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Home My WebLink About09 APPROVAL OF PRE-QUALIFICATION PACKAGE FOR CONSTRUCTION OF THE TUSTIN EMERGENCY OPERATION CENTER & CORPORATION YARD PROJECTAgenda AGENDA REPORT Ree eld: 9 v City Manager Finance Director N A MEETING DATE: OCTOBER 3, 2017 TO: JEFFREY C. PARKER, CITY MANAGER FROM: DOUGLAS S. STACK, DIRECTOR OF PUBLIC WORKS \ CITY ENGINEER SUBJECT: APPROVAL OF PRE -QUALIFICATION PACKAGE FOR CONSTRUCTION OF THE TUSTIN EMERGENCY OPERATION CENTER AND CORPORATION YARD PROJECT SUMMARY Staff has prepared a Pre -Qualification Package for construction of the Emergency Operation Center and Corporation Yard project. The package includes a standard questionnaire and financial statement, a uniform system of rating bidders based upon objective criteria, and an appeal procedure which will allow a contractor to appeal decisions that they are not qualified to bid on this project. RECOMMENDATION It is recommended that the City Council approve the Pre -Qualification Package for construction of the Emergency Operation Center and Corporation Yard project. FISCAL IMPACT There is no fiscal impact associated with this item. CORRELATION TO THE STRATEGIC PLAN The recommended actions contribute to the fulfillment of the City's Strategic Plan Goal B, Public Safety and Protection of Assets, ensuring that Tustin is an attractive, safe and well maintained community in which people feel pride. DISCUSSION Pursuant to Public Contract Code 20101, local public agencies are authorized to require licensed contractors to pre -qualify before bidding for public works projects. A few of the key points of the statute are: 1) Contractors must meet trustworthiness, quality, fitness, capacity, and experience standards in order to pre -qualify to bid. 2) Local public agencies may require contractors and subcontractors to submit completed standardized questionnaires which identify information necessary to determine whether the contractors have met these standards. 3) Uniform, objective rating systems must be used to determine both the minimum requirements for qualification to bid, and the type and size of the contracts upon which each bidder shall be deemed qualified to bid. Pre -Qualification Package for EOC/Corporation Yard Project October 3, 2017 Page 2 4) Agencies must have procedures in place which allow contractors to appeal decisions that they are not qualified to bid, which will result in review and conclusion prior to the submission of bids. The Department of Industrial Relations (DIR) has prepared model guidelines for pre -qualifying bidders of public works projects. Local agencies are allowed to use the DIR model and make the necessary adjustments based on project specific requirements. City staff has prepared the attached Pre -qualification Package for the construction of the Emergency Operation Center and Corporation Yard project, and has closely followed the DIR model guidelines and templates. The pre -qualification procedure has been selected for use with the construction of the Emergency Operation Center and Corporation Yard project due to the very specialized nature of construction, the need to comply with the State Health and Safety and Building Code requirements for "Essential Services" buildings, the highly sophisticated Information Technology components of the project, and the desire to achieve a LEED certified project. Construction scheduling may prove difficult and will require significantly more expertise in coordination and facilitation of project progress. The pre -qualification process will create a short list of prequalified bidders, which will in turn ensure all bidders possess sufficient expertise in constructing this unique facility, and will assist staff in determining bidder responsibility prior to submission of bids and selecting the lowest responsible bidder. 9-, 6'4'/,�, Douglas S. Stack, P.E. Director of Public Works/City Engineer Attachments: Pre -qualification Package SACity Council Items\2017 Council Items\10-03-2017\Pre-Qualify GC for Corp Yard EOC\Approve Pre -Qualified Package for Corp Yard-EOC SC.docx GENERAL CONTRACTOR PRE -QUALIFICATION QUESTIONNAIRE FOR EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT CIP #10067 City of Tustin Public Works Dept. 300 Centennial Way Tustin, Ca. 92780 Deadline for Submissions: 2:00 PM, THURSDAY, NOVEMBER 16TH, 2017 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS The City of Tustin seeks to pre -qualify General Contractors for the construction of RC Sports Park ("Project"), and now invites sealed pre -qualification submittals from General Contracting Class "B" Contractors. Notice is hereby given that the City of Tustin has determined that general contractor bidders on this Project must be pre -qualified prior to submitting a bid on this Project. The pre -qualification evaluation is solely for the purpose of determining which General Building Contractors are deemed qualified for the successful performance of the construction of the Project. Only Class "B" Contractors that have been determined to be qualified under this process will be allowed to bid on the Project. It is mandatory that all Contractors who intend to submit a bid, fully complete the pre - qualification questionnaire, provide all requested materials, and be approved by the City of Tustin to be on the final qualified bidders list. FILING OF SUBMITTALS: All submittals must be filed in a sealed package with the City of Tustin, Public Works Division, 300 Centennial Way, Tustin, California 91780, on or before 2:00 pm, Thursday, November 16th, 2017, for the purpose of pre -qualification for this Project. Pre -Qualification Questionnaires may be obtained at: Jon Hughes, Program Manager Griffin Structures Jhughes@griffinstructures.com It is the sole responsibility of the Contractor to see that the Pre -Qualification Submittal is received before the stated deadline. Page 12 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS PROJECT DESIGN TEAM OWNER CITY OF TUSTIN 300 Centennial Way Tustin, California 92780 Jason Churchill: (714) 573-3355 JchurchilV( tustinca.org PROGRAM MANAGER GRIFFIN STRUCTURES 2 Technology Dr. Irvine, Ca. 92618 Jon Hughes (949) 444-1615 Jhughes(o-)-griffinstructures.com ARCHITECT OF RECORD LPA Inc. 5161 California Ave. suite 100 Irvine, Ca. 92617 Tracey Powl (949) 701-4055 Tpowl(o)_lpainc.com Page 13 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS TABLE OF CONTENTS Project Description and Submittal Instructions.....................................5 Statement of Understanding.................................................................9 Questionnaire Part I: Essential Requirements for Qualification .............................11 Part II: Questionnaire Section A: Current Organization and Structure ......................13 Section B: History of Business and Performance..................16 Section C: Compliance with Regulatory Requirements .......... 20 Part III: Similar Project Experience Questionnaire ..........................23 Part IV: Organizational Resources...........................................29 Questionnaire Scoring...............................................................30 Attachments Attachment A: Project Rendering ................................................. A-1 Attachment B: Standard Contract ................................................. B-1 Page 14 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS PROJECT DESCRIPTION Located 1472 Service Road, Tustin Ca. 92780, the City of Tustin's New Emergency Operations Center (EOC) and Corporate Yard will be placed at the existing Field Services Maintenance Facility. This project includes, but is not limited to; the demolition of the existing Administration Building and portable offices and site elements, and the construction of a new (2) story, 17,284 SF building which will house a new EOC, Telemetry Center, Field Services Administration, City Wellness Center, Field Services Locker Rooms, and supporting infrastructure. The Project also includes site work including but not limited to the construction of a new parking canopy, material bins, site utilities, landscaping, off site infrastructure and both soft and hardscape. The project will involve careful coordination to maintain all operations to the existing Vehicle Maintenance Bay and Fueling Station. Because the facility intended for demotion provides all power and communications to the remaining site buildings, this project will require very specific phasing to insure all buildings intended to remain are supplied with the necessary infrastructure before the Administration Building is demolished. This involves the construction and placement of a new SCE transformer, and construction and placement of a new exterior meter panel. All services to the Vehicle Maintenance Bay and Fueling Station must remain uninterrupted throughout the entire duration of the project. This project also includes extensive, highly technical audio visual and telecommunications installations. This includes installations for 911 Dispatch Facilities, Emergency Operations, Radio Communications, Telemetry Center (Data Center), integration with City Fiber Network, and other elements. The Engineer's estimate for this project is $10,000,000 The current tentative Project Schedule is as follows: Pre -Qualification of Contractors: ....................October, 2017 — December, 2017 Project Bidding: ....................January, 2018 — February, 2018 Award Project: ...................... . ................... March, 2018 Start Construction: ..........................................April, 2017 PRE -QUALIFICATION SCHEDULE Notice Inviting RFQ for Pre -Qualification Submittals: ........................... 10/12/17 Final Date for Submission of Bidder Questions: .................................. 11/02/17 Final Date for Responses to Bidder Questions....................................11/09/17 Page 15 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Submissions Due: ............................................................................. 11/16/17 Selection Notification......................................................................11/30/17 GENERAL The City is seeking qualified Class "B" General Contractors with construction experience of at least five (5) projects demonstrating comparable experience. Please see Part III Similar Project Experience for a definition of "comparable experience." Each prospective Contractor must successfully complete the pre -qualification questionnaire, provide all requested materials in the required form, and be approved by the City of Tustin to be on the final qualified bidders list. The City of Tustin will not accept submission of incomplete or late documentation. Incomplete documentation will result in the rejection of the prospective Contractor. Answers to all questions contained in the attached questionnaire, information about current bonding capacity, notarized statement from surety, and the most recent reviewed or audited financial statements, with accompanying notes and supplemental information, are required. City of Tustin reserves the right to unilaterally adjust, increase, limit, suspend, or rescind the pre -qualification rating based on subsequently learned information. Contractors whose rating changes significantly after pre -qualification to disqualify them will be notified, and given an opportunity for a hearing consistent with the hearing procedures described below to appeal a pre -qualification rating. PRE -QUALIFICATION GUIDELINES Each prospective Contractor must successfully complete the pre -qualification process outlined in this document. No other pre -qualification process completed for the City of Tustin will meet these requirements. Prospective Contractors must submit "Statements of Qualifications" (SOQ) by completing the Pre -Qualification Submittal Questionnaire package. The City will not accept information or documents from other parties. Submission of incomplete and/or unclear Pre -Qualification Submittal Questionnaire or required materials will result in rejection of the prospective contractor. Any questions or requests for information must be submitted in writing to: Jon Hughes Program Manager Griffin Structures, Inc. Email: Jhughes(a-)griffinstructures.com Page 16 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS The submittal information should be presented in a binder and separated by section dividers. Oversize drawings (larger than 11"x17"), if provided, should be folded and inserted into plastic carriers. Five (5) hard copies and one (1) electronic copy in *.PDF format of the Pre -Qualification Submittal shall be delivered to the City of Tustin. The completed Pre -Qualification Submittal should not exceed 50 pages. The City of Tustin reserves the right to waive minor irregularities and omissions in the information contained in the pre -qualification application submitted. EVALUATION AND ANALYSIS Pre -qualification of prospective contractors will be determined from the information submitted in each Pre -Qualification Questionnaire Submittal. The City of Tustin reserves the right to verify from other available sources the information provided by the Contractor and to rely upon such information gathered during the verification process. The City of Tustin's decision will be based on objective evaluation criteria. Further consideration of a prospective contractor's qualifications will be made only if the prospective contractor meets all of the following minimum requirements: 1. Submission of a properly completed and signed Declaration 2. Possession of the valid California Contractors "B" License in good standing 3. Meet bonding capacity requirements 4. Meet insurance requirements 5. Demonstration of General Contractor's Comparable Experience 6. Project Manager/Field Superintendent Comparable Experience 7. No completion of work by surety in the last 10 years 8. Department of Industrial Relations history 9. Meet financial requirements The Pre -Qualification Questionnaire Submittal Analysis Form that will be used to verify minimum qualifications is included. The City of Tustin will screen each responding prospective Contractor's statement for minimum qualifications and develop a list of Pre - Qualified Contractors. City of Tustin reserves the right to reject any or all responses to pre -qualification questionnaires and any or all subsequent bids for construction projects, and to waive any irregularities in any response to the pre -qualification application. While it is the intent of the pre -qualification questionnaire and required documents to assist the City in determining bidder responsibility prior to bid and to aid the City in selecting the lowest responsible bidder, neither the fact of pre -qualification, nor any pre - Page 17 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS qualification rating, will preclude the City of Tustin from a post -bid consideration and determination of whether a bidder has the quality, fitness, capacity and experience to satisfactorily perform the proposed work. All financial and proprietary information provided by prospective contractors will be kept confidential to the extent permitted by law. However, by submitting the pre -qualification packet, the Contractor agrees that the contents of the submittal may be disclosed to third parties for the purpose of verification, investigation of substantial allegations, or in any appeal hearing. Also, the names of prospective contractors applying for pre - qualification status will be subject to disclosure. Any contractor who the City determines to not pass the pre -qualification process shall have the right to request review of the determination. The contractor shall request review by delivering to the Director of the City's Department of Public Services a written notice requesting a review. The contractor shall deliver such written notice to the Director within five (5) business days of being notified that the Contractor has been determined not to be qualified and the basis for the determination. The Contractor waives its right to challenge the City's decision if it fails to deliver the notice within the five (5) business days. The Director or their designee shall conduct a determination hearing no later than ten (10) business days following receipt of the contractor's written notice. The hearing conducted by the Director shall be informal but will be an evidentiary hearing. At the hearing, the Contractor will be given the opportunity to present information and present reasons in opposition to the determination. The Director shall consider all evidence, information and arguments submitted by the contractor relevant to the City's determination, the City's response to such evidence, information and arguments, and any other information the Director deems relevant. Promptly following the hearing, the Director shall issue a written decision whether the contractor is qualified or not qualified. Following the hearing, the contractor may further appeal to the City Manager of the City of Tustin a decision by the Director that the Contractor is not qualified. The Contractor must request a hearing before the City Manager by delivering to the City Clerk, with a copy to the Director, a written notice of appeal. The contractor must deliver the written notice of appeal within five (5) business days of the date of the Director's notice that the contractor is not qualified. The contractor waives its right to challenge the Director's decision if it fails to deliver the notice within the five (5) business days. The City Manager shall hold a de novo hearing within ten (10) days of Contractor's written notice of appeal. The City Manager shall uphold or reverse the Director's Page 18 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS decision based on the entire record, including the information and evidence presented to the Director and any additional information and evidence received by the City Manager at the hearing. Page 19 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS STATEMENT OF UNDERSTANDING The undersigned certifies that the statements and information contained in this submittal are complete and accurate and that the submittal contains no false or deliberately misleading information. The undersigned hereby agrees and declares that receipt of this submittal by the City of Tustin does not constitute either a direct or implied guarantee to the Contractor that pre -qualification is or will be granted and also agrees to the procedures and conditions of the pre -qualification requirements described in the Pre - Qualification Document. (1) Legal Name of Applicant (Contractor) (2) Address of Applicant (Contractor) (3) Phone Number Am Fax (4) Applicant is a ( ) Corporation ( ) Partnership ( ) Sole Proprietorship ( ) Joint Venture (5) If Contractor is a Corporation, name the State of Incorporation (6) Total number of years the Contractor has been contracting (7) Total number of years the Contractor has been in construction (8) Banking institution authorized to provide corroboration of applicant's financial stability: Name: Address: Contact: (9) Execution: Telephone Page 110 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS The undersigned is a legally authorized representative of the Contractor. The legal name of the Contractor is State of California Contractor's License Number: Expiration: Type: , being first duly sworn, says that all statements and information contained in this Submittal are complete and accurate and that this Submittal contains no false or deliberately misleading information. Contractor Printed Name Title Signature Subscribed and sworn to before me this 20 Notary Public in and for the State of Residing at Expiration Date: END OF FORM day of Page 111 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS PART 1: ESSENTIAL REQUIREMENTS FOR QUALIFICATION IMPORTANT NOTE: Contractor may be immediately disqualified if the answer to any of questions 1 through 7 is "no." Contractor will be immediately disqualified if the answer to any of questions 8 through 12 is "yes." If the answer to question 10 is "yes," and if debarment would be the sole reason for denial of pre -qualification, any pre -qualification issued will exclude the debarment period. Contractor possesses a valid and current California Class "B" General Contractor's License in good standing for this project for which it intends to submit a bid. ❑ Yes ❑ No 2. Contractor has (or can provide proof that they can obtain within ten (10) business days prior to award) an insurance policy(ies) consistent with Attachment B "City of Tustin — Standard Contract". ❑ Yes ❑ No 3. Contractor has current workers' compensation insurance policy as required by the Labor Code or is legally self-insured pursuant to Labor Code section 3700 et. seq. ❑ Yes ❑ No 4. Have you attached your latest copy of a reviewed or audited financial statement with accompanying notes and supplemental information? ❑ Yes ❑ No NOTE: A financial statement that is not either reviewed or audited by a Certified Public Accountant (CPA) is not acceptable. A letter verifying availability of a line of credit may also be attached; however, it will be considered as supplemental information only, and is not a substitute for the required financial statement. 5. Have you 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 current bonding capacity is at least $40,000,000 for this project, and $80,000,000 aggregate, should you be selected?' ❑ Yes ❑ No NOTE: Notarized statement must be from Surety Company, not an agent or broker. An additional notarized statement from the surety may be requested by the City of Tustin at the time of submission of a bid, if this pre -qualification package is submitted more than 60 days prior to submission of the bid. Page 112 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 6. Contractor has completed at least five (5) comparable projects in the last ten (10) years? See Part III: Similar Project Experience Questionnaire for criteria. ❑ Yes ❑ No 7. Contractor has (or can provide proof that they can obtain within ten (10) business days prior to award) insurance policy with a policy limits consistent with the sample contract insurance requirements in Attachment B. ❑ Yes ❑ No 8. Has your contractor's license been revoked at any time in the last ten (10) years? ❑ Yes ❑ No If yes, please explain why: 9. Has a surety firm completed, or is in the process of completing, a contract on your behalf, or has paid for completion because your firm was default terminated by the project owner within the last ten (10) years? ❑ Yes ❑ No 10. At the time of submitting this pre -qualification form, is your firm ineligible to bid on or be awarded any local, state or federal public works contracts, or perform as a subcontractor on any such public works contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7 or any other local, state or federal law or regulation? F-1. Yes ❑ No If the answer is "Yes," state the beginning and ending dates of the period of debarment: Starting Ending 11. At any time during the last ten (10) years, has your firm or any of its owners or officers been convicted of a crime involving the awarding of a contract of a government construction project, or the bidding or performance of a government contract? ❑ Yes ❑ No 12. In the last ten (10) years has your firm been denied an award of a public works contract based on a finding by a public agency that your company was not a responsible bidder? ❑ Yes ❑ No If "yes," explain on a separate signed page. Identify the year of the event, the owner, the project and the basis for the finding by the public agency. Page 113 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Section A. Current Organization and Structure of the Business [Mrramt 11 . . I 1 a. Date incorporated: 1 b. Under the laws of what state: 1 c. Provide all the following information for each person who is either (a) an officer of the corporation (president, vice president, secretary, treasurer), or (b) the owner of at least ten percent (10%) of the corporation's stock. Name Position Years % Social with Co. Ownership Security # 1 d. Identify every construction firm that any person listed above has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. NOTE; For this question, "owner" and "partner" refer to ownership of ten percent (10%) or more of the business, or ten percent (10%) or more of its stock, if the business is a corporation. Dates of Person's Person's Name Construction Firm Participation with Firm Page 114 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS For Firms That Are Partnerships: 1 a. Date of formation: 1 b. Under the laws of what state: 1 c. Provide all the following information for each partner who owns ten percent (10%) or more of the firm. Name I Position I Years with Co. I % Ownership I Social Securitv # 1 d. Identify every construction company that any partner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. NOTE. For this question, "owner" and "partner" refer to ownership of ten percent (10%) or more of the business, or ten percent (10yo) or more of its stock, if the business is a corporation. Dates Person's Name Construction Company Participation of Person's with Company Page 115 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS For Firms That Are Sole Proprietorships: 1 a. Date of commencement of business: 1 b. Social security number of company owner: 1 c. Identify every construction firm that the business owner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five (5) years. NOTE: For this question, "owner" and "partner" refer to ownership of ten percent (10%) or more of the business, or ten percent (10%) or more of its stock, if the business is a corporation. Person's Name Dates of Person's Construction Company Participation with Company For Firms That Intend to Make a Bid as Part of a Joint Venture: 1 a. Date of commencement of joint venture: 1 b. Provide all of the following information for each firm that is a member of the joint venture that expects to bid on one (1) or more projects: Name of firm % Ownership of Joint Venture Page 116 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Section B. History of the Business and Performance 1. Has there been any change in ownership of the firm at any time during the last ten (10) years? NOTE: A corporation whose shares are publicly traded is not required to answer this question. ❑ Yes ❑ No If "yes," explain on a separate signed page. 2. Is the firm a subsidiary, parent, holding company, or affiliate of another construction firm? NOTE: Include descriptive and background information about other firms if one firm owns fifty percent (50%) or more of another, or if an owner, partner, or officer of your firm holds a similar position in another firm. ❑ Yes ❑ No If "yes," explain on a separate signed page. 3. Are any corporate officers, partners or owners connected to any other construction firms? NOTE: Include descriptive and background information about other firms if an owner, partner, or officer of your firm holds a similar position in another firm. ❑ Yes ❑ No If "yes," explain on a separate signed page. 4. State your firm's gross revenue for each of the last three (3) years: 2013 2014 2015 5. How many years has your organization been in business in California as a contractor under your present business name and license number? Years 6. Was your firm in bankruptcy at any time during the last ten (10) years? ❑ Yes ❑ No If "yes," please attach a copy of the bankruptcy petition, showing the case number and the date on which the petition was filed, and a copy of the Bankruptcy Court's discharge order, or any other document that ended the case, if no discharge order was issued. Page 117 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Licenses 7. List all California construction license numbers, classifications and expiration dates of the California Contractor Licenses held by your firm: 8. If any of your firm's license(s) are held in the name of a corporation or partnership, list below the names of the qualifying individual(s) listed on the California Contractors State License Board (CSLB) records who meet(s) the experience and examination requirements for each license. 9. Has your firm changed names or license number in the past ten (10) years? ❑ Yes ❑ No If "yes," explain on a separate signed page, including the reason for the change. 10. Has any owner, partner, or (for corporations) officer of your firm operated a construction firm under any other name in the last ten (10) years? ❑ Yes ❑ No If "yes," explain on a separate signed page, including the reason for the change. 11. Has any CSLB license held by your firm or its Responsible Managing Employee (RME) or Responsible Managing Officer (RMO) been suspended within the last ten (10) years? ❑ Yes ❑ No If "yes," please explain on a separate signed sheet. Disputes 12. At any time in the last ten (10) years has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either a public or private owner? ❑ Yes ❑ No If yes, explain on a separate signed page, identifying all such projects by owner, owner's address, the date of completion of the project, amount of liquidated damages assessed and all other information necessary to fully explain the assessment of liquidated damages. Page 118 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 13. In the last ten (10) years has your firm, or any firm with which any of your company's owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason? NOTE: "Associated with" refers to another construction firm in which an owner, partner or officer of your firm held a similar position, and which is listed in response to question 1c or 1d on this form. ❑ Yes ❑ No If "yes," explain on a separate signed page. State whether the firm involved was the firm applying for pre -qualification here or another firm. Identify by name of the company, the name of the person within your firm who was associated with that company, the year of the event, the owner of the project, the project and the basis for the action. NOTE: The following two (2) questions refer only to disputes between your firm and the owner of a project. You need not include information about disputes between your firm and a supplier, another contractor, or subcontractor. You need not include information about "pass-through" disputes in which the actual dispute is between a sub -contractor and a project owner. Also, you may omit reference to all disputes about amounts of less than $10,000. 14. In the past ten (10) years has any claim against your firm concerning your firm's work on a construction project been filed in court or arbitration? ❑ Yes ❑ No If "yes," on separate signed sheets of paper identify the claim(s) by providing the project name, date of the claim, name of the claimant, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution). 15. In the past ten (10) years has your firm made any claim against a project owner concerning work on a project or payment for a contract and filed that claim in court or arbitration? ❑ Yes ❑ No If "yes," on separate signed sheets of paper identify the claim by providing the project name, date of the claim, name of the entity (or entities) against whom the claim was filed, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution). Page 119 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 16. At any time during the past ten (10) years, has any surety company made any payments on your firm's behalf as a result of a default, to satisfy any claims made against a performance or payment bond issued on your firm's behalf, in connection with a construction project, either public or private? ❑ Yes ❑ No If "yes," explain on a separate signed page the amount of each such claim, the name and telephone number of the claimant, the date of the claim, the grounds for the claim, the present status of the claim, the date of resolution of such claim if resolved, the method by which such was resolved if resolved, the nature of the resolution and the amount, if any, at which the claim was resolved. 17. In the last ten (10) years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? ❑ Yes ❑ No If "yes," explain on a separate signed page. Name the insurance carrier, the form of insurance and the year of the refusal. Criminal Matters and Related Civil Sults 18. Has your firm or any of its owners, officers or partners ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public agency or entity? ❑ Yes ❑ No If "yes," explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the investigation and the grounds for the finding. 19. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? ❑ Yes ❑ No If "yes," explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the conviction and the grounds for the conviction. 20. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? ❑ Yes ❑ No If "yes," identify on a separate signed page the person or persons convicted, the court (the county if a state court, the district or location of the federal court), the year and the criminal conduct. Page 120 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Bonding 21. Bonding capacity: Provide documentation from your surety identifying the following: Name of bonding company/surety: Name of surety agent, address and telephone number: 22. If your firm was required to pay a premium of more than one percent (1%) for a performance and payment bond on any project(s) on which your firm worked at any time during the last five (5) years, state the percentage that your firm was required to pay. You may provide an explanation for a percentage rate higher than one percent (1 %), if you wish to do so. 23. List all other sureties (name and full address) that have written bonds for your firm during the last five (5) years, including the dates during which each wrote the bonds: 24. During the last ten (10) years, has your firm ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public construction project when one was required? ❑ Yes ❑ No If yes, provide details on a separate signed sheet indicating the date when your firm was denied coverage and the name of the company or companies which denied coverage; and the period during which you had no surety bond in place. Page 121 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Section C. Compliance with Regulatory Requirements 25. Has CAL OSHA cited and assessed penalties against your firm for any "serious," "willful" or "repeat" violations of its safety or health regulations in the past ten (10) years? NOTE: If you have filed an appeal of a citation, and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal, you need not include information about it. ❑ Yes ❑ No If "yes," attach a separate signed page describing the citations, including information about the dates of the citations, the nature of the violation, the project on which the citation(s) was or were issued, the amount of penalty paid, if any. If the citation was appealed to the Occupational Safety and Health Appeals Board and a decision has been issued, state the case number and the date of the decision. 26. Has the Federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past ten (10) years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. ❑ Yes ❑ No If "yes," attach a separate signed page describing each citation 27. Has the EPA or any Air Quality Management District or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the contractor, in the past ten (10) years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. ❑ Yes ❑ No If "yes," attach a separate signed page describing each citation. 28. How often do you require documented safety meetings to be held for construction employees and field supervisors during the course of a project? 29. List your firm's Experience Modification Rate (EMR) (California workers' compensation insurance) for each of the past three premium years: NOTE: An Experience Modification Rate is issued to your firm annually by your workers' compensation insurance carrier. Current year: Page 122 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Previous year: Year prior to previous year: If your EMR for any of these three years is or was 1.00 or higher you may, if you wish, attach a letter of explanation. 30. Within the last ten (10) years has there ever been a period when your firm had employees but was without workers' compensation insurance or state -approved self- insurance? ❑ Yes ❑ No If "yes," please explain the reason for the absence of workers' compensation insurance on a separate signed page. If "No," please provide a statement by your current workers' compensation insurance carrier that verifies periods of workers' compensation insurance coverage for the last five years. (If your firm has been in the construction business for less than five years, provide a statement by your workers' compensation insurance carrier verifying continuous workers' compensation insurance coverage for the period that your firm has been in the construction business.) Prevailing Wage Compliance Record 31. Has there been any occasion during the last ten (10) years in which your firm was required to pay either back wages or penalties for your own firm's failure to comply with the State's prevailing wage laws? NOTE: This question refers only to your own firm's violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor. ❑ Yes ❑ No If "yes", attach a separate signed page or pages, describing the nature of each violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid and the amount of back wages and penalties that you were required to pay• 32. During the last ten (10) years, has there been any occasion in which your own firm has been penalized or required to pay back wages for failure to comply with the Federal Davis -Bacon prevailing wage requirements? ❑ Yes ❑ No If "yes," attach a separate signed page or pages describing the nature of the violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid, the amount of back wages you were required to pay along with the amount of any penalty paid. Page 123 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Part III is a verification of the answer provided in Part I Essential Requirements, Question 6. Respondents whose experience is not verifiable according to the following criteria shall be disqualified as failing to meet the Essential Requirements. Contractor shall provide information about its five (5) most recent comparable projects, all of which must have been successfully completed within the last ten (7) years. All 5 projects must meet the minimum criteria: 1. Minimum project value of $10,000,000 2. Public Safety, Public Service Facility, and/or Critical Infrastructure (EOC, Fire Station, Police Station, Emergency Dispatch Facility, Critical Infrastructure, Corporate Yard, Utility Facility, City Hall, Public Administration Building, Data Centers) 3. Site Improvements including wet and dry utilities, site landscape, parking, and site concrete. 4. Of the (5) projects listed, (1) of the projects must be LEED SILVER or higher. 5. Of the (5) projects listed, (2) must demonstrate the installation of extensive audio visual and telecommunications infrastructure. Page 124 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS General Contractor Experience Requirements: Reference 1 Project Name: Location: Owner: Owner Representative, address, email and phone number: Architect or Engineer, address, email and phone number: Description of Project, Scope of Work Performed: Percentage of Base Contract subcontracted: Total Value of Construction breakdown with initial contract award/final contract sum: Original Scheduled Completion Date: Initial Contract time in days: Time Extensions granted in Days: Days Liquidated damages assessed: Actual Date of Completion: LEED (Yes / No): Page 125 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS General Contractor Experience Requirements: Reference 2 Project Name: Location: Owner: Owner Representative, address, email and phone number: Architect or Engineer, address, email and phone number: Description of Project, Scope of Work Performed: Percentage of Base Contract subcontracted: Total Value of Construction breakdown with initial contract award/final contract sum: Original Scheduled Completion Date: Initial Contract time in days: Time Extensions granted in Days: Days Liquidated damages assessed: Actual Date of Completion: LEER (Yes / No): Page 126 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS General Contractor Experience Requirements: Reference 3 Project Name: Location: Owner: Owner Representative, address, email and phone number: Architect or Engineer, address, email and phone number: Description of Project, Scope of Work Performed: Percentage of Base Contract subcontracted: Total Value of Construction breakdown with initial contract award/final contract sum: Original Scheduled Completion Date: Initial Contract time in days: Time Extensions granted in Days: Days Liquidated damages assessed: Actual Date of Completion: LEED (Yes / No): Page 127 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS General Contractor Experience Requirements: Reference 4 Project Name: Location: Owner: Owner Representative, address, email and phone number: Architect or Engineer, address, email and phone number: Description of Project, Scope of Work Performed: Percentage of Base Contract subcontracted: Total Value of Construction breakdown with initial contract award/final contract sum: Original Scheduled Completion Date: Initial Contract time in days: Time Extensions granted in Days: Days Liquidated damages assessed: Actual Date of Completion: LEER (Yes / No): Page 128 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS General Contractor Experience Requirements: Reference 5 Project Name: Location: Owner: Owner Representative, address, email and phone number: Architect or Engineer, address, email and phone number: Description of Project, Scope of Work Performed: Percentage of Base Contract subcontracted: Total Value of Construction breakdown with initial contract award/final contract sum: Original Scheduled Completion Date: Initial Contract time in days: Time Extensions granted in Days: Days Liquidated damages assessed: Actual Date of Completion: LEED (Yes / No): Page 129 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Staff Roster/Functions Contractor shall furnish an organization chart that includes all supervisory positions anticipated to be assigned to the Project. Indicate therein which ones are full time on site and which are part time. List key members of your staff whom you consider candidates to be assigned to work as a full-time team member resident on this Project and complete all requested information as shown below. Key, full-time candidate team members must include, without limitation: 1. Project Manager and 2. Superintendent. Use separate sheets of paper that contain all of the following information: Name: Job Title: Number of Years with Firm: Proposed Function on the Project: Number of Years in Current Position: Number of Projects (in job function) Completed: Number of Years in Construction Industry: Minimum of two (2) projects, in a supervisory role, of similar type and scale as described in Section III: Similar Project Experience Questionnaire. On separate sheet provide project description, value, dates of construction, references and reference contact information for each project. I, the undersigned, certify and declare that I have read all the foregoing answers to this pre -qualification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct. Page 130 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Signature Print Name Date Page 131 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS A LIST OF THE SCORABLE QUESTIONS AND THE SCORING INSTRUCTIONS The scorable questions are in two sections as follows: Part II -- Section B History of the business and organizational performance; Part II — Section C Compliance with occupational safety and health laws, workers' compensation and other labor legislation; Note: This section includes only those questions that are "scorable" from the Part II Questionnaire. The following question numbers correspond to those used in the Part II. The Scores Needed for Pre -Qualification To pre -qualify, a contractor would be required to qualify under Part I, then have a passing grade within each of the two large categories in Part II referred to above. Section B, "History of the business and organizational performance," The prospective contractor is required to meet a passing score of 51 on this portion of the questionnaire (of a maximum score of 68 on this portion of the questionnaire). Section C, "Compliance with occupational safety and health laws, workers' compensation and other labor legislation" The prospective contractor is required to meet a passing score of 27 on this portion of the questionnaire (of a maximum score of 38 points on this portion of the questionnaire). Questions about History of the Business and Organizational Performance Section B (14 questions) 5. How many years has your organization been in business in California as a contractor under your present business name and license number? Years 3 years or more = 2 points 4 years = 3 points 5 years = 4 points 6 years or more = 5 points Page 132 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 6. Was your firm in bankruptcy at any time during the last ten (10) years? ❑ Yes ❑ No "No" = 3 points "Yes" = 0 points 11. Has any CSLB license held by your firm or its Responsible Managing Employee ("RME") or Responsible Managing Officer ("RMO") been suspended within the last ten (10) years? ❑ Yes ❑ No "No" = 5 points "Yes" = 0 points 12. At any time in the last ten (10) years has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either a public or private owner? ❑ Yes ❑ No No projects with liquidated damages of more than $10,000, or one (1) project with liquidated damages = 5 points Two (2) projects with liquidated damages of more than $10,000 = 3 points Any other answer. 0 points 13. In the last ten (10) years has your firm, or any firm with which any of your company's owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason? NOTE: "Associated with" refers to another construction firm in which an owner, partner or officer of your firm held a similar position, and which is listed in response to question 1c or ld on this form. ❑ Yes ❑ No "No" = 5 points "Yes" = 0 points NOTE: The following two questions refer only to disputes between your firm and the owner of a project. You need not include information about disputes between your firm and a supplier, another contractor, or subcontractor. You need not include information about "pass-through" disputes in which the actual dispute is between a sub -contractor and a project owner. Also, you may omit reference to all disputes about amounts of less than $10,000. 14. In the past ten (10) years has any claim against your firm concerning your firm's work on a construction project been filed in court or arbitration? ❑ Yes ❑ No Page 133 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS If the firm's average gross revenue for the last three (3) years was less than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" if more than 2 such instances If your firm's average gross revenue for the last three years was more than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1, 2, or 3 such instances 3 points for "Yes" indicating either 4 or 5 such instances 0 points for "Yes" if more than 5 such instances 15. In the past ten (10) years has your firm made any claim against a project owner concerning work on a project or payment for a contract and filed that claim in court or arbitration? ❑ Yes ❑ No If your firm's average gross revenue for the last three (3) years was less than $50 million scoring is as follows: 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" if more than 2 such instances If your firm's average gross revenue for the last three years was more than $50 million scoring is as follows: 5 points for either "No" or "Yes" indicating 1, 2, or 3 such instances 3 points for "Yes" indicating either 4 or 5 such instances 0 points for "Yes" if more than 5 such instances 16. At any time during the past ten (10) years, has any surety company made any payments on your firm's behalf as a result of a default, to satisfy any claims made against a performance or payment bond issued on your firm's behalf, in connection with a construction project, either public or private? ❑ Yes ❑ No 5 points for either "No" or "Yes" indicating 1 such claim 3 points for "Yes" indicating no more than 2 such claims Subtract 5 points for "Yes" if more than 2 such claims Page 134 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 17. In the last ten (10) years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? ❑ Yes ❑ No 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" or if more than 2 such instances 18. Has your firm or any of its owners, officers or partners ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public agency or entity? ❑ Yes ❑ No "No" = 5 points "Yes" = subtract 5 points 19. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? ❑ Yes ❑ No "No" = 5 points "Yes" = subtract 5 points 20. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? ❑ Yes ❑ No "No" = 5 points "Yes" = subtract 5 points - 22. if your firm was required to pay a premium of more than one per cent for a performance and payment bond on any project(s) on which your firm worked at any time during the last five (5) years, state the percentage that your firm was required to pay. You may provide an explanation for a percentage rate higher than one per cent, if you wish to do so. 5 points if the rate is no more than one per cent 3 points if the rate was no higher than 1.10 per cent 0 points for any other answer 24. During the last ten (10) years, has your firm ever been denied bond coverage, by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public construction project when one was required? ❑ Yes ❑ No "No" = 5 points "Yes" = 0 points Page 135 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Questions about compliance with safety, workers compensation, prevailing wage and apprenticeship laws. Section C (8 questions) 25. Has CAL OSHA cited and assessed penalties against your firm for any "serious," "willful" or "repeat" violations of its safety or health regulations in the past ten (10) years? NOTE: If you have filed an appeal of a citation, and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal, you need not include information about it. ❑ Yes ❑ No If the firm's average gross revenue for the last three years was less than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" if more than 2 such instances If the firm's average gross revenue for the last three years wasmorethan $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1, 2, or 3 such instances 3 points for "Yes" indicating either 4 or 5 such instances 0 points for "Yes" if more than 5 such instances 26. Has the Federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past ten (10) years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. ❑ Yes ❑ No If the firm's average gross revenue for the last three years was less than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" or if more than 2 such instances If the firm's average gross revenue for the last three years was more than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1, 2, or 3 such instances 3 points for "Yes" indicating either 4 or 5 such instances 0 points for "Yes" if more than 5 such instances Page 136 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 27. Has the EPA or any Air Quality Management District or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the contractor, in the past ten (10) years? NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation. ❑ Yes ❑ No If the firm's average gross revenue for the last three years was less than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1 such instance 3 points for "Yes" indicating 2 such instances 0 points for "Yes" or if more than 2 such instances If the firm's average gross revenue for the last three years was more than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating 1, 2, or 3 such instances 3 points for "Yes" indicating either 4 or 5 such instances 0 points for "Yes" if more than 5 such instances 28. How often do you require documented safety meetings to be held for construction employees and field supervisors during the course of a project? 3 points for an answer of once each week or more often 0 points for any other answer 29. List your firm's Experience Modification Rate (EMR) (California workers' compensation insurance) for each of the past three premium years: NOTE: An Experience Modification Rate is issued to your firm annually by your workers' compensation insurance carrier. Current year: Previous year: Year prior to previous year: NOTE: An Experience Modification Rate is issued to your firm annually by your workers' compensation insurance carrier. 5 points for three-year average EMR of .95 or less 3 points for three-year average of EMR of more than .95 but no more than 1.00 0 points for any other EMR Page 137 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS 30. Within the last ten (10) years has there ever been a period when your firm had employees but was without workers' compensation insurance or state -approved self- insurance? ❑ Yes ❑ No 5 points for either "No" or "Yes" indicating 1 such instance 0 points for any other answer 31. Has there been any occasion during the last ten (10) years in which your firm was required to pay either back wages or penalties for your own firm's failure to comply with the State's prevailing wage laws? ❑ Yes ❑ No If your firm's average gross revenue for the last three years was less than $50 million, scoring is as follows: 5 points for either "No," or "Yes" indicating either 1 or 2 such instance 3 points for "Yes" indicating 3 such instances 0 points for "Yes" and more than 3 such instances If your firm's average gross revenue for the last three years was more than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating no more than 4 such instances 3 points for "Yes" indicating either 5 or 6 such instances 0 points for "Yes" and more than 6 such instances 32. During the last ten (10) years, has there been any occasion in which your own firm has been penalized or required to pay back wages for failure to comply with the Federal Davis -Bacon prevailing wage requirements? ❑ Yes ❑ No if your firm's average gross revenue for the last three years was less than $50 million, scoring is as follows: 5 points for either "No," or "Yes" indicating either 1 or 2 such instance 3 points for "Yes" indicating 3 such instances 0 points for "Yes" and more than 3 such instances If your firm's average gross revenue for the last three years was more than $50 million, scoring is as follows: 5 points for either "No" or "Yes" indicating no more than 4 such instances 3 points for "Yes" indicating either 5 or 6 such instances 0 points for "Yes" and more than 6 such instances Page 138 TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS Page 139 eW3*lx lit 3nN3AV-nJHa32J ...... . .. - - - - - --- ---------- - j .... . . ....... . . . .............. . ..... . . ............................ . .. ................... . .......... - Id. �7o— Ki . . . . . . . . . . . . . . . -NA. 18 < §0 Wo� oil. 1, 77� O 0 IK H 1-7uta lu ON m 4 " sz a Hn ul U.01 11 H-4 I H 11 MIM UMI 11 loll! oll ill 1 oil in 01 in I It 111. in H H m INHE; ell in 10 H H! 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TUSTIN EMERGENCY OPERATIONS CENTER & CORPORATE YARD PROJECT, CIP No. 10067 REQUEST FOR PRE -QUALIFICATION OF GENERAL CONTRACTORS LIN ir_T91 M I iv, rMR1 11191 Page 11 SECTION D SAMPLE CONTRACT SECTION D CONTRACT FOR EMERGENCY OPERATIONS CENTER & CORPORATE YARD CIP No. 10067 This agreement, made and concluded, in triplicate, this day of 20 , between the City of Tustin, California, hereinafter called City, and hereinafter called Contractor. ARTICLE I Witnesseth, that for and in consideration of the payments and agreements hereinafter mentioned, to be made and performed by the City, and under the conditions expressed in the two bonds, bearing date with these presents and hereunto annexed, the Contractor agreed with City, at his own proper cost and expense, to do all the work and furnish all the materials necessary to construct and complete in good workmanlike and substantial manner and to the satisfaction of the City, in accordance with the plans and specifications, as may be amended from time to time as of the date of this Agreement, entitled: EMERGENCY OPERATIONS CENTER & CITY YARD CIP No. 10067 which said plans and specifications are hereby specifically referred to and by such references made a part hereof. Said plans and specifications are on file in the office of the City Engineer of the City of Tustin, California. ARTICLE II Contractor agrees to receive and accept the following prices as full compensation for furnishing all materials and for doing all the work contemplated and embraced in the Agreement; and also for all loss or damage arising out of the nature of the work aforesaid, or from the action of the elements, or from any unforeseen difficulties or obstructions which may arise or be encountered in the prosecution of the work until its acceptance by the City, and for all risks of every description connected with the work; also for all expenses incurred by or in consequence of the suspension or discontinuance of work and for well and faithfully completing the work, and the whole thereof, in the manner and according to the plans and specifications, and the requirements of the Engineer under them. D-1 CONTRACT FOR EMERGENCY OPERATIONS CENTER & CITY YARD CIP No. 10067 CITY OF TUSTIN ITEM NO. CONTRACT ITEM DESCRIPTION ESTIMATED QUANTITY UNIT TYPE UNIT PRICE TOTAL PRICE GRAND TOTAL CONTRACT PRICE 9ba ARTICLE III City hereby promises and agrees with Contractor to employ and does hereby employ Contractor to provide the materials and to do the work according to the terms and conditions herein contained and referred to, for the prices aforesaid, and hereby contracts to pay the same at the time, in the manner and upon the conditions above set forth; and the said parties for themselves, their heirs, executors, administrators, successors and assigns do hereby agree to the full performance of the covenants herein contained. ARTICLE IV It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this instrument and the bid or proposal of Contractor, then this instrument shall control and nothing herein,shall be considered as an acceptance of the said terms of said proposal conflicting herewith. ARTICLE V 1. The CITY OF TUSTIN has obtained from the Director of Industrial Relations the general prevailing rate of per diem wages and the general prevailing rate for legal holiday and overtime work in the locality in which the work is to be performed for each craft or type of work needed to execute this contract and maintains copies thereof in the office of the City Engineer. The Contractor agrees that not less than said prevailing rates shall be paid to workers employed on this public works contract as required by Labor Code Sections 1771 and 1774 of the State of California. Prevailing Wages Notice Requirements • No contractor or subcontractor shall be listed on a bid proposal for a public works project unless registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5. No contractor or subcontractor shall be awarded a contract for public work on a public works project unless registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5 • This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. (For federally funded Davis -Bacon projects, add the following) This is a Davis -Bacon project and the Federal Regulations will be enforced. Any contract entered into pursuant to this notice will incorporate the provisions of the Federal Labor Standards, which are on file at the office of the City Engineer, 300 Centennial Way, Tustin, CA 92780. Attention is directed to the Federal minimum wage rate requirements in the Special Provisions. If there is a difference between the minimum wage rates determined by the Director of the California Department of Industrial Relations for similar classifications of labor, the Contractor and subcontractor shall pay not less than the higher wage rate. The City will not accept lower State wage rates not specifically included in the Federal minimum wage determinations. This includes "helper" (or other classifications based on hours of experience) or any other classification not appearing in the Federal wage determinations. Where Federal wage determinations do not contain the State wage rate determination otherwise available for use by M the Contractor and subcontractors, the Contractor and subcontractors shall pay not less than the Federal minimum wage rate which most closely approximates the duties of the employees in question. 2. The Contractor shall, as a penalty to the CITY OF TUSTIN, forfeit Two Hundred Dollars ($200.00) for each calendar day or portion thereof for each worker paid (either by Contractor or any subcontractor of Contractor) less than the prevailing rate as prescribed in the preceding paragraph for the work provided for in this contract, all in accordance with Sections 1774 and 1775 of the Labor Code of the State of California. 3. Section 1773.1 of the Labor Code of the State of California, regarding the payment of travel and subsistence payments, is applicable to this contract. 4. Section 1777.5 of the Labor Code of the State of California, regarding the employment of apprentices, is applicable to this contract if the prime contract involves Thirty Thousand Dollars ($30,000.00) or more, or twenty (20) working days or more and under such circumstances, Contractor shall be fully responsible to ensure compliance with all the provisions of Labor Code §1777.5 for all apprentice -able occupations on the project. A Contractor or subcontractor who violates Section 1777.5 shall forfeit to the City of Tustin, as a civil penalty, the sum of One Hundred Dollars ($100.00) for each calendar day of noncompliance. Notwithstanding Section 1727 of the Labor Code, upon receipt of a determination that a civil penalty has been imposed, the City of Tustin shall withhold the amount of the civil penalty from contract progress payments then due or to become due. Any funds withheld by the City of Tustin pursuant to this section shall be deposited in the General Fund of the City of Tustin. 5. The Contractor shall not employ, or allow work to be performed by, a subcontractor who is ineligible to perform work on the project pursuant to Section 1777.1 or 1777.7 of the Labor Code pertaining to debarment by the Labor Commissioner for violations of the Prevailing Wage Laws. 6. In performance of this contract, not more than eight (8) hours shall constitute a day's work. The Contractor shall fully conform to Article 3, Chapter 1, Part 7, Division 2 (Sections 1810 et seq.) of the Labor Code of the State of California. Pursuant to the provisions of Section 1813 of the Labor Code of the State of California, the Contractor shall, as a penalty to the City of Tustin, forfeit twenty-five Dollars ($25.00) for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than eight (8) hours in any one calendar day and forty (40) hours in any one calendar week in violation of the provisions of Article 3 of Chapter 1 of Part 7 of Division 2 of the Labor Code of the State of California. Contractor shall keep an accurate record showing the name and actual hours worked each calendar day and each calendar week by each worker employed by Contractor in connection with the public work. 7. Contractor agrees to keep accurate payroll records showing the name, address, social security number, work classification, straight time and overtime hours worked each day and week and the actual per diem wages paid to each journeyman, apprentice or worker employed by him in connection with the public work, and agrees to insist that each of his subcontractors do the same. Contractor further agrees that his payroll records and those of his subcontractors shall be available to the employee or his representative, the Division of Labor Standards Enforcement, and the Division of Apprenticeship Standards, and shall comply with all of the provisions of Labor Code Section 1776, et seq., in general. 8. Contractor is also aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for Worker's Compensation or undertake self-insurance in accordance with the provisions of that code and will comply with such provisions before commencing the performance of the work of this contract. D-4 ARTICLE VI In connection with the performance of this contract, the City shall have the authority to enter the worksite at any time for the purpose of identifying the existence of conditions, either actual or threatened, that may present a danger or hazard to any and all employees. The Contractor agrees that the City, in its sole authority and discretion, may order the immediate abatement of any and all conditions that may present an actual or threatened danger or hazard to any and all employees at the worksite. The Contractor acknowledges the provisions of Section 6400 of the Labor Code, which requires that employers shall furnish employment and a place of employment that is safe and healthful for all employees working therein. In the event the City identifies the existence of any condition that presents an actual or threatened danger or hazard to any or all employees at the worksite the City is hereby authorized to order the immediate abatement of that actual or threatened condition pursuant to this section. The City may also, at its sole authority and discretion, issue an immediate stop work order to the Contractor to ensure that no employee working at the worksite is exposed to a dangerous or hazardous condition. Any stop work order issued by the City to the Contractor in accordance with the provisions of this section shall not give rise to any claim or cause of action for delay damages by the Contractor or the Contractor's agents or subcontractors against the City. ARTICLE VII The Contractor shall indemnify and save harmless the City of Tustin and all officers and employees thereof from all claims, suits, or actions of every name, kind and description, brought for, or on account of, injuries to or death of any person including, but not limited to, workers and the public, or damage to property resulting from the construction of the work or by or in consequence of any negligence regarding the work, use of improper materials or equipment in construction of the work, neglect or refusal of Contractor to faithfully perform the work and all of Contractor's obligations under the contract, or by or on account of any act or omission by the Contractor or his agents or a subcontractor or his agents or a third party during the progress of the work or at any time before its completion and final acceptance, or which might arise in connection with the agreed upon work or is caused by or happening in connection with the progress of said work, or on account of any passive or active negligent act or omission by the City of Tustin, its officers, employees and agents, save and except claims arising through the sole and exclusive negligence or sole and exclusive willful misconduct of the City of Tustin. The defense and indemnification by Contractor shall include all costs and expenditures including attorney's fees incurred by the City of Tustin or its employees, officers or agents with respect to such claim or suit and Contractor will, if requested by City of Tustin, defend any litigation arising out of such claims at the sole cost and expense of Contractor. In addition to any remedy authorized by law, so much of the money due the Contractor under and by virtue of the contract as shall be considered necessary in the sole discretion of the City of Tustin may be retained by the City until disposition has been made of such claims for damages as aforesaid. ARTICLE VIII The Contractor shall take out and maintain during the life of the contract, commercial general liability, automobile liability and worker's compensation insurance. Contractor will procure, at no additional cost to the City, a Builder's Risk and Installation Construction coverage" insurance policy for the work of this contract. Coverage must name the D-5 City as insured and shall include all perils coverage and a face value equal to the contracted amount for such work. Such policy, to be obtained after acceptance of bid, must be approved by the City Attorney and on file prior to the execution of the Contract by the City. The amount of the commercial general liability and automobile insurance shall not be less than the following: • Single limit coverage applying to bodily and personal injury liability and property damage: $2,000,000. Primary General Liability and Automobile Liability policy shall have single limit coverage not less than $ 2,000,000. The minimum insurance requirements cannot be satisfied through Umbrella/Excess insurance policies. The following insurer endorsements are required if not part of the policy: The City of Tustin, its elective and appointive boards, officers, agents and employees named as additional insured in the policy as to the work being performed under the contract; 2. The coverage is primary and no other insurance carried by the City of Tustin will be called upon to contribute to a loss under this coverage; 3. The policy covers blanket contractual liability; 4. The policy limits or liability are provided on an occurrence basis; 5. The policy covers broad form property damage liability; 6. The policy covers personal injury as well as bodily injury liability; 7. The policy covers explosion, collapse, and underground hazards; 8. The policy covers products and completed operations; 9. The policy covers use of non -owned automobiles; and 10. The coverage shall not be cancelled or terminated unless thirty (30) days' written notice is first given to the City of Tustin. 11. Insurers shall be authorized to do business in the State by the Department of Insurance and shall meet the following qualifications: A.M. Best's Rating of Grade A and Class VII (seven) (if an Admitted Insurer), and Grade A- or better and Class X (ten) or better (if offered by a Surplus Line Broker) is acceptable. Workers' compensation insurance rated Grade B- or better and Class VII (seven) or better, or offered by the State Compensation Fund, is acceptable. 12. The worker's compensation and employer's liability insurance policies shall contain a waiver of subrogation in favor of the City. Contractor shall provide to the City within ten (10) working days after the date of notice of award of the contract evidence of the aforementioned insurance with insurer endorsements, which must meet the requirements of this Article. An Acord Certificate will be accepted solely as evidence of the name of the insurers and the amounts of insurance. Failure to comply with W. these requirements will result in annulment of the award, forfeiture of the proposal guarantee, and the City will pursue award to the next qualified responsive bidder. Contractor is advised that insurance requirements are non-negotiable and City will not consider waiving insurance requirements. There are no exceptions. ARTICLE IX Upon receipt of a claim or summons and complaint by the City Clerk relating to this Contract, the City Clerk shall provide written notice within five (5) working days to the contractor of the claim or summons and complaint. For purposes of this section, notice to the contractor may be via facsimile, messenger or by first class mail and addressed to: [Insert name & address of contractor] Nothing herein obligates the City to provide notice of a claim or summons and complaint that does not clearly identify the contract or contractor. D-7 In Witness Whereof, the parties have hereunto set their hands and seals the year and date first above written. THE CITY OF TUSTIN M (SEAL) Mayor of the City of Tustin ATTEST: CONTRACT AND BOND APPROVED AS TO FORM: Date City Attorney APPROVED AS TO CONTENT: City Engineer Date Firm Name: (SEAL) By: Title: City Clerk of the City of Tustin CONTRACTOR Note: Attach proper acknowledgment for signatures of authorized person(s) (use copies of blank form provided in Section C). M: i9arlik- Amount Premium CITY OF TUSTIN PUBLIC CONTRACT FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That , as and hereinafter referred to collectively as "Principal", and a corporation organized and existing under the laws of the State of and duly authorized to transact surety business in the State of California, as, and hereinafter referred to as, "Surety", are held and firmly bound unto the City of Tustin hereinafter referred to as the "City", in the sum of $ for payment of which Principal and surety bind themselves, their heirs, administrators, successors and assigns, jointly and severally as follows: THE CONDITION OF THE ABOVE OBLIGATION IS THAT: WHEREAS, Principal has entered into a contract dated , 20—, with City to do and perform the following, generally described work, which is more particularly described in said contract for the construction of: EMERGENCY OPERATIONS CENTER & CITY YARD. CIP No. 10067 WHEREAS, all of such improvements are to be constructed and installed in accordance with the plans and specifications described, referred to and incorporated in said contract; and WHEREAS, Principal shall commence and complete the construction and installation of such improvements as provided in said contract; and NOW, THEREFORE, if Principal shall faithfully perform all agreements contained in the aforesaid contract, then this obligation shall be null and void. PROVIDED, HOWEVER, if Principal shall not faithfully perform all agreements contained in the hereinabove described contract and all obligations, then this obligation shall remain in full force and effect. PROVIDED FURTHER HOWEVER, that Surety hereby stipulates and agrees that no change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder shall in any way affect its obligation on this bond and it does hereby waive notice of any such change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder; and PROVIDED FURTHER, that in case suit is brought upon this bond by the City or any other person who may bring an action on this bond, a reasonable attorney's fee, to be fixed by the Court, shall be paid by Principal and Surety. W IN WITNESS WHEREOF, Principal and Surety have caused these presents to be duly signed and sealed this day of , 20_. (SEAL) APPROVED AS TO FORM: City Attorney (SEAL) APPROVED AS TO CONTENT: Date City Engineer SURETY: (Name) Attorney -in -Fact M Address of Surety: PRINCIPAL: BY: (Name) TITLE: Address of Principal: Note: Attach proper acknowledgment for both Surety & Principal (use copies of blank form provided in Section C). D-10 GM, Me Amount Premium CITY OF TUSTIN LABOR AND MATERIALS PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: That as and hereinafter referred to collectively as "Principal®, and a corporation organized and existing under the laws of the State of and duly authorized to transact surety business in the State of California, as and hereinafter referred to as, "Surety", are held and firmly bound unto the City of Tustin hereinafter referred to as the "City", in the sum of $ for payment of which Principal and surety bind themselves, their heirs, administrators, successors and assigns, jointly and severally as follows: THE CONDITION OF THE ABOVE OBLIGATION IS THAT: WHEREAS, Principal has entered into a contract dated , 20 with the City to do and perform the following, generally described work, which is more particularly described in said contract for the construction of: EMERGENCY OPERATIONS CENTER & CITY YARD CIP No. 10067 WHEREAS, Principal shall commence and complete the construction and installation of such improvements provided in said contract; and NOW THEREFORE, if Principal shall pay the Contractor, his subcontractor, and all persons renting equipment or furnishing labor or materials to them for such improvements, for the full cost of such improvements and submit amounts due under the State Unemployment Insurance Act with respect to such labor, then this obligation shall be null and void. PROVIDED, HOWEVER, if Principal shall not pay the subcontractor and all persons renting equipment or furnishing labor or materials to them for such improvements for the full cost of such improvements, or if Principal fails to submit amounts due under the State Unemployment Insurance Act with respect to such labor, then Surety will pay for the same in an amount not exceeding the sum set forth above, which amount shall inure to the benefit of all persons named in Civil Code Section 3181. PROVIDED FURTHER, HOWEVER, that Surety stipulates and agrees that no change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder shall in any way affect its obligation on this .bond and it does hereby waive notice of any such change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder; and PROVIDED FURTHER, that in case suit is brought upon this bond by the City or any other person named in Civil Code Section 3181 who may bring an action on this bond, a reasonable attorney's fee, to be fixed by the Court, shall be paid by Principal and Surety. D-11 IN WITNESS WHEREOF, Principal and Surety have caused these presents to be duly signed and sealed day of , 20 (SEAL) APPROVED AS TO FORM: City Attorney (SEAL) APPROVED AS TO CONTENT: Date City Engineer SURETY: AN (Name) Attorney -in -Fact Address of Surety: PRINCIPAL: BY: (Name) TITLE: Address of Principal Note: Attach proper acknowledgments for both Surety & Principal (use copies of blank form provided in Section C). D-12 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each Contractor to whom a public works contract has been awarded shall sign the following certificate and shall submit same to the City prior to performing any work on the contract: I am aware of the provisions of Section 3700 of the Labor Code which reads as follows: "Every employer except the State shall secure the payment of compensation in one or more of the following ways: (a) By being insured against liability to pay compensation in one or more insurers duly authorized to write compensation insurance in this State. (b) By securing from the Director of Industrial Relations a certificate of consent to self -insure, which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self -insure and to pay any compensation that may become due to his employee." CONTRACTOR: SIGNED: NAME: TITLE: COMPENSATION INSURANCE CERTIFICATE TO BE SUBMITTED WITH CONTRACT D-13 CONTRACTOR LICENSING STATEMENT TO BE PROVIDED BY SUCCESSFUL BIDDER PRIOR TO AWARD OF CONTRACT The undersigned Contractor or Corporate Officer, declares under penalty of perjury that the attached copy of the Contractor's pocket licenses or certificate of licensure is current and valid, and is in a classification as required by the project specifications and appropriate to the work to be undertaken for this project. PROJECT: EMERGENCY OPERATIONS CENTER & CITY YARD CIP No. 10067 CONTRACTOR: SIGNED: NAME: TITLE: Note: Attach proper acknowledgments for both Surety & Principal (use copies of blank form provided in Section C). 1915115! TUSTIN BUILDING OUR FUTURE HONORING OUR PAST P roj e ct: Project Number: To (Contractor): CITY OF TUSTIN PUBLIC WORKS DEPARTMENT CONTRACT CHANGE ORDER Change Order Number: You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY ENGINEER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by: CHANGE IN CONTRACT ITEMS The following changes are hereby made to the contract: INCREASE(DECREASE) ITEM NO. DESCRIPTION UNIT PRICE QUANTITY AMOUNT TOTAL ADDITIONAL WORK (NON CONTRACT ITEM) DESCRIPTION UNIT PRICE QUANTITY AMOUNT TOTAL GRAND TOTAL NET CHANGE Payment for elimination/additions of bid items will be reflected on the progress payments. D-15 CHANGE TO CONTRACT PRICE The contractor shall be paid a sum of $ for all work included in this change order. This sum constitutes full compensation, including mark-ups and extended overhead. The compensation (time and cost) set forth in this Change Order comprises the total compensation due the Contractor, the Subcontractors and all suppliers, for the work or change defined in this Change Order, including all impact on any unchanged work. By signing this Change Order, the Contractor acknowledges and agrees, on behalf of himself, all Subcontractors and all suppliers, that the stipulated compensation includes payment for all work contained in this Change Order, plus all payment for the interruption of schedules, extended overhead costs, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this Change Order shall indicate that the Change Order constitutes full mutual accord and satisfaction for the change, and that the time and/or cost under the Change Order constitutes the total equitable adjustment owed the Contractor, all Subcontractors, and all suppliers, as a result of this change. The Contractor, on behalf of himself, all Subcontractors and all suppliers, agrees to waive all rights, without exception or reservation of any kind whatsoever, to file any further claim or request for equitable adjustment of any type, for any reasonably foreseeable cause that shall arise out of or as a result of this Change Order or the impact of this Change Order on the remainder of the work under this Contract. TOTAL COST THIS CHANGE ORDER: DECREASE INCREASE By reason of this order the contract time completion will be adjusted as follows: working days. SUMMARY OF CONTRACT CHANGE ORDERS COST OF PRECEDING CHANGE ORDERS: DECREASE INCREASE TOTAL COST OF CHANGE ORDERS TO DATE DECREASE INCREASE We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all services necessary for the work above specified, and will accept as full payment therefore the prices shown above. Accepted Date Contractor By Title Approval recommended by Date Construction Manager/Contract Administrator Approved by Date City Engineer D-16 CITY OF TUSTIN DEPT OF PUBLIC WORKS ENGINEERING DIVISION 300 Centennial Way Tustin. CA 92780 (714)573.3160 PLEASE PRINT PUBLIC RIGHT-OF-WAY ENCROACHMENT . AND CONSTRUCTION PERMIT PERMIT NO.: DRAWING NO,: CITY BUSINESS LICENSE NO.: JOSAOpRESS TLDCA ION: PEAMn IS NOT UNLESS OESCRImiDN OF WOA%: . - STAMPED HERE APPLICANT PHONE: ADDRESS APPLICANTI CITY zwc006 CONTRACTOR STATE LICENSE NO, PHONE ADDRESS rcow ACTOR) CITY zip Coca Ymnan.s CCMFENSATWN PDLICY NO. INSURANCE CO. E%PIMTIOH DATE EYEMPtION FROM WORKERS COMPENSATION SECTION 3590 OF STATE L 011 CODE: =NATURE: WE: SFECML PROVISIONS CONDITIONS; REMAA", INSPECTION FEES IMPORTANT DESCRIPTION OF WORK OUANTITY SCHEDULE FEE AMOUNT Call (714) 573-3150 - Engineering @S_- S Division 48 hours prior to start of work for inspection. No @ s = s construction will be allowed on Saturdays, Sundays, Holidays or @ s . s alternate Fridays City is closed, unless otherwise authorized. Read s = s Standard Provisions and Conditions on reverse side and/or attached. @ S - s Southern California Edison must be notified prior to workers and/or _@3-- S equipment operating within 6 feet, and cranes or hoisting devices s _ within 10 feet of overhead electric - lines. Section 4216/4217 of the @ s = s Government Code requires a Digalert Identification Number be @ S = S issued before a "Permit to ExcavaleF will be valid. For your DigAlen I.D. @ s = s number call Underground Service Alert toll free at 1-800-422-4133 @ s = s two working days before you dig, @5 = S TQTAt:: f'EE7-.-:'°'r'•� :>: CASH PERMIT INSPECTION DEPOSIT 3 + FEES _ + FEES S = S _ FINAL CASH DEPOSIT TO BE REFUNDED TO: D APPLICANT -7 LJ CONTRACTOR INSPECTION: DATE: AMOUNT OF CASH DEPOSIT RELEASED: S RELEASED BY: DATE: PLEASE READ CAREFULLY: I agree to comply with the provisions and conditions set forth on the back and/or attached to this application and all City ordinances, resolutions, standards and specifications currently in force, and to pay for removal and proper replacement of any item installed under this permit which does not comply with the above. I agree to pay for any additional caplacements in excess of the amounts shown above which maybe cut or damaged as a result of any work accomplished under this permit. APPLICANT: -NAME SIGNATURE DATE: . APPROVED BY: ISSUED BY: - DATE: WHITE- PERMANENT RECORD " GREEN -INSPECTION ° CANARY -FINANCE ° PINK -APPLICANT ° GOLDENROD -WATER DIVISION U-1 / STANDARD PROVISIONS AND CONDITIONS PERMIT. This permit is not valid unless signed by the City Engineer or his authorized representative, and contains a City validation stamp. This permit or an exact copy must be kept at the site of the work. This permit is void if work is not completed within 6 months of the validation date, unless otherwise noted. An extension may be granted, if such extension is applied for no later than 72 hours before pen -nit expires. The City reserves the right to revolve this pennit at anytime for non-compliance with its provisions and conditions. INSPECTION. Inspections are required prior to beginning work, after completion of work, and at all other times as may be deemed necessary by the City Engineer or as specified in any applicable standards. Inspections will be performed and construction permitted between the hours of 7:30 a.m. and 5:00 p.m. Mondays through Fridays, except City observed Holidays and alternating off Fridays. STANDARDS. Applicant agrees to perform the work authorized by this permit in a safe and workmanlike manner subject to the approval of the City Engineer or his authorized representative. Work shall be done in conformance with all City ordinances, resolutions, standards and specifications in force and the latest edition of the Standard Specifications for Public Works Construction, "The Green Book", unless otherwise specified. The applicant shall also comply with all pertinent codes, orders, regulations and laws of local, state, and federal governments, agencies and utilities. PUBLIC CONVENIENCE AND SAFETY. Barricades must be kept and maintained on all trenches, excavations and obstructions. Warning lights must be maintained at night. Arrow boards shall be required on all arterial lane closures, and as required elsewhere. All traffic control warning and safety devices shall conform to the requirements set forth in the current Manual of Traffic Controls for Construction and Maintenance Work Zones issued by the State of California Department of Transportation (Caltrans). The applicant shall be responsible for placing and maintaining in a safe and neat manner temporary bituminous surfacing in all areas where existing pavement has been removed. Permanent paving shall be placed in a timely manner as directed by the City Engineer. Street closure(s) will not be permitted except upon specific approval of the City Engineer. Access to fire hydrants shall be maintained at all times. Construction materials, debris or equipment shall not be stored within the public right-of-way unless authorized by the City Engineer. RESPONSIBILITY FOR DAMAGE AND LOSS. Applicant shall indemnify and save harmless the City of Tustin, its Officers and Agents from all suits or actions for any injuries or damages received or sustained by any person or persons by or from the applicant, his servants or agents and from any loss, damage, liability, cost or expense, including, but not limited to reasonable attorney fees that may arise during or be caused in any way by or in the construction of the work or by or inconsequence of any negligence in guarding the same, or for improper methods or materials used in the construction. The applicant shall indemnify and be liable for all costs or expenses, including, but not limited to reasonable attorney fees that may be incurred in enforcing this clause again the applicant. LICENSES. Contractor must hold a valid State Contractors License for the class of work they will perform and must hold a valid CITY OF TUSTIN Business License. GUARANTEES AND RESPONSIBILITIES. The work done shall be guaranteed for a period of one year. Failure of City Inspectors to detect flaws in the work shall not relieve the applicant of the responsibility to construct all work per City Standards. ADDITIONAL FEES. The applicant shall be responsible and may be charged additional fees for reinspections and/or any miscellaneous inspections not expressly mentioned in the foregoing schedule. Fees for a permit issued after work has started shall include a $100.00 penalty fee. The City shall reserve the right to correct any deficiencies and all costs shall be borne by the applicant. Failure to install barricades which are subsequently placed by the City to protect the public shall be billed to the applicant at a charge of $5.00 per barricade per day, $2.50 per warning light per day, plus all applicable City crew call -out costs. CASH DEPOSITS. Excess deposits will be refunded only after final inspection and approval. LABOR NON-DISCRIMINATION AND DISABILITIES ACT. In compliance with Federal Regulations, the City of Tustin does not discriminate on the basis of race, color, national origin, age or disability. All public facilities must be constructed to the standards contained within the Americans with Disabilities Act. USA/UTILITY MARKINGS. All USA/Utility markings shall be removed when work is completed. E