Base Qualification Questionnaire

Base Qualification Questionnaire

As used herin, the term "Entity" and "Contractor" shall both mean the California licensed contractor submitting this Base Qualification Questionnaire.

SUBMITTED BY:*

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OTHER OWNERSHIP:*

BUSINESS ENTITY NAME:*

CALIFORNIA CONTRACTOR LICENSE NUMBER(S):*

CONTACT NAME:*

MAILING ADDRESS:*

CITY:*

STATE*

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ZIP CODE:*

TELEPHONE NUMBER:*

Phone

FACSIMILE NUMBER:

Phone

EMAIL ADDRESS:*

SELECT ENTITY'S PRIMARY OWNERS, OFFICERS, AND/OR PARTNERS::*

(Select all that apply)

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PRIMARY OWNERS:*

(List Names and Titles)

OFFICERS:*

(List Names and Titles)

PARTNERS:*

(List Names and Titles)

SMALL BUSINESS ENTERPRISE (SBE) or DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)

Select one of the following, if applicable:

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NAME OF SBE/DVBE CERTIFYING AGENCY:

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SBE/DVBE CERTIFICATION EXPIRATION DATE:

If Certified, Upload an SBE/DVBE certificate at the end of this form.

*Definitions of SBE/DVBE can be found here:

https://ucop.edu/sbe-dvbe-certifications

Checking either SBE or DVBE will make the firm eligible for participation in the Sheltered Applicant Pool program. Please complete the Construction Contractor Profile form: https://app.smartsheet.com/b/form/c3989664281e478c865ba621bfdf69ff

Base Qualification Questions (1-10)

Choose only (1) answer for each question. If more than one answer applies, choose the most relevant response.

1. Contractor requests that it be BASE QUALIFIED to submit bids for UC projects in the following capacity or capacities:*

(Select all that apply)

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2. Contractor possesses a valid and current California Contractors License for the project(s) for which it intends to submit bids on?*

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3. Contractor has a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and $2,000,000 aggregate?*

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4. Contractor either has one of the following?*

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5. Contractor is currently registered with the California Department of Industrial Relations as a public works contractor pursuant to Division 2, Part 7, Chapter 1(commencing with section 1720) of the California Labor Code?*

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6. Contractor has either of the following?*

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*The submitted Financial Statement will be considered confidential and University of California will maintain its confidentiality to the extent permitted by law.

7. Contractor’s intended surety insurer is “admitted” (as approved by the California Department of Insurance) and authorized to issue bonds in the State of California?*

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8. Contractor has sufficient bonding capacity for all project(s) it intends to submit bids on?*

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9. Entity has either:*

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10. Contractor agrees to comply with all applicable UC provisions regarding nondiscrimination, payment of prevailing wages, payroll records, apprentices, and working days?*

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11. Contractor has one or more Final Order (as declared by OSHA) Willful Violations in California of Part 1 Section 6300 of Division 5 of the Labor Code within the last five (5) years?*

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12. Entity’s California Contractors License has been revoked in the last five (5) years?*

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13. One or more surety firms have completed a contract on the entity’s behalf, or paid for completion because the entity was default terminated by a project owner within the last five (5) years?*

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14. Contractor is currently ineligible to bid on or be awarded a public works contract, or perform as a subcontractor on a public works contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7?*

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15. At any time during the last five years, the entity, or any of its owners or officers have been convicted of a crime involving the bidding, award, or performance of a public contract?*

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16. The entity is currently, or has at any time in the last five (5) years been the debtor in a bankruptcy case?*

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17. Contractor has been assessed and/or paid liquidated damages on more than two separate projects in the last five (5) years with either a public or private owner?*

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18. Contractor has been required to pay either back wages or penalties, on more than three separate occasions in the last three (3) years, for Contractor’s own willful or intentional failure to comply with the state’s prevailing wage laws, including laws governing the employment of apprentices?*

(NOTE: This question refers only to Contractor’s violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor. A good faith dispute over interpretation or application of the prevailing wage laws shall not be considered a willful or intentional failure to comply with the state's prevailing wage laws.)

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19. Has your firm been disqualified or otherwise barred from doing business with a public agency (e.g., federal, state, city, University of California System, California State University System, school district) within the last five years? This includes the entity or any member of the entity if a joint venture or partnership under its current name or under any other alias.*

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NAME AND TITLE OF SUBMITTER:*

NAME OF ENTITY:*

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