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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