csoq-form.docx
DOCX document 60 KB Posted
- Attached to
- RFQ FOR PLANNING SERVICES
- Solicitation number
- 0000037170
- Issued by
- Sacramento County, San Francisco City, California
About this file
This is a Consultant Statement of Qualifications (CSOQ) form issued by UC Davis Health's Facilities Design & Construction office located at 4800 2nd Avenue, Suite 3010, Sacramento, California 95817. The form requests comprehensive information from design professionals and consultants seeking commission opportunities with UC Davis Health. Prospective firms must provide general company information including main and branch office addresses, remit-to address, and primary contact details. The form requires detailed staffing information for principal and associate personnel, including educational credentials, institutional affiliations, and a five-year average of local office employment broken down by licensed professionals, professionals on licensure track, technical support, clerical, and other staff categories. Firms must describe their managerial approach, team methodology, and quality control programs, and provide documentation of previous UC project experience through a list of up to three major projects completed within the past five years, presented in reverse chronological order with project specifications including owner contact information, contract award amounts, final project costs, square footage, construction timelines, completion dates, facility type, and project descriptions.
The form additionally requires submission of key personnel information identifying specific individuals assigned to projects, their degrees and institutions, years of professional experience, relevant licenses with expiration dates and states, tenure with the firm, and two professional references. Interested consultants must indicate where they typically source information about proposed University projects and may attach supplementary materials such as firm brochures or discussions of recent work. All information requested on the form is mandatory for consideration, as per California's Information Practices Act of 1977. The Facilities Design & Construction Manager maintains records and individuals have the right to access their submitted information. Contact for inquiries is L.C.C. Ouceiro at lccouceiro@ucdavis.edu.
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Text version
GENERAL INFORMATION
FIRM NAME:
MAIN (STREET) ADDRESS:
CITY:
STATE:
ZIP CODE:
BRANCH (STREET) ADDRESS:
CITY:
STATE:
ZIP CODE:
REMIT TO ADDRESS:
CITY:
STATE:
ZIP CODE:
CONTACT
CONTACT NAME & TITLE:
TELEPHONE:
FAX:
EMAIL:
WEB PAGE:
STAFF [PRINCIPAL (P) AND ASSOCIATE (A) (CHECK "P" OR "A" FOR EACH)]
| NAME |
| P |
| A |
| DEGREE OR CERTIFICATE |
| INSTITUTION |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
AVERAGE STAFF EMPLOYED IN LOCAL OFFICE: (AVERAGE OF PAST 5 YEARS)
| LICENSED PROFESSIONALS: |
| PROFESSIONALS ON LICENSURE TRACK: |
| TECHNICAL SUPPORT: |
| CLERICAL: |
| OTHER: |
WHAT IS YOUR MANAGERIAL APPROACH, TEAM APPROACH AND QUALITY CONTROL PROGRAM? (PROVIDE ATTACHMENT, IF NECESSARY)
INDICATE PREVIOUS UC PROJECT EXPERIENCE (IF ANY).
PROJECT EXPERIENCE
LIST UP TO THREE (3) MAJOR PROJECTS WITHIN THE PAST FIVE (5) YEARS THAT INDICATES YOUR EXPERIENCE (LIST MOST RECENT FIRST).
| Project No. 1 Name: |
| Owner (include phone): |
| Contract Award Amount: |
| Final Project Cost: |
| Project Sq. Ft.: |
| Original Construction Time: |
| Actual Construction Time: |
| Year of Completion: |
| Type of Facility: |
Project Description:
| Project No. 2 Name: |
| Owner (include phone): |
| Contract Award Amount: |
| Final Project Cost: |
| Project Sq. Ft.: |
| Original Construction Time: |
| Actual Construction Time: |
| Year of Completion: |
| Type of Facility: |
Project Description:
| Project No. 3 Name: |
| Owner (include phone): |
| Contract Award Amount: |
| Final Project Cost: |
| Project Sq. Ft.: |
| Original Construction Time: |
| Actual Construction Time: |
| Year of Completion: |
| Type of Facility: |
Project Description:
FACILITIES DESIGN & CONSTRUCTION
UC DAVIS HEALTH
4800 2ND AVENUE, SUITE 3010
SACRAMENTO, CA 95817
EMAIL: LCCOUCEIRO@UCDAVIS.EDU
CONSULTANT STATEMENT OF QUALIFICATIONS
| UC Davis Health | Page 1 of 3 | Rev. 01-2016 |
| UC Davis Health | Page 2 of 3 | Rev. 01-2016 |
KEY PERSONNEL INFORMATION
| PROJECT ROLE |
| NAME |
| DEGREES |
| INSTITUTION |
| YEARS OF PROF. EXPERIENCE |
| DISCIPLINE, LICENSE NUMBER, EXPIRATION DATE & STATE |
| YEARS W/FIRM |
REFERENCES [PROVIDE TWO (2)]
| Name: |
| Title: |
| Firm: |
| Telephone: |
| Name: |
| Title: |
| Firm: |
| Telephone: |
| Where do you normally look for information about proposed University projects? |
Please attach to this form any other information you wish us to consider, such as your firm's brochure or a discussion of your recent work.
PRIVACY NOTIFICATION
The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University of California to provide the following information to individuals who are asked to supply personal information about themselves.
The principal purpose for requesting the information on this form is for use in the selection process for Design Professionals and Consultants commissioned by the University. University Policy authorizes maintenance of this information.
Furnishing all information requested on this form is mandatory – failure to provide such information will delay or may even prevent completion of the action for which the form is being filled out. Information furnished on this form will be used by the Facilities Design & Construction Office in the consideration of commissions to Design Professionals and Consultants.
Individuals have the right to have access to this record as it pertains to themselves.
The official responsible for maintaining the information contained on this form is the Manager, Facilities Design and Construction.
FACILITIES DESIGN & CONSTRUCTION
UC DAVIS HEALTH
4800 2ND AVENUE, SUITE 3010
SACRAMENTO, CA 95817
UC Davis Health Page 3 of 3 Rev. 07-2019 image1.jpeg
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