A05_2024-05_Pre-Qualifications_for_Contractor.docx

In 1999, the Legislature enacted a law that allows public agencies to require licensed contractors that wish to bid for public works to "pre-qualify" for the right to bid on a specific public works project. To qualify, Contractor seeking to bid on a public works project is required to answer the following:

1. Identification of the company submitting this bid:

Name of firm:

Address:

2. Person authorized to execute an agreement for the company: Name:

Title:

3. Type of company (must be one of the following, check applicable):

Corporation Partnership Individual Joint Venture

4. Bidder possesses a valid and current California Contractor's license for the project or projects for which it intends to submit a bid.

Yes No (Attach copies of licenses qualifying bidder to perform work specified.)

5. Current Class A, General Engineering Contractor license is required. Complete the following: Licensee:

IFB Number 2024-05 Page 4 of 22 California State Lands Commission Platform Holly Caretaker Services

ATTACHMENT 5

PRE-QUALIFICATIONS FOR CONTRACTOR

6.

License Number:

Expiration Date:

7. Do you have a written company Illness and Injury Prevention Program?

Yes No

8. Bidder has a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and $2,000,000 aggregate as specified in the Invitation for Bid.

Yes No

9. Bidder has current workers' compensation insurance policy as required by the Labor Code or is legally self- insured pursuant to Labor Code Section 3700 et. seq.

Yes No

10. Attachment 4 | Have you attached a notarized statement from an admitted surety insurer (approved by the California Department of Insurance) and authorized to issue bonds in the State of California, which states that your current bonding capacity is sufficient for the project for which you are bidding?

Yes No

11. In the past five (5) years, has there been any occasion on which your firm was required to pay either back wages or penalties for your own firm's failure to comply with the State's prevailing wage laws?

Yes No

12. At any time during the last five years, has your firm been found to have violated any provision of California apprenticeship laws or regulations or the laws pertaining to the use of apprentices on public works?

Yes No

13. Has the bidder, any officer of the bidder or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or safety regulation?

Yes No If Yes, attach explanation of circumstances.

14. Within the preceding three (3)years, has the bidder been convicted of any offenses referred to in Public Contract Code Section 10285.1, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or federal antitrust law in connection with the bidding upon, award of or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University? The term "bidder" is understood to include any partner, member officer, director, responsible officer, or responsible managing employee thereof, as referred to in Section 10285.1.

Yes No

15. Most recently completed public works project. Type of work (mark all that apply):

Dredging Wetlands Restoration

Grading and drainage Other:

Earth embankment/fill placement Other:

16. Within the previous three years, has the bidder had any business activities or other operations outside of the United States?

Yes No If Yes, you must complete and submit Attachment 20, Darfur Certification.

I, the undersigned, certify and declare that I have read all the foregoing answers to the above questions and know their contents. Answers to the above questions are true and of my own knowledge and belief. I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct.

Signature Print Name Date

The State Lands Commission reserves the right to reject any bidder, or any employee of such bidder who has a proprietary interest in such bidder, based on the information provided herein.