BioEPIC CM-GC Pre-Q Response Form_01.15.20.xlsx

Pre-Q Response Form

Subcontract Information

Addenum No. Addendum Name Addendum Date

MINIMUM REQUIREMENTS

1 OFFEROR's current and active California Contractors State License Board (CSLB) Class B Contractor’s License No. (See attached CA CSLB license abstract screenshot) No. ###### Class B

2 Offeror's evidence of Payment and Performance Bonding Capacity See attached evidence from Offeror's surety

3 Offeror's compliant Injury and Illness Prevention Program (IIPP) See attached IIPP

4 Offeror's evidence of ability to provide compliant Insurance Coverage See attached letter or sample certificate from insurance carrier

5 Offeror's eligibility for receiving new federal government prime contracts or subcontracts; Determination by LBNL that the Offeror is not on a restricted, sanctioned, or denied party list for export controls through a search performed via Descartes Visual Compliance See attached completed and signed Representations and Certifications form

6 Offeror's permanent local office within a 75-mile radius of the project site See OFFEROR's Permanent Local Office information above

Factor 7 - PAST PERFORMANCE

Provide information and details on at least two (2) Relevant Projects (as defined in the Prequalification Notice) successfully completed by the offeror within the last eight years. Complete a separate block for each Relevant Project.

b Safety c Cost d Quality e Lower-tier subcontractor management f Small business subcontracting g Discuss problems encountered and corrective actions taken:

b Safety c Cost d Quality e Lower-tier subcontractor management f Small business subcontracting g Discuss problems encountered and corrective actions taken:

(c) Has the Offeror been cited for any Cal-OSHA violations over the past five years? See attached for any YES responses. YES NO

(d) Has the Offeror been cited for any Serious, or Willful, or Repeated, or Failure to Abate violations over the past 5 years? See attached for any YES responses. YES NO

9 Does the Offeror have experience developing and implementing a successful and effective Construction Jobsite Safety Incentive Program? See attached example of its successful and effective Construction Jobsite Safety Incentive Program. YES NO

b What specific behavior, actions, conditions, and results the program was intended to incentivize… c How the incentive helped achieve the desired results… d How the program was monitored and evaluated, and how well the program achieved the desired results… e Price of the program…

10 Does the Offeror have experience developing and successfully implementing a Small Business Subcontracting Plan (SBSP) containing the elements, goals, and assurances set forth in Paragraph (d) of FAR Clause 52.219-9, Small Business Subcontracting Plan, and FAR Clause 52.219-8, Small Business Utilization? See two attached printed examples of Offeror's semi-annual Individual Subcontracting Report (ISR) and semi-annual Summary Subcontracting Report (SSR) submitted via the on-line Electronic Subcontracting Reporting System (eSRS) for one or more of its Relevant Projects YES NO

11 Does the Offeror have adequate financial resources to perform the potential resulting subcontract, or the ability to obtain them? See attached description of the Offeror’s current financial condition and its financial ability to fully support performance of the proposed subcontract. YES NO

&"-,Bold"&20PROCUREMENT SENSITIVE LAWRENCE BERKELEY NATIONAL LABORATORY Prequalification SH1018-2018 - BioEPIC CM-GC rev 01.15.20 &A page &P of &N mailto:name@email.commailto:name@email.com