CON27-0001_Attachment_3_Bidder_s_Questionnaire.docx

Bidder’s Questionnaire

Within 48 hours following a request by the San Francisco Recreation and Parks Department (RPD), a bidder must submit to the RPD a completed, signed Bidder’s Questionnaire using this form and all required attachments, including clearly labeled additional sheets as needed. The RPD may request the Questionnaire from one or more of the apparent low bidders following the bid opening, and may use the completed Questionnaire as part of its investigation to evaluate a bidder’s qualifications and responsibility for this Project. The RPD reserves the right to verify any information provided in this Questionnaire and to contact any owner, contractor, design professional, or other reference identified by the Bidder. The Questionnaire must be filled out completely, accurately, and legibly. Any errors, omissions, or misrepresentations in completion of the Questionnaire may be grounds for rejection of the bid or termination of a Contract awarded pursuant to the bid.

Part A: General Information

Main Office Address, Phone and Email:

Local Office Address, Phone and Email:

Company Website:

Owner(s), Managing Member(s), or Corporate Officer(s):

Contact Name and Title:

Contact Phone and Email:

Bidder’s California Contractor’s License Number(s):

Bidder’s California Contractor License Classification(s):

Bidder’s DIR Registration Number:

2026 Form San Francisco Recreation and Parks Department

BIDDER’S QUESTIONNAIRE

Part B: Bidder Experience

1. How many years has Bidder been in business under its present business name? years

2. Has Bidder completed projects similar in scope, complexity, and size to this Project as a general contractor?

Yes No

3. Has Bidder been disqualified within the past five (5) years from a bid on grounds that it is not responsible, or otherwise disqualified or disbarred from bidding under state or federal law?

Yes No

If yes, provide additional information on a separate sheet regarding the disqualification or disbarment, including the name and address of the agency or owner of the project, the type and size of the project, the reasons that Bidder was disqualified or disbarred, and the month and year in which the disqualification or disbarment occurred.

4. Has Bidder or any proposed subcontractor performing dredging operations been terminated within the past five (5) years for any reason, either as a general contractor or as a subcontractor?

Yes No

If yes, provide additional information on a separate sheet regarding the termination, including the name and address of the agency or owner of the subject project, the type and size of the project, whether Bidder was under contract as a general contractor or a subcontractor, the reasons that Bidder was terminated, and the month and year in which the termination occurred.

5. Provide information about Bidder’s past projects performed as general contractor as follows:

5.1 Six most recently completed public works projects within the last three years;

5.2 Three largest completed projects within the last three years; and

5.3 Any project which is similar to this Project including scope and character of the work.

Projects may be used to satisfy more than one category above.

6. Use separate sheets to provide all of the following information for each project identified in response to the above three categories:

6.1 Project name, location, and description;

6.2 Owner (name, address, email, and phone number);

6.3 Prime contractor, if applicable (name, address, email, and phone number);

6.4 Architect or engineer (name, email, and phone number);

6.5 Project and/or construction manager (name, email, and phone number);

6.6 Scope of work performed (as general or as subcontractor);

6.7 Initial contract price and final contract price (including change orders);

6.8 Original scheduled completion date and actual date of completion;

6.9 Time extensions granted (number of days);

6.10 Number and amount of stop notices or mechanic’s liens filed;

6.11 Amount of any liquidated damages assessed against Bidder; and

6.12 Nature, current status, and resolution (if applicable) of any project-related claim, lawsuit, mediation, or arbitration involving Bidder.

6.13 Contract delivery method (Design-Bid-Build, CM/GC, Design-Build, Job Order Contract, etc.).

Part C: Safety

1. Provide the following safety metrics in the table below:

1.1 Bidder’s Experience Modification Rate (EMR), also referred to as the Experience Modification Factor (EMF), for each of the last three completed workers’ compensation policy years.

1.2 Total Recordable Incident Rate (TRIR) and Days Away, Restricted, or Transferred (DART) Rate for the last three completed calendar years.

2. Attach Bidder’s Cal/OSHA Form 300A, Annual Summary of Work-Related Injuries and Illnesses, for the three most recently completed calendar years.

3. Has Bidder ever been cited, fined, or prosecuted by any local, state, or federal agency, including OSHA, Cal/OSHA, or EPA, for violation of any law, regulation, or requirements pertaining to health and safety?

Yes No If yes, provide additional information on a separate sheet regarding each such citation, fine, or prosecution, including the name and address of the agency or owner of the project, the type and size of the project, the reasons for and nature of the citation, fine, or prosecution, and the month and year in which the incident giving rise to the citation, fine, or prosecution occurred.

4. Name, title, and email for person responsible for Bidder’s safety program:

Name Title Email

Part D: Verification

In signing this document, I, the undersigned, declare that I am duly authorized to sign and submit this Bidder’s Questionnaire on behalf of the named Bidder, and that all responses and information set forth in this Bidder’s Questionnaire and accompanying attachments are, to the best of my knowledge, true, accurate and complete as of the date of submission. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signature: Date:

By:

Name and Title

END OF BIDDER’S QUESTIONNAIRE