csoq-form.docx
DOCX document 60 KB Posted
- Attached to
- RFQ FOR PROJECT DEVELOPMENT SERVICES
- Solicitation number
- 0000037171
- Issued by
- Sacramento County, San Francisco City, California
About this file
This is a Consultant Statement of Qualifications (CSOQ) form used by UC Davis Health's Facilities Design & Construction office to solicit and evaluate qualifications from design professionals and consultants. The form requests comprehensive information about firms seeking consideration for design and construction commissions, including general firm information, contact details, office locations, and staffing structure. Firms must document their managerial approach, team structure, and quality control programs, along with any previous experience on UC projects. The application requires submission of up to three major projects completed within the past five years, with detailed information including project name, owner contact information, contract award amount, final project cost, square footage, original and actual construction timelines, completion year, facility type, and project description.
The form mandates disclosure of key personnel information for project roles, including staff names, degrees, institutional affiliations, years of professional experience, professional licenses with expiration dates and states of licensure, and tenure with the firm. Applicants must provide two professional references with names, titles, firm affiliations, and telephone numbers. The form also requests information about where firms typically source information regarding proposed University projects and invites submission of supplementary materials such as firm brochures or discussions of recent work. Completion of all requested information is mandatory, as the State of California Information Practices Act requires the University to explain that failure to provide information may delay or prevent action on the application. The UC Davis Health Facilities Design & Construction Office, located at 4800 2nd Avenue, Suite 3010, Sacramento, California 95817, maintains and uses this information for the consultant selection process.
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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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