csoq-form.docx
DOCX document 60 KB Posted
- Attached to
- RFI - California Monitoring Program
- Solicitation number
- 0000037184
- 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, a University of California entity located in Sacramento, California, to evaluate design professionals and consultants for potential commission on university projects. The form requests comprehensive information about prospective firms and their qualifications to support the selection process for design and construction services. Respondents must provide detailed firm information including main and branch office addresses, contact details, and staffing composition broken down by licensed professionals, professionals on licensure track, technical support, and clerical personnel. Firms are required to document their managerial approach, team structure, and quality control programs, and to list up to three major projects completed within the past five years, including project specifics such as contract award amounts, final costs, square footage, construction timelines, completion dates, facility types, and detailed project descriptions. Additionally, firms must identify key personnel by role with relevant degrees, professional experience, discipline credentials with license numbers and expiration dates, tenure with the firm, and provide two professional references.
The form emphasizes that submission of all requested information is mandatory, with incomplete submissions potentially delaying or preventing consideration in the selection process. UC Davis Health's Facilities Design & Construction Office, located at 4800 2nd Avenue, Suite 3010, Sacramento, California 95817, maintains and reviews the submitted information. The form includes privacy notification in compliance with the California Information Practices Act of 1977, informing applicants of data usage restrictions and their right to access records pertaining to themselves. No specific pricing terms, contract amounts, or award timelines are outlined in this template document, as the CSOQ form functions as a qualification evaluation tool rather than a solicitation with established contract terms.
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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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