ior-csoq.docx
DOCX document 476 KB Posted
- Attached to
- RFQ FOR INSPECTOR OF RECORD SERVICES
- Solicitation number
- 0000031048
- Issued by
- Sacramento County, Sacramento City, California
About this file
This document is a Consultant Statement of Qualifications (CSQ) from UC Davis Health in Sacramento, California requesting qualifications from firms interested in providing Inspector of Record Services for the Central Utility Plant Expansion project. The project involves a 40,000 square foot annex building and 9,000 square feet of renovations within the existing Central Utility Plant facility. The total estimated construction cost is $193 million, with a multi-year contract term expected from approximately 2024 to 2029. Statements of Qualifications must be submitted electronically no later than 4:00 p.m. on April 29, 2024. A Screening Committee will review the submissions, conduct reference checks, and recommend a shortlist of firms for interviews by a Selection Committee prior to selecting the successful firm.
The successful firm and its subconsultants will be required to pay prevailing wages and comply with nondiscrimination requirements. The work is considered a public work subject to Section 1771 of the California Labor Code, and the consultant/design professional must pay no less than the UC Fair Wage of $15 per hour. Firms interested in responding must notify UC Davis Health by April 26, 2024 to receive a link for electronic submission. No hard copies will be accepted.
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| attachment-b-ior.pdf |
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Text version
GENERAL INFORMATION
FIRM NAME:
WEBPAGE:
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:
STAFF [PRINCIPAL (P) AND ASSOCIATE (A) (CHECK "P" OR "A" AS APPLICABLE)]
| NAME | |
| P | |
| A | |
| DISCIPLINE, LICENSE NUMBER |
TYPE, LICENSE NUMBER
EXPIRATION DATE & STATE
| DEGREE OR CERTIFICATE |
| INSTITUTION |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
AVERAGE STAFF EMPLOYED IN LOCAL OFFICE: (AVERAGE OF PAST 5 YEARS)
| LICENSED PROFESSIONALS: |
| PROFESSIONALS ON LICENSURE TRACK: |
| TECHNICAL SUPPORT: |
| PERSONNEL WITH OSHPD EXPERIENCE: |
| CLERICAL: |
OTHER:
DESCRIBE FIRM’S QUALIFICATIONS TO PROVIDE INSPECTION SERVICES (PROVIDE ATTACHMENT, IF NECESSARY).
TECHNICAL APPROACH TO THIS PROJECT (PROVIDE ATTACHMENT, IF NECESSARY).
PROJECT EXPERIENCE
LIST THREE (3) MAJOR PROJECTS WITHIN THE PAST TEN (10) 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 |
| YEARS OF PROF. EXPERIENCE |
| DISCIPLINE, LICENSE NUMBER, EXPIRATION DATE & STATE |
| YEARS W/FIRM |
RESPONDING FIRM REFERENCES [PROVIDE THREE (3)] MUST BE OWNER REFERENCES
| Name: |
| Title: |
| OWNER REFERENCE 1 |
| Firm: |
| Telephone: |
| Name: |
| Title: |
| OWNER REFERENCE 2 |
| Firm: |
| Telephone: |
Name:
Title:
| OWNER REFERENCE 3 |
| Firm: |
Telephone:
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.png
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