2-Attachment C Profile of Qualifier.pdf

2026-RFQ-AAHC-HD-004

ESPERANZA ELECTRICAL UPGRADE RENOVATION WORK

ISSUED: July 24, 2026

ATTACHMENT C

“PROFILE OF QUALIFIER”

(This Form must be fully completed and placed under Part No.3 of the qualification submittal.)

(1) Prime ☐ Subcontractor ☐ (this form must be completed by and for each)

(2) Name of Qualifier: Telephone: Fax:

E-Mail:

(3) Street Address, City, State, Zip:

(4) Please attach a brief biography/resume of the company, including the following information:

Year Qualifier Established; (b) Former Name and Year Established (if applicable); and

(c) Name of Parent Company and Date Acquired (if applicable).

(5) Identify Principals/Partners in Qualifier (submit under Part 5 a brief professional resume for each):

NAME TITLE % OF OWNERSHIP

(6) Identify the individual(s) that will act as project manager and any other supervisory personnel that will work on project; please submit under Part 5 a brief resume for each. (Do not duplicate any resumes required above):

NAME TITLE

(7) Federal Tax ID No.:

(8) State of California Business Entity Number (Secretary of State):

(9) Worker’s Compensation Insurance Carrier:

Policy No.: Expiration Date:

(10) General Liability Insurance Carrier:

Policy No.: Expiration Date:

ISSUED: July 24, 2026

(11) Professional Liability Insurance Carrier:

Policy No.: Expiration Date:

(12) Has your qualifier or any member of your qualifier been a part to litigation with a public entity?

☐ Yes ☐ No

If yes, please include in section a full detailed explanation including dates, with who and state the circumstances and any resolution.

(13) Is your qualifier currently involved in local, County, State, Federal mortgage foreclosure proceedings or currently 90 days in arrears on a local public or private loan?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(14) Is your qualifier currently in foreclosure or substantial tax arrears with a City/County or local jurisdiction?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(15) Has, or is this qualifier or any member of your qualifier, currently in default on any contract obligation or agreement of any kind entered into with a City/County or local public agency?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(16) In the past 10 years, has your qualifier or any member of your qualifier failed to qualify as a responsible bidder, or refused to enter into a contract after an award has been made, privately or with any government agency?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(17) In the last 7 years, has your qualifier filed a bankruptcy petition or been the subject of involuntary bankruptcy proceedings?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

In the last 10 years, failed to file any required tax returns, or failed to pay any applicable Federal, State of California, or City of Alameda or other fees?

☐ Yes ☐ No

ISSUED: July 24, 2026

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(18) Does your qualifier or any member of your qualifier have a record of substantial Building Code Violations or litigation against properties owned by the qualifier or by any entity or individual that comprises the Qualifier?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(19) Has your qualifier or any member of your qualifier been convicted for fraud, bribery, or grand larceny?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(20) Debarred Statement: Has this qualifier, or any principal(s) ever been debarred from providing any services by the Federal Government, any state government, the State of California, or any local government agency within or without the State of California? Has this qualifier been de-designated as a developer of any government sponsored or publicly assisted project?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(21) Disclosure Statement: Does this qualifier or any principals thereof have any current, past personal or professional relationship with any Commissioner or Officer of the AAHC?

☐ Yes ☐ No

If yes, please include clarifying information including dates, with who and state the circumstances and any resolution in section (23) below.

(22) Additional clarifying information regarding questions and statements (12) through (22) – include below and/or attach related documents:

(23) Non-Collusive Affidavit: The undersigned party submitting this bid hereby certifies that such bid is genuine and not collusive and that said bidder entity has not colluded, conspired, connived or agreed, directly or indirectly, with any qualifier or person, to put in a sham qualification or to refrain from proposing, and has not in any manner, directly or indirectly sought by agreement or collusion, or communication or conference, with any person, to fix the

ISSUED: July 24, 2026 qualification price of affiant or of any other qualifier, to fix overhead, profit or cost element of said qualification price, or that of any other bidder or to secure any advantage against the AAHC or any person interested in the proposed contract; and that all statements in said bid are true.

(24) Verification Statement: The undersigned bidder hereby states that by completing and submitting this bid he/she is verifying that all information provided herein is, to the best of his/her knowledge, true and accurate, and agrees that if the AAHC discovers that any information entered herein is false, that shall entitle the AAHC to not consider nor make award or to cancel any award with the undersigned party.

Signature:

Printed Name:

Title:

Company:

Date: