AM; the virtual meeting room will be open no later than 10:45 AM. Participants arriving later than 11:00 AM will not be allowed to submit proposals as Design-Builder on the project. Attendance will be confirmed by roll call; please designate one person from each firm who will confirm attendance.

PROPOSERS INTERESTED IN ATTENDING THE MANDATORY PREQUALIFICATION CONFERENCE MUST EMAIL LEILA COUCEIRO, FD&C CONTRACTS MANAGER, AT [email protected] BY 5:00 PM, JUNE 9, 2020 TO BE PROVIDED A LINK TO JOIN THE VIRTUAL MEETING.

M. Submittal Procedures and DeadlineProposers interested in prequalifying to propose on this project must submit a completed Prequalification Questionnaire. The University is not responsible for any costs that Proposers may incur to complete the prequalification process. All applicable portions of the attached



https://health.ucdavis.edu/facilities/contractors/OUT-TO-BID.html

forms shall be completed with attachments if the space provided on the questionnaire is not sufficient. Each copy of the submittal must be complete and fully responsive to the requirements of the Prequalification Questionnaire.

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.

Completed Prequalification Questionnaires must be submitted electronically no later than 4:00 PM , Thursday, July 2, 2020 to the link to be provided by UC Davis Health. Prequalification documents will not be accepted after the due date and time. No supplemental data or additional project information will be accepted after due date and time unless specifically requested by the University. No hard copies will be accepted.

Proposers interested in prequalifying to propose on this project must email Leila Couceiro, FD&C Contracts Manager, at [email protected] by 5:00 PM, June 29, 2020 to be provided a link to upload their Qualifications package.

UPLOAD ONE (1) ELECTRONIC COPY (PDF FORMAT) OF THE PREQUALIFICATION QUESTIONNAIRE DOCUMENTS TO THE LINK PROVIDED BY THE UNIVERSITY. SUBMITTALS MUST BE RECEIVED NO LATER THAN 4:00 PM, THURSDAY JULY 2, 2020 .

N. Rating and Evaluation Procedures

To be considered for prequalification, a prospective Proposer must have:1. CONSTRUCTION EXPERIENCE: Have sufficient project experience for the Contractor and Design Firm as referenced in Section

III.E The projects submitted will receive points based on the extent to which they meet the listed criteria, per Section IV.2. KEY PERSONNEL: Demonstrate adequate experience for Contractor and Design Firm Team Key Personnel as referenced in

Section III.F (information submitted will receive points based on experience per Section IV).3. LICENSE: Hold the proper license(s) in good standing, current and active.4. SURETY: Submit a notarized statement from the proposed surety(ies) that states:

a. Contractor’s current available bonding capacity meets or exceeds the minimum capacity described in the Questionnaire. (Must meet or exceed estimated project cost.)

b. Contractor’s 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.

5. 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.

6. ANNUAL REVENUE (FINANCIAL DATA): Have annual revenue, averaged over the last 3 years (2017, 2018, 2019) equal to or greater than $250,000,000.

7. DECLARATION: Certify that all requested information is current, accurate, and complete.

To be considered for prequalification, a prospective Contractor, including any proposed joint venture partners, must not have:1. EXPERIENCE MODIFIER RATE: An average Experience Modifier Rate (EMR: Workers’ Comp) injury rating greater than 1.0

for the past five (5) years.2. SURETY: A surety required to complete work on any contract within the past ten (10) years.3. CONTRACTOR LICENSE BOARD DISCIPLINARY PROCEEDINGS: A Contractors State License Board disciplinary action in

the past ten (10) years. 4. LABOR CODE VIOLATIONS: Willful Labor Code violations including, but not limited to, repeated or willful violations of

applicable laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices during the past ten (10) years.

5. CLAIMS HISTORY: A claim filed against it that meets the parameters specified in Sections V.A & V.C, and have not filed a claim against an Owner that meets the parameters specified in Section V.B.

6. UNSETTLED WARRANTIES OR CLAIMS: Any unsettled/pending claims, demands, or notices of default issued against the contractor or joint venture partners by the University of California on any University project.

Contractor will be evaluated on the following additional criteria:1. FINANCIAL DATA. A desired financial current ratio of at least 1.0 for current assets to current liabilities (cash, accounts

receivable net of allowance for uncollectible receivables) / (accounts payable, current portion of long term debt), and has a debt to equity ratio less than 1.0.The University will deem Contractors with poor financial standing not qualified.



2. OWNER PERFORMANCE REFERENCES: The University may find a prospective Contractor not qualified if the University receives poor owner performance references on other projects.

3. LOCAL PREFERENCE: Physical office locations within 100 miles of the UC Davis Medical Center are preferred.

After review of the Prequalification Questionnaire, the University may request clarifying information. The Questionnaire must be complete and address all the stated requirements. Responses such as “N/A” are not acceptable. If not applicable, state “Not Applicable” and explain why. If none, state “NONE”. Do not leave any spaces blank.

Proposers selected for interviews will be notified via email, and will specify the date, time, and location of their interviews and outline the interview process. The University reserves the right to re-open the Design-Builder prequalification process if the University determines that there are insufficient prequalified Design-Builders to support the Proposal process.

O. Joint VenturesIf two entities intend to form a Joint Venture for the purpose of executing the work on the Project, they must state their intentions on the Prequalification Questionnaire Form. Each entity of the proposed Joint Venture must submit a separate and independent set of the Prequalification Questionnaire forms. To be considered, each entity must meet all the requirements in Section I.N Rating and Evaluation Procedures. Section II.L Surety, shall be submitted on one of the two applicants’ forms completely documenting the stated requirements by a qualified Surety. Requests of Design-Builder Joint Ventures to prequalify for this project will not be considered after close of acceptance of prequalification questionnaires unless the University decides that it is in its best interest to reopen the prequalification process in a manner stated in the prequalification questionnaire.

P. University Controlled Insurance Program (UCIP)The University has determined that this project will be covered under the University Controlled Insurance Program, or “UCIP.” The UCIP is a single insurance program that insures the University of California, Enrolled Contractors, Enrolled Subcontractors, and other designated parties (“Contractors”) for Work performed at the Project Site. Certain Contractors or Subcontractors may be excluded from the UCIP. Details of this program are contained in The Regents of the University of California UCIP Insurance Manual. Coverage under the UCIP includes Workers’ Compensation/Employer’s Liability, General Liability, and Excess Liability. The Regents of the University of California are covered under the General and Excess Liability policies. Contractors are covered under the Workers’ Compensation/Employer’s Liability and General and Excess Liability policies. The University of California will pay the insurance premiums for the UCIP coverages described in the UCIP Insurance Manual. When the University includes UCIP coverage on a project, each proposer is required to submit a bid net of all insurance costs for coverages provided by the University of California. When the solicitation documents are assembled in the resulting bid package, UCIP project insurance will be covered in Article 11.1 of the General Conditions, with project specific details provided in the UCIP Insurance Manual, provided as an exhibit in the RFP.

Q. Content of Prequalification SubmissionAt a minimum, all Prequalification Submissions must include:

1. Cover Letter (1 page)Provide a cover letter that summarizes and demonstrates your understanding of the Project and the focus on patient experience, as well as the ability of your proposed team to successfully deliver a completed project which supports UC Davis Health’s goals.

2. Prequalification Questionnaire & Financial Stability – Item II3. Construction Experience – Item III 4. Comparable Project Experience

Provide five (5) projects that demonstrate your team’s qualifications for the design and delivery of the Project and which best show your ability to achieve the project’s goals and vision. The focus should be on projects that include proposed staff. Also provide the information for each project on the Project Data Sheet found at the end of this document (reference Section III.F - Experience)

5. Project Teama. Attach a description of the Design-Builder team and an organization chart that includes Key Personnel list in Section

III.G. Proposers are advised that, after the selection, no changes in the composition of the project ream personnel or their roles and responsibilities can be made without written approval by the University.

b. Provide resumes for each of the Key Personnel as directed in Section III.G.c. Provide staff availability information for the Key Personnel in matrix form. At a minimum include project role and duration

of individual assignments (by percent of time allocated per project phase). 6. Record of Claims, Legal Actions and Terminations – Item V7. Required Completed Attachments

a. Notarized Statement from Surety stating (reference Section II.M – Financial Capacity):i. Current available bonding exceeds the project Estimated Construction Cost;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;iv. Surety(ies) acknowledge its intent to provide bonding of the Project in the event Contractor is awarded the Project.

b. Audited Financial Statements (reference Section II.N – Financial Data).


c. 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 (reference Section II.O - Insurance).

d. Insurance Certificate (reference Section II.O - Insurance).e. Letter from Workers’ Compensation carrier evidencing your EMR for the past 5 years (reference Section II.P –

Experience Modification Rate)f. Signature declaring the answers on Forms A, B, and C are true and correct (reference Section V – Claims History).



PREQUALIFICATION QUESTIONNAIRE

for

Outpatient Clinic Renovations in the Ambulatory Care Center (ACC)

Project No.: M050782

FACILITIES DESIGN AND CONSTRUCTIONUC DAVIS HEALTH

SACRAMENTO, CALIFORNIA

Each prospective Proposer must have the appropriate contractor’s license required by the State of California and must complete and submit all portions of this Prequalification Questionnaire.

Each prospective Proposer must answer all applicable questions and provide all requested information. Any prospective Proposer failing to do so may, at the sole discretion of the University of California, be deemed to be not responsive and not responsible with respect to this Prequalification, and its proposal will be rejected.

The undersigned declares under penalty of perjury that the Prequalification information submitted with this form is correct, complete and not misleading and that this declaration was executed

in County, California, on

(Proposer Name)

(Name and Title of Proposer’s Contact Person for Questions)

(Address)

(City, State, Zip Code)

(Telephone Number) (Email Address)

(Signature)

(Typed Name and Title)

Each prospective Proposer must answer all of the following questions and provide all requested information, where applicable. Any prospective Proposer 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 of California. All information submitted for prequalification evaluation will be considered official information acquired in confidence, and the University of California will maintain its confidentiality to the extent permitted by law. Any prospective Proposer found to be not prequalified as a result of the Proposer's answers to this Prequalification Questionnaire will receive written response from the University Facility explaining the Facility's decision. The decision of the Facility is final and not appealable within the University of California.

DESIGN FIRM (ARCHITECT) CONTACT INFORMATION:

Firm Name:


Telephone

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

Contact Person: Name, Title Telephone

Provide the name of the Architect of Record to be used on the Project:

Name, Title Current License Number

The Progressive Design-Build contract will require the successful Proposer to provide both design and construction services. The entity that provides these services is the Proposer, but the actual structure of the entity is up to each Proposer. The Proposer may, as an example, be a construction company, may be a joint venture between construction companies, or an independent contractor. All information required herein shall be submitted within the following parameters:

1. The Proposer shall hold all required licenses and DIR registration.

2. The Proposer shall be the financially responsible entity for bonding and insurance.



II. PREQUALIFICATION QUESTIONNAIRE – REQUIRED ELEMENTSAll information requested must be furnished on the forms provided below and must be completed in order to prequalify. Proposer must pass the following requirements to be considered qualified.

NOTE: IF “YES” IS ANSWERED TO ANY OF THE YES/NO QUESTIONS IN THIS SECTION, YOU HAVE NOT MET THE MINIMUM QUALIFICATIONS FOR FURTHER CONSIDERATION FOR THIS PROJECT.

A. Proposer Company Name and Address

Company Name:

Telephone


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: Joint Venture:

Sole Proprietorship: Other: (Please list)

Total number of employees on payroll in the corporation:

Total number of employees on payroll in the local office submitting this prequalification:

Principal Office (if different from above): Street Address

President’s Name: City, State & Zip Code

If a partnership, provide the following information:

Date of Organization: General: Association:


Name and complete legal address of each general partner:

(Partner’s Name) (Legal Address)

(Partner’s Name) (Legal Address)

If a Joint Venture, provide the above information for the financially responsible party.

IF MORE SPACE IS NEEDED, PROVIDE THE INFORMATION ON YOUR COMPANY’S LETTERHEAD WITH REFERENCE TO THE PROJECT NAME AND NUMBER, AND ATTACH IT TO THIS QUESTIONNAIRE.

E. Year Company was Established

F. Parent Company Information

Company Name:

Telephone Website



G. List All Former Company Names

H. License and Registration with California DIR

Proposer must have a current and active California State Contractors license in good standing with a “B” General Building Contractor Classification for this Project. Proposer must also be registered with the Department of Industrial Relations (DIR) pursuant to Labor Code section 1725.5 and 1771.1.

For Joint Venture applications by two or more licensees, the Joint Venture entities must submit a written commitment to obtain the proper California joint venture license by the Prequalification Questionnaire submittal deadline, and at least one entity of the joint venture must have a proper license in good standing that is current and active upon submission of the Design-Builder Prequalification Questionnaire. The letter of commitment must include:

1. Name, address, and phone number of the Joint Venture as it will appear on the records of the Contractors State License Board2. Name, address, and telephone number of each entity comprising the Joint Venture as it appears on the records of the Contractors

State License Board3. Name of the Responsible Managing Officer of the Joint Venture4. Organizational chart of the Joint Venture5. Signatures of the Responsible Managing Officers for each entity comprising the Joint Venture

NOTE: THE ENTITY SUBMITTING THIS PREQUALIFICATION QUESTIONNAIRE MUST BE THE HOLDER OF THE REQUISITE LICENSE


Year established:

ALL LICENSES AND REGISTRATION MUST BE MAINTAINED IN GOOD STANDING, CURRENT AND ACTIVE THROUGHOUT THE PROJECT.

Does your firm LACK the required California State Contractors license? Yes No

Is your firm NOT registered with the Department of Industrial Relations (DIR)? 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):

DIR Registration No.:

For Joint Venture: List Joint Venture entity’s license information above as the Design Builder and the license information for the proposed Joint Venture license in the space below:

License No. Issue Date: Expiration Date:

License Class/Classes:

Description of Classification(s):

DIR Registration No.:

HAS THE ABOVE CONTRACTOR LICENSE(S) BEEN SUSPENDED OR REVOKED BY THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD WITHIN THE PAST TEN (10) YEARS?

YES NO

I. Design Firm (Architect)

Firm Name:

Telephone



Provide the name of the Architect of Record to be used on the Project:

Name, Title Current License Number


J. Debarment

Has your company entity (or any member of the entity if a joint venture or partnership) 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 ten (10) years?

YES NO

K. Labor Code Violations

Has your company, during the past ten (10) years, received a determination by a court or an administrative agency of any Labor Code violations including, but not limited to laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices on public works projects?

YES NO

L. Surety

List below all Surety companies used by your company within the past five (5) years 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:

Surety Company #1: Surety’s Name Telephone


Has listed Surety Company #1 completed work for your Company within the past ten years? Yes No Period Covered

Surety Company #2: Surety’s Name Telephone


Has listed Surety Company #2 completed work for your Company within the past ten years? Yes No Period Covered

IF MORE SPACE IS NEEDED, PROVIDE THE INFORMATION ON YOUR COMPANY’S LETTERHEAD WITH REFERENCE TO THE PROJECT NAME AND NUMBER, AND ATTACH IT TO THIS QUESTIONNAIRE

M. Financial Capability

Attach a notarized statement from the surety(ies) that states: (i) current available bonding capacity meets or exceeds the overall Target Cost; (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 Proposer is awarded the Project.

N. Financial Data

Provide your company’s Total Revenue, Net Income, Current Assets, Current Liabilities, Total Debt, and Total Net Worth for the past three (3) fiscal years. Also, specify your company’s total and current available bonding capacity. Provide the most current fiscal year data available.

1. Total Revenue (past 3 fiscal years):Year Ending 2017 $


Year Ending 2018 $ Year Ending 2019 $

3 year Average: $__________________________

2. Net Income (past 3 fiscal years):Year Ending 2017 $ Year Ending 2018 $ Year Ending 2019 $

3. Current Assets (past 3 fiscal years):Year Ending 2017 $ Year Ending 2018 $ Year Ending 2019 $

4. Current Liabilities (past 3 fiscal years):Year Ending 2017 $ Year Ending 2018 $ Year Ending 2019 $

5. Total Debt (past 3 fiscal years):Year Ending 2017 $ Year Ending 2018 $ Year Ending 2019 $

6. Total Net Worth (past 3 fiscal years):Year Ending 2017 $ Year Ending 2018 $ Year Ending 2019 $

7. Total Bonding Capacity $

8. Total Available Bonding Capacity $

FINANCIAL STATEMENT(S): PROVIDE COPIES OF AUDITED FINANCIAL STATEMENTS FOR THE PAST THREE YEARS OF OPERATION.

O. Insurance

While on-site Work will be covered under the University Controlled Insurance Program, or “UCIP,” the Proposer wishing to prequalify hereunder is 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), Contractor‘s Professional Liability, Business Automobile Liability, Pollution Liability, and Workers’ Compensation insurance in the amounts below.

The insurance required for Commercial Form General Liability, Excess Liability, Contractor’s Professional 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:

COMMERCIAL FORM GENERAL LIABILITY INSURANCE – LIMITS OF LIABILITY MINIMUM REQUIREMENTS EACH OCCURRENCE - COMBINED SINGLE LIMIT FOR BODILY INJURY AND PROPERTY DAMAGE: $5,000,000

PRODUCTS-COMPLETED OPERATIONS AGGREGATE: $5,000,000PERSONAL AND ADVERTISING INJURY: $5,000,000

GENERAL AGGREGATE: $5,000,000


PROFESSIONAL (ERRORS AND OMISSIONS) LIABILITY – LIMITS OF LIABILITY MINIMUM REQUIREMENT CONTRACTOR’S PROFESSIONAL LIABILITY (EACH OCCURRENCE & AGGREGATE) $2,000,000

BUSINESS AUTOMOBILE LIABILITY INSURANCE – LIMITS OF LIABILITY MINIMUM REQUIREMENT EACH ACCIDENT - COMBINED SINGLE LIMIT FOR BODILY INJURY AND PROPERTY DAMAGE: $1,000,000

CONTRACTOR’S POLLUTION LIABILITY INSURANCE – LIMITS OF LIABILITY MINIMUM REQUIREMENTS EACH OCCURRENCE: $2,000,000

PRODUCTS-COMPLETED OPERATIONS AGGREGATE: $2,000,000GENERAL AGGREGATE: $2,000,000

ARCHITECT’S PROFESSIONAL (ERRORS AND OMISSIONS) LIABILITY – LIMITS OF LIABILITY MINIMUM REQUIREMENTS EACH OCCURRENCE & AGGREGATE: $2,000,000

WORKERS’ COMPENSATION – AS REQUIRED BY FEDERAL AND STATE OF CALIFORNIA LAW

EMPLOYER’S LIABILITY – LIMITS OF LIABILITY MINIMUM REQUIREMENTS EACH EMPLOYEE: $1,000,000EACH ACCIDENT: $1,000,000

POLICY LIMIT: $1,000,000

EXCESS/UMBRELLA – LIMITS OF LIABILITY MINIMUM REQUIREMENTS EACH OCCURRENCE: $10,000,000

AGGREGATE: $10,000,000

For those not covered under UCIP, 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 the amount required by Federal and State of California law.

1. Will your firm be UNABLE to obtain the insurance in the required limits and ratings from companies that meet the criteria stated above?

YES NO

2. If “no,” 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.

P. Experience Modification Rate

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

2015: 2016: 2017: 2018: 2019:

Average:

SUBMIT A LETTER FROM YOUR WORKERS’ COMPENSATION CARRIER SHOWING THE EXPERIENCE MODIFICATION RATE FOR THE PAST FIVE YEARS.

Has your Worker’s Compensation Experience Modification Rate average risen above 1.0 over the last five (5) years?

YES NO

Q. Qualification History

Has the Proposer failed to qualify to perform work for University of California?


YES NO

R. Unsettled Warranties or Claims

Does the Proposer have unsettled/pending claims, demands or notices of default issued by the University of California for University projects?

YES NO

NOTE: IF “YES” IS ANSWERED TO ANY OF THE YES/NO QUESTIONS IN THIS SECTION, YOU HAVE NOT MET THE MINIMUM QUALIFICATIONS FOR FURTHER CONSIDERATION FOR THIS PROJECT.



III. CONSTRUCTION EXPERIENCE

Proposer must complete the following information entirely to be considered further.

A. Years of Experience

Does Proposer have at least ten (10) years of experience as a General Contractor? Yes No

Does Proposer have at least ten (10) years of experience as a Design Firm? Yes No

B. Local Preference

Is the physical office of the Contractor located within a 50 mile radius of the UC Davis Medical Center?Yes No

Is the physical office of the Contractor located between 50 and 100 miles away from the UC Davis Medical Center?Yes No

Is the physical office of the Design Firm located within a 50 mile radius of the UC Davis Medical Center?Yes No

Is the physical office of the Design Firm located between 50 and 100 miles away from the UC Davis Medical Center?Yes No

C. Project Completion

Has Proposer failed to complete a Contract or been removed for cause from a project within the past ten (10) years? Yes No

If yes, give details including dates:

IF MORE SPACE IS NEEDED, PROVIDE THE INFORMATION ON COMPANY LETTERHEAD WITH REFERENCE TO THE PROJECT NAME AND NUMBER, AND ATTACH IT TO THIS QUESTIONNAIRE

D. Liquidated Damages

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

If yes, give details including dates and damage values:

IF MORE SPACE IS NEEDED, PROVIDE THE INFORMATION ON COMPANY LETTERHEAD WITH REFERENCE TO THE PROJECT NAME AND NUMBER, AND ATTACH IT TO THIS QUESTIONNAIRE

E. Supplemental Company Information

1. Contractor 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


F. Comparable Project ExperienceOnly information, experience and Work performed by the Design Builder’s office that will bid, manage, coordinate design, construct, and staff the project will be considered for prequalification unless otherwise indicated below. (May include an affiliated office that shares staff resources.)

Submit detailed project documentation including photos that addresses the criteria below for only five (5) projects not less than $75 million in construction cost performed during the past ten (10) years (completed after 2009). A minimum of one project each shall be submitted by the Contractor and Design Firm. This documentation shall demonstrate the Design Builder’s ability to successfully complete the project with respect to project size, cost, use, complexity, etc. Projects must be at least 50% complete with the construction phase to be considered for review.

In addition to providing detailed project documentation, each project must be submitted on the form below in this section AND must address the criteria summarized below, to be considered a comparable project:

1. Each project must be a Healthcare facility or highly technical facility of similar scope, cost, size and complexity.

2. At least two projects must be delivered as a Design-Build contract or similar (i.e., Integrated Form of Agreement, or GMP Construction contract having provided Preconstruction Services, or CM-at-Risk).

3. One project must be located in California and meet OSHPD 3 requirements.

4. One project must be a multi-phased renovation with adjacencies to existing, operating, and occupied facilities.

5. One project must have used Target Value Design and model based estimating.

6. For each project please provide owner performance reference. Include owner contact information (name, title, email, phone).

G. Proposed Key PersonnelAttach a description of your organization and an organizational chart proposed for this project, that includes the Key Personnel listed in the table below. It is understood that the full project team will include additional staff, consultants and subcontractors that do not need to be listed at this time for determination of prequalification. Please do not include information on any team members not specifically requested in the table below. Note: Key Personnel must be committed for the duration of the project.

CONTRACTOR DESIGN FIRM ENGINEERSProject Executive Architect of Record Structural Engineer of RecordProject Manager Project Manager Mechanical Engineer of RecordSuperintendent Medical Planner Plumbing Engineer of RecordPre-Construction Manager Designer Electrical Engineer of RecordDesign Manager Project ArchitectCost Estimator Interior Designer

Provide a 2 page max. resume for each of the Key Personnel members. At a minimum, include the following:

1. Full name, position in the firm, years with the firm and current location (if a multi-office firm). If less than five years with the firm, provide the name of previous firm.

2. Project role and responsibilities.3. Education - list all degrees, including institution and year received.4. Certifications – list all certifications, including LEED, DBIA, etc.5. Relevant project experience working on buildings of similar scope, size and complexity. Include project name, owner, project

description, size (construction cost), project delivery method and current status (completion date if applicable). If the project listed is performed with previous employer, please list the firm’s name.

6. Relevant Progressive Design-Build experience. Include project name, owner and size (construction cost).7. Identify if individual worked on any of the five (5) submitted comparable projects.


IV. EVALUATION SCORING

A. Scoring Criteria Only Proposers who meet all of the minimum requirements listed herein will be evaluated for prequalification.

A maximum of 500 points is possible. Approximately five proposers with the highest scores on this Prequalification Questionnaire will be invited to participate in Level 2 Interviews.

Required Financial, Insurance, & Claims History Data pass/fail

Required Current Licenses pass/fail

Local Preference 15 points

Comparable Project Experience 325 points Key Personnel 160 points

Total Possible: 500 points

B. Local PreferenceOnly physical office locations within 100 miles of the UC Davis Medical Center (UCDMC) are eligible for a maximum of 15 points.

Contractor: maximum 10 points

(10 points) within 50 mile radius of UCDMC

(5 points) between 50 and 100 mile radius of UCDMC

Design Firm: maximum 5 points

(5 points) within 50 mile radius of UCDMC

(3 points) between 50 and 100 mile radius of UCDMC

C. Comparable Project Experience Only five (5) comparable projects may be submitted with a maximum of 65 points possible for each.

Part A: The following criteria are worth a maximum 25 points for each comparable project:

(5 points) Project was by performed by the Design-Builder (Contractor and Design Firm)

(5 points) At least six (6) of the Key Personnel worked on the project together.

(5 points) Positive owner reference provided for Project.

(2 points) Contractor’s proposed Project Manager managed the Project.

(2 points) Design Firm’s proposed Project Manager managed the design of the Project.

(2 points) Contractor’s proposed Superintendent supervised construction of the Project.

(2 points) Project utilized Target Value Design and model based estimating.

(2 points) Project was an OSHPD Level 3 facility, minimum.

Part B: The following criteria are worth a maximum 40 points for each comparable project:

(25 points) Similarity to ACC Renovation Project (scope, size and complexity).

(10 points) Project was phased with adjacencies to existing, operating and occupied facilities.

(5 points) Design-Build contract delivery method or similar (Integrated Form of Agreement, GMP Construction Contract having provided Preconstruction Services or CM-at-Risk)

(0 points) Yes/No Comparison Criteria.

Separate sheets must be prepared for each project submitted.

D. Proposed Key PersonnelOnly Key Personnel listed in the table located in section III-G may be submitted with a maximum of 10 points possible for each.

COMPARABLE PROJECT EXPERIENCE DATA SHEET


COMPLETE AND SUBMIT THE FOLLOWING PROJECT DATA SHEET FOR THE EACH OF THE FIVE COMPARABLE PROJECTS SUBMITTED AS EVIDENCE OF THE DESIGN BUILDER’S EXPERIENCE. SUBMIT NO MORE THAN FIVE.

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.”

Required Criteria:

Project Name:

Project or Contract Number:

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

Owner Information:

Owner Information: Contact Person: Owner’s Name Name & Title

Address: , , Street Address City & State Zip Code

Telephone: Email:

Contractor Information:

Address of Contractor’s Office that Performed the Work:

, , Street Address City & State Zip Code

Contact Person: Telephone: Name & Title

Email:

Name of Contractor’s Project Manager for project:

Name of Contractor’s Superintendent for project:

Architect Information:

Design Firm: Contact Person: Name & Title

Address: , , Street Address City & State Zip Code

Telephone: Email:

Name of Design Firm’s Project Manager for project:

Contract Time:Start Date: Scheduled Completion Date:

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


(must not be prior to January 2010) Month/Day/Year

Contract Amount:

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

(Min $75M dollars required)

Minimum Required Elements:

1. A minimum of one project each shall be submitted by the Contractor and Design Firm. Project Submitted by:

Contractor Design Firm

2. Each project submitted at least $75,000,000 Construction Value?

YES NO

3. Each project is a Healthcare facility or highly technical facility of similar scope, cost, size and complexity?

YES NO

4. At least two projects must be delivered as a Design-Build contract or similar (Integrated Form of Agreement), or with a GMP Construction Contract having provided Preconstruction Services, or CM-at-Risk. Indicate if this project meets this criteria.

YES NO

5. One project must be located in California and meet OSHPD 3 requirements, minimum. Indicate if this project meets this criteria.

YES NO

6. One project must be a multi-phased renovation project with adjacencies to existing, operating, and occupied facilities. Indicate if this project meets this criteria.

YES NO

7. One project must have used Target Value Design and model based estimating. Indicate if this project meets this criteria.

YES NO

8. Projects completed prior to January of 2010 will not be considered.

9. For each project please provide owner performance reference. Include owner contact information (name, title, email, phone).

PART A – SCORED ELEMENTS:

Refer to Item IV.C and provide requested information listed below. A maximum of 25 points is possible.

5 ptsProject performed by the proposed Design-Builder (Contractor and Design Firm)?

YES NO

5 ptsAt least six (6) of the Key Personnel worked on this project together?

YES NO

5 ptsIs a positive owner reference provided for the project?

YES NO

2 ptsContractor’s proposed Project Manager managed the project?

YES NO

2 ptsDesign Firm’s proposed Project Manager managed the design of the project?

YES NO


2 ptsContractor’s proposed Superintendent supervised construction of the project?

YES NO

2 ptsDid the project utilize Target Value Design and model based estimating?

YES NO

2 ptsIs the project an OSHPD Level 3 facility, minimum?

YES NO

PART B – SCORED ELEMENTS:

Refer to Item IV.C and provide requested information on a separate sheet. A maximum of 40 points is possible.

SPACE INTENTIONALLY LEFT BLANK


V. CLAIMS HISTORY

ONLY INFORMATION FOR THE PROPOSER’S OFFICE THAT WILL BID, MANAGE THE DESIGN, CONSTRUCT, AND STAFF THE PROJECT SHALL BE SUBMITTED

A. Owner Against Contractor Claim

Provide the information requested below for the Contractor (Licensee) listed in Section II.A.

Complete a separate FORM A – OWNER AGAINST CONTRACTOR CLAIM tabulation sheet for all claims: a) in excess of $100,000 for poor workmanship, incomplete performance, defective work, or b) in excess of $100,000 for unexcused delays in completion, asserted by Owner and/or Performance/Payment Bond sureties against the Contractor within the past five (5) years which were resolved with the result that Contractor, its surety or insurer was required to pay to Owner, or was assessed a deduction in the contract price by Owner, an amount exceeding forty percent (40%) of the highest amount claimed. Claims, as used in the preceding sentence, means all claims adjudicated by a final decision of mediation, arbitration or lawsuit or by negotiated settlement with Owner or third party.

A signature by the Proposer’s sole proprietor, general partner, or corporate officer is required on Form A. If signed by other than the sole proprietor, a general partner or corporate officer, attach original notarized power of attorney or corporate resolution

B. Contractor Against Owner Claim

Provide the information requested below for the Contractor (Licensee) listed in Section II.A.

Complete a separate FORM B – CONTRACTOR AGAINST OWNER CLAIM tabulation sheet for all claims (including false claims) in excess of $100,000 for extra compensation or damages asserted by Contractor against Owners within the past five (5) years, which were resolved with the result that Contractor received less than sixty percent (60%) of the highest amount claimed. Claims, as used in the preceding sentence, includes claims for extra compensation or damages and includes subcontractor claims (“pass through” claims) even if the contractor had no interest in those claims. Claims, as used in the preceding sentence, means all claims adjudicated by a final decision of mediation, arbitration or lawsuit or by negotiated settlement with Owner or third party. Do not include stop notices or causes of action to enforce stop notices.

A signature by the Proposer’s sole proprietor, general partner, or corporate officer is required on Form B. If signed by other than the sole proprietor, a general partner or corporate officer, attach original notarized power of attorney or corporate resolution.

C. Owner Against Design Firm Claim

Provide the information requested below for the Design Firm (Licensee) listed in Section II.I.

Complete a separate FORM C - OWNER AGAINST DESIGN FIRM CLAIM tabulation sheet for all claims in excess of $100,000 for either excessive Change Orders, lack of coordination or design errors and omissions asserted by Owner over the past five (5) years which were resolved with the result that the Architect or its insurer was required to pay to Owner, or was assessed a deduction in fee by Owner, an amount exceeding forty percent (40%) of the highest amount claimed.

A signature by the Proposer’s sole proprietor, general partner, or corporate officer is required on Form C. If signed by other than the sole proprietor, a general partner or corporate officer, attach original notarized power of attorney or corporate resolution.


T FORM A

Use one Form per Lawsuit or Arbitration (Make Copies as Needed)

Are there claims that meet the criteria in Section V.A of this statement? If yes, please complete & sign the form below: Yes No

Case Name and Number including Name and Location of Court or Arbitration Service:

Date Arbitration or Litigation Commenced:

Project Name:



Name of Owner:


Highest Amount Sought for All Claims: $ (Amount in Figures)

Amount Recovered: $ (Amount in Figures)

Method of Resolution (Check One): Judgment: Arbitration Award: Litigation:

Settled by Contracting Parties without Litigation or Arbitration:

Other: List:

Date of Claim Resolution:

Basis for Claim:

If the lawsuit or arbitration was resolved for more than forty percent (40%) of the highest amount sought for all claims, state why the lawsuit or arbitration should not be considered a meritorious lawsuit or arbitration filed by an owner against Contractor and/or persons or entities associated with Contractor:

My signature below signifies my declaration that the answers provided on this Form A are current, accurate, and complete.

Proposer’s Signature:

Printed Name & Title Date

IF SIGNED BY OTHER THAN THE SOLE PROPRIETOR, A GENERAL PARTNER OR CORPORATE OFFICER, ATTACH ORIGINAL NOTARIZED POWER OF ATTORNEY OR CORPORATE RESOLUTION.


OWNER AGAINST CONTRACTOR CLAIM

OWNER AGAINST CONTRACTOR CLAIM

FORM BUse one Form per Lawsuit or Arbitration

(Make Copies as Needed)

Are there claims that meet the criteria in Section V.B of this statement? If yes, please complete & sign the form below: Yes No



Project Name:



Name of Owner:






Other: List:


Basis for Claim:

If the lawsuit or arbitration was resolved for more than sixty percent (60%) of the highest amount sought for all claims, state why the lawsuit or arbitration should not be considered a meritorious lawsuit or arbitration filed by an owner against Contractor and/or persons or entities associated with Contractor:

My signature below signifies my declaration that the answers provided on this Form B are current, accurate, and complete.

Proposer’s Signature:




CONTRACTOR AGAINST OWNER CLAIM

T

FORM CUse one Form per Lawsuit or Arbitration

(Make Copies as Needed)

Are there claims that meet the criteria in Section V.C of this statement? If yes, please complete & sign the form below: Yes No



Project Name:



Name of Owner:






Other: List:


Basis for Claim:

If the lawsuit or arbitration was resolved for more than forty percent (40%) of the highest amount sought for all claims, state why the lawsuit or arbitration should not be considered a meritorious lawsuit or arbitration filed by an owner against Design Firm and/or persons or entities associated with Design Firm:

My signature below signifies my declaration that the answers provided on this Form C are current, accurate, and complete.

Design Firm’s Signature:




OWNER AGAINST DESIGN FIRM CLAIM

VI. DECLARATION

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 Proposer; and that all information set forth in this Questionnaire and all attachments hereto are, to the best of my knowledge, current, 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.

[END]


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