UNIVERSITY OF CALIFORNIA CONTRACTORS’ QUESTIONNAIRE
Firm Name: ____________________________________________________________
1. How many years has your company been in business under its present business name?
_______ Years
2a. For General Contractors: How many years experience in construction work has your
company had as a General Contractor? ____________
2b. For Subcontractors: How many years experience in construction work has your company
had as a Subcontractor? _____________
3. Has your firm ever been formally disqualified from performing work for any contracting
entity, including the University of California?
□ Yes □ No
4. Has your firm had any OSHA citations in the past two years?
□ Yes □ No
Provide explanation of OSHA citations in the past two years. (Enter N/A if not
applicable):
_________________________________________________
_________________________________________________
5. Can you truthfully state that no surety has paid out any monies on claims on the
payment bond (required on all public works jobs over $25,000.00) issued by a surety for
the benefit of an Owner arising out of the construction activities of the entity within the
last 10 years?
□ Yes □ No
6. Can you truthfully state that no surety has paid out any monies on claims on the
performance bond (required on all University jobs over $50,000.00) issued by a surety for the
benefit of an Owner arising out of the construction activities of the entity within the last 10
years?
□ Yes □ No
7. Can you truthfully state that your contractor’s license has not been suspended or revoked
by the California State License Board within the last 10 years?
□ Yes □ No
UNIVERSITY OF CALIFORNIA CONTRACTORS’ QUESTIONNAIRE
8. Is your company able to obtain the following insurance in the limits stated?
□ Yes □ No
|General Liability Limits of Liability: |Minimum Requirement |
|Bodily Injury & Property Damage – each Occurrence-Combined Single Limit |$1,000,000 |
|Products – Completed Operations Aggregate |$1,000,000 |
|Personal and Advertising Injury |$1,000,000 |
|General Aggregate |$1,000,000 |
|Business automobile Liability Insurance | |
|Each Accident-Combined Single Limit for Bodily Injury and Property Damage|$1,000,000 |
|Workers Compensation |(as required by Federal / State of California law) |
9. Separately list on the form provided, three (3) projects your company has completed
within the past five (5) years.
I declare under penalty of perjury that the foregoing is true and correct and that this declaration
was subscribed at:
_______________________, (City) ________________, (County), State of ________________
On ______________________, 20____.
_____________________________________(Individual, Partner, or Officer must sign here)
PROJECT DATA SHEET
List experience in successful and timely installation and completion of at least 3 projects within the last
5 years. Experience shall include at least one project for work performed during a relatively short period
of time and that required completion by a specific date. Additionally, at least one project shall be for work
performed on a building continuously occupied during contract performance.
(A separate project data sheet must be prepared for each project.)
1. Project Name:
2. Project Location (including full address, if any):
City: State: Zip:
3. Project Description:
4. Was construction of the project begun and completed within the last 5 years? YES □ NO □
5. Owner’s Name:
6. Owner’s Contact/Phone Number:
7. General Contractor’s Name: ______________________________________________________
8. General Contractor’s Contact/Phone Number: ________________________________________
9. Design Consultant’s Contact/Phone Number:
10. Start Date: ________________________________________
11. Actual Completion date: _______________________________
12. Contract Time at bid date (Number of calendar days): _______
13. Formally adjusted Contract Time (Number of calendar days): _______
14. Was the Project completed on time, including time extensions? YES □ NO □
15. If completion did not occur within the Contract Time at bid date or within the formally adjusted
Contract Time, then explain the reason or reasons for the delay:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
16. Did the project include adherence to critical path scheduling? YES □ NO □
17. Was the project completed within budget? YES □ NO □
18. Cost of Bid: $____________
19. Cost at Completion: $___________
PROJECT DATA SHEET
List experience in successful and timely installation and completion of at least 3 projects within the last
5 years. Experience shall include at least one project for work performed during a relatively short period
of time and that required completion by a specific date. Additionally, at least one project shall be for work
performed on a building continuously occupied during contract performance.
(A separate project data sheet must be prepared for each project.)
1. Project Name:
2. Project Location (including full address, if any):
City: State: Zip:
3. Project Description:
4. Was construction of the project begun and completed within the last 5 years? YES □ NO □
5. Owner’s Name:
6. Owner’s Contact/Phone Number:
7. General Contractor’s Name: ______________________________________________________
8. General Contractor’s Contact/Phone Number: ________________________________________
9. Design Consultant’s Contact/Phone Number:
10. Start Date: ________________________________________
11. Actual Completion date: _______________________________
12. Contract Time at bid date (Number of calendar days): _______
13. Formally adjusted Contract Time (Number of calendar days): _______
14. Was the Project completed on time, including time extensions? YES □ NO □
15. If completion did not occur within the Contract Time at bid date or within the formally adjusted
Contract Time, then explain the reason or reasons for the delay:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
16. Did the project include adherence to critical path scheduling? YES □ NO □
17. Was the project completed within budget? YES □ NO □
18. Cost of Bid: $____________
19. Cost at Completion: $___________
PROJECT DATA SHEET
List experience in successful and timely installation and completion of at least 3 projects within the last
5 years. Experience shall include at least one project for work performed during a relatively short period
of time and that required completion by a specific date. Additionally, at least one project shall be for work
performed on a building continuously occupied during contract performance.
(A separate project data sheet must be prepared for each project.)
1. Project Name:
2. Project Location (including full address, if any):
City: State: Zip:
3. Project Description:
4. Was construction of the project begun and completed within the last 5 years? YES □ NO □
5. Owner’s Name:
6. Owner’s Contact/Phone Number:
7. General Contractor’s Name: ______________________________________________________
8. General Contractor’s Contact/Phone Number: ________________________________________
9. Design Consultant’s Contact/Phone Number:
10. Start Date: ________________________________________
11. Actual Completion date: _______________________________
12. Contract Time at bid date (Number of calendar days): _______
13. Formally adjusted Contract Time (Number of calendar days): _______
14. Was the Project completed on time, including time extensions? YES □ NO □
15. If completion did not occur within the Contract Time at bid date or within the formally adjusted
Contract Time, then explain the reason or reasons for the delay:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
16. Did the project include adherence to critical path scheduling? YES □ NO □
17. Was the project completed within budget? YES □ NO □
18. Cost of Bid: $____________
19. Cost at Completion: $___________
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