Purchasing Services Department 1900 W Olive Ave

Burbank, CA 91506 www.burbankusd.org

BID 2627-015 SUMMER 2027 ROOFING AT VARIOUS SITES 1

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

CONTRACTOR INFORMATION

Firm/Company Name: _________________________________________________________________________ (as it appears on your license)

Address: _____________________________ __________________________ ______ _______________ Street City State ZIP

Contact Person: ____________________________________________ Phone: ___________________________

Email Address: ________________________________________________________________________________

Contractor State License Board (CSLB)

License Number:________________ Expiration Date: ______________ Classification(s) ___________________ (Automatic disqualification without a C-39 Classification)

Department of Industrial Relations (DIR) SB854

Registration Number: __________________ Expiration Date: ___________ (Automatic disqualification if omitted)

Construction Operations:

Bonding Capacity (per contract): $ __________________ Surety: ______________________________________

Value of largest contract: $ ________________________ Owner: ______________________________________

Annual Gross Revenue: $ ______________________ $ ______________________ $ ______________________ (previous 3 years)

FY _________ FY _________ FY _________

REQUIRED Attachments

1. Firm’s latest copy of Reviewed and Audited Financial Statement, with Notes and Supplemental Information (Information contained in this statement shall not be public records and shall not be open to public inspection)

2. W-9 Request for Taxpayer Identification Number and Certification

3. Certificate of Liability Insurance for all operations with Burbank Unified School District as Additional Insured

4. Garland Letter of Certification for this project

Submit all documents together in a single PDF file to davidgerharter@burbankusd.org

I, the undersigned, certify and declare that I have read all the answers to this prequalification application and questionnaire and know their contents. The matters stated in the questionnaire answers are true to the best of my knowledge and belief. I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct.

Authorized Signature ____________________________________________ Date: ________________________

Print Name ____________________________________ Title: ________________________________________ http://www.burbankusd.org/ mailto:davidgerharter@burbankusd.org

Burbank, CA 91506 www.burbankusd.org

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 1

ESSENTIAL REQUIREMENTS FOR QUALIFICATION

NOTE: Contractor shall be disqualified if questions 1, 2, 3 or 4 are answered “No”

1. Do you have a liability insurance policy with policy limit of at least $1,000,000 per occurrence and $2,000,000 aggregate?

Yes No

2. Do you have a current Workers Compensation Insurance policy as required by the State of California Labor Code or are you legally Self Insured pursuant to Labor Code Section 3700 et seq?

Yes No

3. Do you have a current DIR Registration Number as required by the Department of Industrial Relations under

SB854?

Yes No

4. Are you a Certified Installer of Garland Roofing products? Please attach proof of Garland certification specifically listing this bid. Please contact Tony DeMartinis at tdemartinis@garlandco.com to obtain certification.

Yes No

NOTE: Contractor shall be disqualified if questions 5, 6 or 7 are answered “Yes”

5. Has your license been revoked at any time in the last five (5) years?

Yes No

6. Has a Surety firm completed a contract on your behalf, or paid for completion because your firm was default terminated by the Owner within the last five (5) years?

Yes No

7. At the time of submitting this Pre-Qualification form, is your firm ineligible to bid on or be awarded a public works contract, or perform as a Sub-Contractor on a public works contract, pursuant to either Labor Code Section 1777.1 (Violation of public works labor laws) or Labor Code Section 1777.7 (Violation of apprenticeship requirements)?

Yes No

If Yes, state the beginning and ending dates of the period of debarment:

Beginning: ___________________ Ending: ___________________

NOTE: A Contractor disqualified solely because of a “YES” answer given to question 5, 6 or 7 may appeal the disqualification and provide an explanation of the relevant circumstance during the appeal procedure.

BID 2627-015 SUMMER 2027 ROOFING AT VARIOUS SITES

mailto:tdemartinis@garlandco.com

Burbank, CA 91506 www.burbankusd.org

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 2

HISTORY, PERFORMANCE, AND COMPLIANCE WITH CIVIL AND CRIMINAL LAW

NOTE: If your answer to any of the following questions is “YES”, please explain on a separate signed sheet.

1. Is your firm currently the debtor in a bankruptcy case? Has your firm been in a bankruptcy case at any time during the last five (5) years?

Yes No

2. Has your license(s) been suspended by the California State License Board (CSLB) or has any Responsible Managing Employee (RME) or Officer (RMO) been suspended within the last five (5) years?

Yes No

3. Has your firm been assessed and paid Liquidated Damages after completion of a project under a construction contract with either public or private owner within the last five (5) years?

Yes No

4. In the last five (5) years, has your firm, or any firm with which any of your company’s owners, officers, or partners were “associated with”, been debarred, disqualified, removed, or otherwise prevented from bidding on, or competing at any government agency or public works project for any reason?

Yes No NOTE: “associated with” refers to another construction firm in which an owner, partner, or officer of your firm held a similar position.

5. In the last five (5) years, has your firm been denied an award of a public works contract based on a finding by a public agency that your firm was NOT a RESPONSIBLE bidder?

Yes No

6. In the past five (5) years, has any claim against your firm concerning your firm’s work on a construction project been filed in court or arbitration?

Yes No

7. At any time during the past five (5) years, has any surety company made any payments on your firm’s behalf as a result of a default to satisfy any claims made against a performance or payment bond issued on your firm’s behalf in connection with a construction project, either public or private?

Yes No

8. In the last five (5) years, has any insurance carrier, for any form of insurance, refused to renew an insurance policy for your firm?

Yes No

9. During the last five (5) years, has your firm ever been denied bond coverage by a surety company, or has there been a period of time when your firm had no surety bond in place during a public construction project when one was required?

Yes No

10. Has CAL OSHA cited and assessed penalties against your firm for any “serious,” “willful” or “repeat” violations of safety or health regulations in the past five years?

Yes No

BID 2627-015 SUMMER 2027 ROOFING AT VARIOUS SITES

Burbank, CA 91506 www.burbankusd.org

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 2

HISTORY, PERFORMANCE, AND COMPLIANCE WITH CIVIL AND CRIMINAL LAW (cont.)

11. Has the federal Occupational Safety and Health Administration cited and assessed any penalties against your firm in the past five years?

Yes No

12. In the past five years, 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 a contractor?

Yes No

13. Has there been more than one occasion during the last five years in 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 NOTE: This question refers only to your own firm’s violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor.

14. During the last five years, has there been more than one occasion in which your own firm has been penalized or required to pay back wages for failure to comply with federal prevailing wage requirements?

Yes No

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

Yes No

Burbank, CA 91506 www.burbankusd.org

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 3

COMPLETED PROJECTS INFORMATION

NOTE: Provide information about the 3 most recently completed public works projects. Names and references must be current and verifiable.

PROJECT #1 INFORMATION

Project Title __________________________________________________________________________________

Location _____________________________________________________________________________________

Owner / Public Agency __________________________________________________________________________

Owner Contact _________________________________ Title ________________________________________

Email address _______________________________________________ Phone ___________________________

Project Description (Scope of Work)

Contract Amount $ ___________________________ Final Project Cost $ ________________________________

Scheduled Completion Date ____________________ Actual Completion Date ____________________________

Additional Comments

Burbank, CA 91506 www.burbankusd.org

PROJECT #2 INFORMATION

Project Title __________________________________________________________________________________

Location _____________________________________________________________________________________

Owner / Public Agency __________________________________________________________________________

Owner Contact _________________________________ Title ________________________________________

Email address _______________________________________________ Phone ___________________________

Project Description (Scope of Work)

Contract Amount $ ___________________________ Final Project Cost $ ________________________________

Scheduled Completion Date ____________________ Actual Completion Date ____________________________

Additional Comments

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 3

COMPLETED PROJECTS INFORMATION

NOTE: Provide information about the 3 most recently completed public works projects. Names and references must be current and verifiable.

Burbank, CA 91506 www.burbankusd.org

PROJECT #3 INFORMATION

Project Title __________________________________________________________________________________

Location _____________________________________________________________________________________

Owner / Public Agency __________________________________________________________________________

Owner Contact _________________________________ Title ________________________________________

Email address _______________________________________________ Phone ___________________________

Project Description (Scope of Work)

Contract Amount $ ___________________________ Final Project Cost $ ________________________________

Scheduled Completion Date ____________________ Actual Completion Date ____________________________

Additional Comments

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

PREQUALIFICATION QUESTIONNAIRE – PART 3

COMPLETED PROJECTS INFORMATION

NOTE: Provide information about the 3 most recently completed public works projects. Names and references must be current and verifiable.

Burbank, CA 91506 www.burbankusd.org

CONTRACTOR PREQUALIFICATION APPLICATION (PCC 22000)

COMMUNITY WORKFORCE AGREEMENT

LETTER OF ASSENT

To be signed by all contractors bidding on work covered by the Community Workforce Agreement.

Community Workforce Coordinator Burbank USD

Re: Community Workforce Agreement - Letter of Assent

To whom it may concern:

This is to confirm that ____________________________________ agrees to be party to and bound by the Burbank Unified School District Community Workforce Agreement effective March 1, 2025, as such Agreement may, from time to time, be amended by the negotiating parties or interpreted pursuant to its terms. Such obligation to be a party and bound by this Agreement shall extend to all work covered by the Agreement undertaken by this Company on the Project and this Company shall require all of its contractors and subcontractors of whatever tier to be similarly bound for all work within the scope of the Agreement by signing and furnishing to you an identical Letter of Assent prior to their commencement of work.

Sincerely, By: ________________________________

Name: ________________________________

Title: ________________________________

Contractor State License No. _______________________________