RFQ_Parts_A_&_B_Forms_Soft_Copy.docx

Request for Qualifications Progressive Design-Build Services Consolidated Rental Car Facility

PART A –QUESTIONNAIRE FORMS AND TEMPLATES

PART A – QUESTIONNAIRE

Section 4: Insurance and Bonds

The Respondent may elect to not use the forms provided, but all information requested must be presented in the same order and format as outlined in the RFQ document and corresponding forms.

SECTION 1 – Declaration The Respondent, herein referred to as “Design-Build Entity” and each of its general partners, and/or joint venture members, if any, must sign the declaration below, certifying under penalty of perjury declaring that the information provided in PART A – QUESTIONNAIRE and PART B – EXPERIENCE is true and correct. If the proposed Design‑Build Entity is a corporation, Limited Liability Company, partnership, joint venture, or other legal entity, the information provided shall be certified under penalty of perjury by the Design-Build Entity and its general partners or joint venture members.

I, __________________________________________________, authorized agent of the Design-Build Entity, ___________________________________________ ‑, hereby certify under penalty of perjury that the information provided in PART A ‑ QUESTIONNAIRE and PART B – EXPERIENCE has been prepared using reasonable diligence and is true and complete to the best of my knowledge. (The declaration must be certified under penalty of perjury by the Design-Build Entity and each of its general partners and/or joint venture members, if any)

Printed:

Signed:

Dated:

Printed:

Signed:

Dated:

Printed:

Signed:

Dated:

SECTION 2 – Identification of the Design Build Team Identify each proposed member of the Respondent’s Design-Build Team below:

Design-Build Entity Role: Design-Build Entity

General Contractor (if not the Design‑Build Entity) Role:

General Contractor’s Preconstruction Manager Role:

General Contractor’s Project Manager Role:

General Contractor’s Superintendent Role:

Indicate the role in the Design-Build Team by indicating either “Design-Build Entity” or “Subconsultant”.

Architect of Record (AOR) Role:

Design Architect (if not the AOR) Role:

Structural Engineer of Record Role:

Design Architect Project Manager Role:

Mechanical Engineer of Record Role:

Electrical Engineer of Record Role:

Fuel Systems Engineer of Record Role:

Specialty Consultant Role:

Role:

Role:

Name/Firm/Address

Role:

ATTACH ADDITIONAL PAGES AS REQUIRED

SECTION 3 – Licensure The Respondent’s Design-Build Team must have a General Contractor actively licensed in the State of California and registered with the Department of Industrial Relations (DIR) as a public works contractor pursuant to Labor Code section 1725.5. Provide the following information:

Company Name (under which license is held):

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

Has this license ever been revoked?

Yes No If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No If “yes,” explain each incident below or on a separate page.

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

The Respondent’s Design-Build Team must include an Architect licensed in the State of California. Provide the following information:

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

The Respondent’s Design-Build Team must include a Structural Engineer licensed in the State of California. Provide the following information:

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

The Respondent‘s Design-Build Team must include a Mechanical Engineer licensed in the State of California. Provide the following information:

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

The Respondent’s Design-Build Team must include an Electrical Engineer licensed in the State of California. Provide the following information:

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

The additional (Specialty Consultant) provided by the Design-Build Team must be licensed in the State of California. Provide the following information:

Contractors State License Board, State of California Class B License Number, name under which license is held, and expiration date:

License No:

Name:

Exp. Date:

If “yes,” explain below or on a separate page.

Has either the company or individual named above had any violations of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints?

Yes No

California Department of Industrial Regulations (DIR) Registration No:

DIR has provided information that all firms, whether Construction or Architectural & Engineering (and subcontractors), with very limited exceptions, must be registered as Public Works Contractors with DIR. This registration must be present at the time of SOQ submission and maintained throughout the life of the PDB Contract (re-registration is necessary every July 1st); new subcontractors/subconsultants employed to perform work under the PDB Contract are also subject to this requirement. When new entities are known (or a substitution is to be performed), the State must be notified so those entities can be added to the contract registration.

SECTION 4 – Insurance and Bonds Submit the information required under RFQ Part V (Statement of Qualifications Instructions, Scoring, and Submittal Requirements), Part A Section 4.

SECTION 5 – Termination/Failure to Complete Violations; Claims, Arbitration and Litigation Provide a declaration certifying that the Respondent’s primary Design-build team members have not had a surety company finish work on any project within the last five years.

Declaration:

I, __________________________________________________, authorized agent of the Design-Build Entity, __________________________________________, hereby certify that none of the Design-Build Entity’s primary design-build team members have not had a surety company finish work on any project within the last five years.

Printed:

Signed:

Dated:

Provide information and details below for any construction or design claim, arbitration or litigation totaling more than five hundred thousand dollars ($500,000) or five percent of the annual value of work performed, whichever is less, settled against any of Respondent’s primary Design-build team member’s firm or previous firm within the last five years.

PROJECT:

Location:

Nature of Claim:

Final Disposition:

PROJECT:

Location:

Nature of Claim:

Final Disposition:

PROJECT:

Location:

Nature of Claim:

Final Disposition:

PROJECT:

Location:

Nature of Claim:

Final Disposition:

Provide information pertaining to any violations of Federal or State law, including, but not limited to, those laws governing the payment of wages, benefits, or personal income tax withholding, or of Federal Insurance Contributions Act (FICA) withholding requirements, state disability insurance withholding, or unemployment insurance payment requirements, settled against any of Respondent’s primary Design-build team members over the last five years. For the purposes of this subclause, only violations by a primary Design-build team member as an employer shall be deemed applicable, unless it is shown that the primary Design-build team member, in their capacity as an employer, had knowledge of their subcontractor's violations or failed to comply with the conditions set forth in Labor Code section 1775(b).

Provide information pertaining to any violations by the Respondent’s primary Design-build team members ‑ of the Contractors State License Law (Business and Professions Code section 7000 et seq.), excluding alleged violations or complaints.

Provide a declaration that none of the Respondent’s primary Design-build team members has been convicted of submitting a false or fraudulent claim to a public agency within the last ten (10) years.

Declaration:

I, __________________________________________________, authorized agent of the Design-Build Entity, __________________________________________ (hereby certify that none of the Design-Build Entity’s primary Design-build team members has been convicted of submitting a false or fraudulent claim to a public agency within the last ten years.

Printed:

Signed:

Dated:

Provide a declaration that the Design-Build Entity will comply with all other provisions of law applicable to the Project, including, but not limited to, the requirements of Labor Code section 1720 et seq.

Declaration:

I, __________________________________________________, authorized agent of the Design-Build Entity, ___________________________________________, hereby certify that the Design-Build Entity will comply with all other provisions of law applicable to the Project, including, but not limited to, the requirements of Labor Code section 1720 et seq.

Printed:

Signed:

Dated:

SECTION 6 – Safety Record Information You Must Submit Includes:

Provide a written safety policy, mission statement, or other document addressing the Respondent's attitude and responsibility towards worker safety and the safety of the general public during construction. (NOTE: Do not send full copies of safety manuals. If desired, in addition to the above, an index or Table of Contents from the manual is sufficient.)

Provide your Safety Officer’s qualifications, work experience, authority, job duties, percentage of time spent in fulfilling their duties as Safety Officer, and who they report to.

Safety Performance:

Consolidate your firm’s injury and illness data for the last three years, starting on January 1, 2023, for the General Contractor and complete the table below. The Occupational Safety and Health Administration’s (OSHA) Industry Group 154 (Business Category), classification 1542, will be used as the applicable standard for the construction of this Project. The information provided must be for your company as a whole and not individual office locations. Provide copies of your OSHA 300 and OSHA 300A logs for the last three years.

Average Number of Employees

Hours Worked

Number of Fatalities*

Permanent Total Disabilities (PTD)

Lost Workday Cases (LWC)

Lost Time Injuries (LTI) [Rows C+D+E]

Lost Time Injury Rate (LTIR)

Lost Workdays

Lost Workday Severity Rate

Restricted Workday Cases (RWC)

Medical Treatment Cases (MTC)

Total Recordable Cases. [Rows F+J+K]

Total Recordable Incident Rate (TRIR)

Environmental Occurrences

*For each fatality, attach a description of the accident, including cause, actions taken resulting from that fatality and actions taken to prevent future fatalities.

Provide your Worker's Compensation Experience Ratings (Experience Modification Rating (EMR)) for the past three years, starting on January 1, 2023.

1. Attach the endorsement page from your policy listing your EMR or have your insurance carrier or broker provide this information on their letterhead. The information is available from your worker’s compensation insurance carrier.

Insurance Carrier:

Contact for Insurance Information:

Title:

Telephone:

Provide information and details below for any serious violations of the Occupational Safety and Health Act as provided in Labor Code section 6300 et seq., settled against any of Respondent’s primary design-build team members.

PART B – EXPERIENCE FORMS AND TEMPLATES

PART B – EXPERIENCE

Section 1: Design-Build Team Narrative and Organizational Chart Working Relationship Matrix* Firm Profiles

SECTION 1 – Design-Build Team See Instructions – Working Relationship Matrix Template included below.

Working Relationship Matrix (Template) Check boxes to indicate on which projects team members have worked. If a member has not worked on a project leave the box blank.

Design-Build Entity’s Exec. Leader (insert name)

GC’s Project Executive (insert name)

AOR’s Project Executive (insert name)

AOR’s Project Manager (insert name)

Architect of Record (insert name)

AOR’s Lead Architectural Designer (insert name)

Structural Engineer of Record (insert name)

Fuel System Engineer of Record (insert name)

Mechanical Engineer of Record (insert name)

Electrical Engineer of Record (insert name)

GC’s General Superintendent (insert name)

GC’s Preconstruction/Design Manager (insert name)

GC’s Project Manager (insert name)

GC’s Preconstruction/Project Estimator (insert name)

GC’s Quality Control Manager (insert name)

GC’s Schedule Control Manager (insert name)

Specialty Consultant: (insert name)

Specialty Consultant: (insert name)

Specialty Consultant: (insert name)

SECTION 2 – Personnel Resume Maximum two pages per resume including the following information.

Name:

Title:

Firm:

Years of Experience:

Years with this Firm:

Education:

Active Registrations, Licenses or Credentials:

Awards:

Responsibilities on this Project:

Experience: Identify relevant projects on which employee has worked. Include a brief description of the project and specifically identify employee’s roles, responsibilities, and duration of involvement on the project.

Experience on similar projects:

Design‑Build Experience:

Experience with Facilities Construction for Public Entity Clients (Identify California Projects):

Experience with energy efficiency/sustainable building design measures:

Other experience, training, education, and qualifications relevant to the proposed project:

Describe what makes this individual uniquely suited for this assignment:

SECTION 3 – Project Profile Cover Sheet See Instructions – five profiles maximum showing Design Experience and five profiles maximum showing Construction Experience; three pages maximum per profile not including the Project Cover Sheet.

Firm:

Firm’s Role on Project:

Project Name:

Location:

Project Description:

Firm’s Project Manager:

Personnel on project being proposed for this Project:

General Contractor (if not Firm):

Architect of Record (if not Firm):

Construction Manager:

Other Relevant Entities:

Explain Difference, if any:

Original Const. Contract Amount: Final Const. Contract Amount:

Explain Difference, if any:

Delivery Method:

Sustainable Building Measures Incorporated:

Relevance to this Project:

Awards:

Project Owner:

Owner’s Representative:

E-mail Address: Telephone:

This form may be reproduced/reprinted for use on each of the required project profiles being submitted.

SECTION 4 – Project Reference To be completed for each project included in Project Profiles.

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

Reference Firm Name:

Contact Name:

Title:

Phone Number:

E‑mail:

Relationship to Project:

SECTION 5 – Project Approach See Instructions in RFQ Part B – Experience Instructions, Project Approach.

SECTION 6 – Client References Please provide three client references.

Firm/Company/Agency:

Address:

Telephone No.:

Project associated with:

Firm/Company/Agency:

Address:

Telephone No.:

Project associated with:

Firm/Company/Agency:

Address:

Telephone No.:

Project associated with:

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