IFB_2024-18_A2_Bidder_Pre-Qualifications___Certification.docx

IFB #2024-18 Page 2 of 2 State Lands Commission | [Bidder] Prosser Dam Road Fuel Reduction Project

ATTACHMENT #2

BIDDER PRE-QUALIFICATIONS & CERTIFICATION

In 1999, the Legislature enacted a law that allows public agencies to require licensed contractors that wish to bid for Public Works to “pre-qualify” for the right to bid on a specific Public Works project. To qualify, any Contractor/Company (Bidder) seeking to bid on Public Works projects is required to answer the following questions. An unsigned Bidder Pre-Qualification and Certification sheet may be cause for Bid rejection. Comment by Beard, Kevin@SLC: Bidder to update the header of this Attachment with the Bidder’s business name. Comment by Beard, Kevin@SLC: Bidder to provide the requested information and answer all questions identified in RED

1) Identification of company submitting this bid:

a) Name of company

b) Address of company

c) Phone number

d) e-mail address

2) Person authorized to execute an agreement for the company:

a) Name of individual

b) Title of individual

c) e-mail address of individual

3) Type of company:

a) Sole Proprietorship, Corporation, Partnership, Individual, or Joint Venture – select applicable one.

4) Provide the applicable identification numbers:

a) Federal Employee Identification Number (FEIN): xxxxxxxxxx

b) California Corporation Number: xxxxxxxxxx

5) Does Contractor possess a valid and current California Contractor’s License for the project(s) for which it intends to submit a bid?

a) Confirm Yes or No

6) Licenses:

a) Current California Licensed Timber Operator classification LTO-A license is required.

i) License # xxxxxxxxxx

ii) Expiration Date: xx/xx/xxxx

b) Current C-49 Tree and Palm Contractor license issued by the California Contractor’s State License Board is required.

i) License # xxxxxxxxxx

ii) Expiration Date: xx/xx/xxxx

7) Company maintains a written Illness and Injury Prevention Program

a) Confirm Yes or No

8) Company maintains a liability insurance policy with a policy limit of minimum $1,000,000 per occurrence and $2,000,000 aggregate, as specified in the Solicitation: IFB #2024-03.

a) Confirm Yes or No

9) Company maintains a workers’ compensation insurance policy as required by the Labor Code, or is legally self-insured pursuant to Labor Code Section 3700 et. seq.

a) Confirm Yes or No

10) Company has attached a notarized statement from an admitted surety insurer, approved by the California Department of Insurance and authorized to issue bonds in the State of California, which states that your bonding capacity is sufficient for the project for which you are bidding.

a) Confirm Yes or No

11) In the past five (5) years, has there been any occasion on which your firm was required to pay either back wages or penalties for the Company’s failure to comply with the State of California’s prevailing wage laws?

a) Confirm Yes or No

12) In the past five (5) years, has the Company been found to have violated any provision of California apprenticeship laws or regulations, or the laws pertaining to the use of apprentices on public works project?

a) Confirm Yes or No

13) Has the Company, any officer of the Company, or any employee of the Company who has a proprietary interest in the Company, ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state, or local government project because of a violation of law or safety regulation?

a) Confirm Yes or No – If Yes, attach an explanation of the circumstances in question.

14) Within the preceding three (3) years, has the Company been convicted of any offenses referred to in Public Contract Code Section 10285.1, including any charge of fraud, bribery, collusion, conspiracy, or any other act, in violation of any state or federal antitrust law in connection with the bidding upon, awarding of, or performance of any Public Works contract as defined in Public Contract Code Section 1101, with any public entity as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University? The term “Company” is understood to include any partner, member officer, responsible officer, responsible managing employee, or director thereof, as referred to in Public Contract Code Section 10285.1.

a) Confirm Yes or No

15) Within the preceding three (3) years, has the Company engage in any business activities or other operations outside of the United States?

a) Confirm Yes or No – If Yes, Darfur Certification (Attachment #xx) must be completed and submitted.

16) Is the Bidder certified with the Department of General Services, Office of Small Business & Disabled Veteran Business Enterprises (DVBE) (OSDS) as either a Certified Small Business or DVBE?

a) Confirm Yes or No

b) If yes, provide certification number: xxxxxxxxxx

i) A copy of your Certification is required to be included with this Bidder Pre-Qualification and Certification sheet.

c) If application is pending, date application was submitted to OSDS: xx/xx/xxxx I, the undersigned, certify and declare that I have read all the foregoing answers to the above questions, know their content, and that all answers to the questions above are true and of my own knowledge. I declare under penalty of perjury, under the laws of the State of California, that the foregoing is correct.

Signature Name Date

The State Lands Commission reserves the right to reject any Bid, based on the information provided herein.

www.slc.ca.gov