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CUPCCAA Application CUPCCAA Application 2019

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PASADENA AREA COMMUNITY COLLEGE DISTRICT (PACCD)
2020 Pre-qualification Application
For
California Uniform Public Construction Cost Accounting Act (CUPCCAA)
At their August 21, 2013 Board meeting, the Trustees of the Pasadena Area Community College
District elected to become subject to the CUPCCAA procedures pursuant to Public Contract Code
22030 et seq. The District is inviting licensed contractors to submit their information and qualifications
for inclusion on the District’s list of qualified bidders for the 2020 Calendar year.
Completion of this application certifies that listed contractor is requesting to be included in the
Pasadena City College list of pre-qualified contractors to receive Notices Inviting Informal Bids.
1. APPLICANT INFORMATION
Firm Name:
Contact Name:
Title:
Street Address:
City:
State:
Zip Code:
Telephone:
Fax:
Email Address:
Alternate Contact Name:
Title:
Telephone:
Fax:
Email Address:
License Number:
License Classification:
Responsible Managing Officer:
Expiration Date:
1.1. APPLICANT FORM OF ENTITY (check appropriate box)
☐ General Partnership ☐ Limited Liability Partnership
☐ Limited Partnership ☐ Joint Venture
☐ Limited Liability Corporation ☐ Sole Proprietorship
☐ Corporation
1.2. REVENUE Complete the following for the Applicant’s construction operations; if any portion of
the revenue disclosed is generated by non-construction operations or activities, the Applicant
must identify the portion of revenue attributed to construction operations and generally describe
business activities of the Applicant that generates non-construction operations related revenue.
Annual Gross
Revenue
Annual Net Revenue
Average Dollar Value
of all Contracts
2019 (FY 2019/2020)
2018 (FY 2017/2018)
2017 (FY 2016/2017)
Page 1 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
CATEGORIES OF WORK
Asbestos Abatement C-22 Low Voltage Systems C-7
Boiler, Hot Water Heating & Steam C-4 Masonry C-29
Building Moving, Demolition C-21 Ornamental Metals C-23
Cabinet, Mill Work & Finish Carpentry C-6 Painting & Decorating C-33
Concrete C-8 Parking & Highway Improvement C-32
Construction Zone Traffic Control C-31 Pipeline C-34
Drywall C-9 Plumbing C-36
Earthwork & Paving C-12 Refrigeration C-38
Electrical (General) C-10 Roofing C-39
Electrical (Signs) C-45 Sanitation System C-42
Elevator Contractor C-11 Sheet Metal C-43
Fencing C-13 Solar C-46
Fire Protection C-16 Steel, Reinforcing C-50
Flooring & Floor Covering C-15 Steel, Structural C-51
Glazing C-17 Swimming Pool C-53
Insulation & Acoustical C-2 Tile (Ceramic & Mosaic) C-54
Landscaping C-27 Warm Air Heating, Ventilating & Air Conditioning C-20
Lathing & Plastering C25 Water Conditioning C-55
Limited Specialty C-61 Welding C-60
Lock & Security C-28 Well Drilling C-57
Doors, Gates and Activating Devices D-28
Machinery and Pumps D-21
1.3. REFERENCES
Material Suppliers
Supplier Name
Address
Telephone No.
Contact Name
Owners
(Community Colleges and/or K-12 School District Preferred)
Owner Name
Address
Telephone No.
Contact Name
1.4. PRE-QUALIFICATION CATEGORIES Check the applicable box for each trade category for
which pre-qualification is requested. In addition to other pre-qualification criteria, the Applicant
must currently possess a valid and in good standing California Contractors’ License required (as
noted below) for each trade category for which pre-qualification is requested. General
Engineering (Class A) and/or General Building (Class B) contractors should circle those
categories of work in which they have specialized knowledge and skill, and in which they would
be interested in participating in an informal bid project with the College.
Page 2 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
1.5. INSURANCE
1.5.1. Commercial General Liability Insurance
Insurer
Current Policy No.
1.5.2. Commercial General Liability Insurance Broker
Broker
Address
Telephone No.
Fax No.
Contact Name
1.5.3. Workers’ Compensation Insurance
Insurer
Current Policy No.
1.5.4. Workers’ Compensation Insurance Broker
Broker
Address
Telephone No.
Fax No.
Contact Name
2. ESSENTIAL REQUIREMENTS
2.1. Bidder possesses a valid, and currently in good standing, California Contractors’ License for the
trade category(ies) checked in paragraph 1.4 above.
☐ Yes ☐ No (Not Qualified)
2.2. Bidder has a current commercial general liability insurance policy with coverage limits of at least
$500,000 per occurrence and $1,000,000 in the aggregate.
☐ Yes ☐ No (Not Qualified)
2.3. Bidder has a current workers’ compensation insurance policy as required by the Labor Code of
is legally self-insured pursuant to Labor Code § 3700.
Page 3 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
2.4.
2.5.
2.6.
2.7.
2.8.
2.9.
☐ Yes ☐ No (Not Qualified)
☐ Applicant is exempt from this requirement because the Applicant has no employees
Certificates of Insurance evidencing the Bidder’s current commercial general liability insurance
policy and workers compensation insurance are attached to the response to this Pre-
Qualification Application.
Commercial General Liability Certificates of Insurance
☐ Yes ☐ No (Not Qualified)
Workers’ Compensation Certificates of Insurance
☐ Yes ☐ No (Not Qualified)
☐ Applicant is exempt from this requirement because the Applicant has no employees
Is the Applicant ineligible or debarred from submitting Bid Proposals for public works projects or
public works contracts pursuant to Labor Code § 1777.1 or Labor Code § 1777.7?
☐ Yes (Not Qualified) ☐ No
Has any public agency, within the past five (5) years conducted proceedings that resulted in a
finding that the Applicant, or any predecessor to the Applicant, is not a “responsible” bidder for
a public works project or a public works contract?
☐ Yes (Not Qualified) ☐ No
At any time during the last five (5) years, has the Applicant or any predecessor to the Applicant,
or any of the equity owners of the Applicant been convicted of a federal or state crime involving
fraud, theft, or any other act of dishonesty?
☐ Yes (Not Qualified) ☐ No
Bidder is currently registered with the Department of Industrial Relations (DIR), Public Works
Division pursuant to State Legislation SB854?
☐ Yes ☐ No (Not Qualified)
Registration No.
Bidder pays prevailing wage pursuant to California Department of Industrial Relations
standards?
☐ Yes ☐ No (Not Qualified)
Page 4 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
3. PERFORMANCE/EXPERIENCE
A Bidder must receive a minimum of 75 points in out of a possible 85 points in this section to be
deemed pre-qualified.
3.1. Within the past two (2) years, has your organization performed work on public works projects
where the value of your work was at least $50,000?
☐ No (0 points) ☐ Yes, 1 – 5 projects (3 points)
☐ Yes, 6 – 10 projects (5 points) ☐ Yes, 11 or more projects (10 points)
If yes, was your organization the general contractor of a subcontractor?
☐ General Contractor ☐ Subcontractor
3.2. Has a complaint ever been filed against your organizations’ California Contractors’ License with
the California Contractors State License Board?
☐ Yes (0 points) ☐ No (10 points)
3.3. Has your organization ever asked to be relieved of or refused to sign a contract for construction
services awarded to it?
☐ Yes (0 points) ☐ No (5 points)
3.4. Has your organization ever failed to complete a construction contract?
☐ Yes (0 points) ☐ No (5 points)
3.5. Has your organization ever been declared in default of a construction contract?
☐ Yes (0 points) ☐ No (10 points)
3.6. Has your organization ever failed to complete a public works construction contract within the
authorized time?
☐ Yes (0 points) ☐ No (10 points)
3.7. Has your organization ever been assessed and paid liquidated damages under a construction
contract with either a public or private owner?
☐ Yes (0 points) ☐ No (10 points)
3.8. Has your organization ever been denied an award of a public works contract based upon a
finding by a public agency that your organization was not a responsible bidder?
☐ Yes (0 points) ☐ No (10 points)
Page 5 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
3.9. Has your organization or any principal of your organization ever been found guilty of violating
any federal, state or local law, rule or regulation regarding a construction contract?
☐ Yes (0 points) ☐ No (5 points)
3.10. Has any insurance carrier, for any policy of insurance, refused to renew an insurance policy for
your organization?
☐ Yes, more than 1 occasion (0 points) ☐ Yes, 1 occasion only (3 points) ☐ No (10 points)
4. SAFETY
A Bidder must receive a minimum of 25 points out of a possible 33 points in this section to be
deemed prequalified.
4.1. Has CAL OSHA cited and assessed penalties against your firm for any “serious,” “willful,” or
“repeat” violations of its safety or health regulations in the past five (5) years?
☐ 0 to 1 occasions (5 points) ☐ 2 occasions (3 points) ☐ 3 or more occasions (0 points)
4.2. Has the California Occupational Safety and Health Administration (“CA/OSHA”) cited and
assessed penalties against your firm in the past (5) years?
☐ 0 to 1 occasions (5 points) ☐ 2 occasions (3 points) ☐ 3 or more occasions (0 points)
4.3. Has the EPA, any Air Quality Management District or any Regional Water Quality Control Board
cited and assessed penalties against either your firm or the owner of a project on which your
firm was the contractor in the past five (5) years?
☐ 0 to 1 occasions (5 points) ☐ 2 occasions (3 points) ☐ 3 or more occasions (0 points)
4.4. How often to you require documented safety meetings to be held for construction employees
and field supervisors during the course of a project?
Frequency of Meetings
☐ Once a week or more (3 points) ☐ Less than once a week (0 points)
4.5. List your firm’s Workers’ Compensation Insurance Experience Modification Rate (EMR) for each
of the past three (3) premium years: (Note: An Experience Modification Rate is issued to your
firm annually by your workers’ compensation insurance carrier.)
2019 premium year
2018 premium year
2017 premium year
Page 6 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
☐ 3 year average EMR of 0.95 or less (5 points)
☐ 3 year average EMR above 0.95 but less than 1.10 (3 points)
☐ 3 year average EMR above 1.10 (0 points)
4.6. Has there been more than one occasion during the last five (5) years when your firm was
required to pay either back wages or penalties for your own firm’s failure to comply with
California’s prevailing wage laws? (Note: This question applies only to your own firm’s violation
of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor to your
firm.)
☐ 0 to 2 occasions (5 points) ☐ 3 occasions (3 points) ☐ 4 or more occasions (0 points)
4.7. At any time during the last five (5) years, has your firm been found to have violated any provision
of California apprenticeship laws or regulations, of the laws pertaining to use of apprentices on
public works?
☐ Yes ☐ No
If yes, provide the date(s) of such findings and attach copies of the Department’s final
decision(s):
☐ 0 to 2 occasions (5 points) ☐ 3 occasions (3 points) ☐ 4 or more occasions (0 points)
The combined maximum total points in section 3 and 4 is 118 points.
5. CERTIFICATE OF ACCURACY AND AUTHORITY
The undersigned is duly authorized to execute this Informal Bidding Pre-Qualification Application
under penalty of perjury on behalf of the above-identified Applicant. The undersigned
warrants and represents that he/she has personal knowledge of each of the responses to this
Informal Bidding Pre-Qualification Application and/or that he/she has conducted all necessary and
appropriate inquiries to determine the truth, completeness and accuracy of responses to this Informal
Bidding Pre-Qualification Application.
The undersigned declares and certifies that the responses to this Informal Bidding Pre-Qualification
Application are complete and accurate; there are no omissions of material fact or information that render
any response to be false or misleading and there are no misstatements of fact in any of the responses.
The above-identified Applicant acknowledges and agrees that if the District determines that any
response herein is false or misleading or contains misstatements of fact, the Applicant will not be
deemed pre-qualified to participate in the District’s Informal Bidding procedures.
Page 7 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
Tel: 626.585.7997 Fax: 626.585.7900
The undersigned certifies that the above referenced Contractor is properly licensed and skilled to
perform the above work and is able to secure bonds to perform the work. The undersigned further
acknowledges that verification of current license, insurance and bonds will be conducted before any
work will begin. This form is not a promise or guarantee of work but provides information and pre-
qualification for the selection of contractors.
Executed this _____ day of __________ 20 _____ at _______________________________________
(City and State)
I declare under penalty of perjury under California law that the foregoing is true and correct.
Print Name
Mail, Email or Fax form to:
Cameron Hurst
Purchasing Services Pasadena City College
1570 E. Colorado Blvd.
Pasadena, CA 91106
Email: churst@lpasadena.edu
Signature
Title
Date
Page 8 of 8
INFORMAL BIDDING
PRE-QUALIFCATION APPLICATION - 2020
Rev. Nov 2019.
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Completed 6 December 2019

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