Pre-Qualification Questionnaire - Amador Water Agency

18 Pages·2013·0.19 MB·English

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May 2013

This document is not a public record.

Amador Water Agency
12800 Ridge Road
Sutter Creek, California 95686
Phone:[phone] Fax:[phone]
INVITATION TO PRE-QUALIFY FOR BID

Sealed Pre-Qualification Questionnaires will be received at the Amador Water Agency office,
12800 Ridge Road, Sutter Creek, California 95685 until 2:00 p.m. local time on June 13, 2013, or
such later date as may be set by addendum. Questionnaires will be opened, reviewed and
analyzed for the opportunity to qualify to bid on the Gravity Supply Line Project. Only pre-Qualified
Bidders will be invited to participate in the bidding process, with advertisement for bids expected to
begin August 2013, or such later date as may be set by addendum.
Pre-Qualification Questionnaires are available at the Amador Water Agency office, 12800
Ridge Road, Sutter Creek, California 95685, at www.amadorwater.org or by phone at (209) 257-
5206.
Work will include construction of a new, approximately 6.7 mile, 20-inch and 24-inch diameter
raw water pipeline from the PG&E owned and operated Tiger Creek Regulator reservoir to the
Amador Water Agency’s Buckhorn Water Treatment Plant. The new pipeline will begin with a new
siphon out of the Regulator reservoir and proceed in logging roads, gravel and paved roads, cross
country and through existing easements to the Buckhorn Water Treatment Plant. Approximately 3
miles of the pipeline will be 20-inch and 24-inch thermal butt fusion welded HDPE, with the
remainder being 24-inch diameter steel pipe and ductile iron pipe, 20-inch diameter ductile iron pipe
and 20-inch diameter C905 pipe. The siphon will consist of a screened intake structure, siphon
piping and a 720 square foot pump station building with appurtenances. Open cut excavation
methods will be used to construct the pipeline, with the exception of the Regulator intake, four aerial
crossings, one creek diversion, one jack and bore crossing and an approximately 290 foot long
section of above ground construction where slopes approach 75%. While the majority of
construction is in roads, in the cross country areas the pipeline alignment proceeds through
extremely steep slopes (up to 75%) and some of the existing easement construction as well as
some road areas have a maximum 20 foot construction width. Elevation of the project (2950’ to
3600’) and the remote access may limit majority construction of the project to between May and
October.
Documents for the project will not be available during the pre-qualification process. Bidders
please note that only contractors who successfully complete the pre-qualification process at this
time will be considered responsible Bidders at the time of project bid.
The Agency reserves the right to reject all Pre-Qualification Questionnaires. Any Pre-
Qualification Questionnaires not conforming to the intent and purpose of or meeting the
requirements of the questionnaire may be rejected. Each firm submitting this questionnaire shall
not be considered a responsible Bidder if the firm submits a questionnaire that is not fully completed
or contains false information.
Amador Water Agency Pre-Qualification Questionnaire
NOTICE

The firm submitting this questionnaire shall not be considered a responsible Bidder if the
firm submits a questionnaire that is not fully completed or contains false information. All
of the following questions regarding "your firm" refer to the firm (corporation,
partnership or sole proprietor) submitting this questionnaire, as well as any firm(s) which
any of your firm's owners, officers, or partners are or have been associated with as an
owner, officer, partner or similar position within the last five years.

By submitting this questionnaire, the Bidder consents to the disclosure of its questionnaire
answers: (i) to third parties for the purposes of verification or investigation, and; (ii) in
connection with any protest, challenge or appeal of any action taken by the Amador Water
Agency; and (iii) as required by law or regulation. This questionnaire is not a public
record under the California Public Records Act (Calif. Gov't Code sections 6250 et seq.),
but the list of contractors who submitted this questionnaire is a public record. Each
questionnaire must be signed under penalty of perjury in the manner designated at the end
of the form, by an individual who has the legal authority to bind the Bidder submitting the
questionnaire. If any information provided by a Bidder is or becomes inaccurate, the
Bidder shall immediately notify the Agency and provide updated accurate information in
writing, under penalty of perjury.
This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
PHASE I
Complete Part I before proceeding to Part II
PART I: ESSENTIAL REQUIREMENTS FOR PRE-QUALIFICATION

Firm Name

Firm Address

Contractors’ License Number(s)

Phone and Fax Numbers Date
Entity Type: □ Corporation □ Partnership □ Joint Venture □ Sole Proprietorship
1. Does the Contractor possess a valid and current California Contractor’s license for the
project, or projects, for which it intends to submit a bid?
□ Yes □ No
2. Does the Contractor have a liability insurance policy with a policy limit of at least
$1,000,000 per occurrence and $2,000,000 aggregate?
□ Yes □ No
Liability Insurance Carrier*: A.M. Best Rating:
Policy #: Policy Limits:
*List all Liability Insurance Carriers, Policy #s and Limits over the last 5 years on a separate sheet.
3. Does the Contractor have an automobile insurance policy with a limit of at least $1,000,000?
□ Yes □ No
Automobile Insurance Carrier*: A.M. Best Rating:
Policy #: Policy Limits:
*List all Automobile Insurance Carriers, Policy #s and Limits over the last 5 years on a separate sheet.
4. Does the Contractor have a 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 □ Not Applicable - Contractor has no employees
5. Have you attached a letter of bond-ability confirming name, address and telephone of a
contact for a surety listed in the current edition of the California Department of the Treasury
Listing of approved sureties? The letter must also include both single and aggregate bonding
capacity totals and should be provided by the surety company or an authorized agent. A letter
from an authorized agent must include a power of attorney and notary acknowledgment.
□ Yes □ No
6. As an average of the last three years, does the Contractor have an average Experience
Modification Rate equal to or less than one (< 1.0)?
□ Yes □ No *If the Contractor is self-insured, an EMR must be calculated using industry formulas.
Contractor will be disqualified if the answer to any of questions 1 through 6 is “No”.
This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
NOTE: For purposes of this questionnaire, “Person” is defined as individuals who constitute
the management of a corporate or other legal entity. Additionally, it includes any individual or
other legal entity that: (a) directly or indirectly (e.g. through an affiliate), submits offers for or
is awarded, or reasonably may be expected to submit offers for or be awarded, a contract, or a
subcontract under a contract; or, (b) conducts business, or reasonably may be expected to
conduct business, with the Agency as an agent or representative of another person.
7. In the last five years, has any Person in your firm had their Contractors license revoked?
□ Yes □ No
8. In the last five (5) years, has your firm, or any Person, been convicted of a crime involving
the awarding of a contract of a government (local, state or federal) construction project, or
the bidding or performance of a government contract?
□ Yes □ No
9. In the last five (5) years, has your firm, or any Person, been “defaulted” or “ terminated” by
an owner (other than for convenience of the project owner) or has your surety completed a
contract for your firm?
□ Yes □ No
10. At the time of submitting this pre-qualification form, is your firm, or any Person, ineligible to
bid on or be awarded any public works contract, or perform as a subcontractor on a public
works contract?
□ Yes □ No
If the answer is “Yes”, state the beginning and ending dates of the period of debarment
or non-responsibility: _______________________________________________________
11. Has your firm, or any Person, ever been found guilty in a criminal action, for making any
false claim or material misrepresentation to any public agency or entity?
□ Yes □ No
12. In the last ten (10) years, has your firm, or any Person, ever been convicted of a crime
involving any federal, state or local law related to construction, including acts of dishonesty?
□ Yes □ No

Contractor will be disqualified if the answer to either questions 7, 8, 9 11 or 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.
This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
PHASE I
PART II: ORGANIZATION, HISTORY, ORGANIZATIONAL PERFORMANCE,
COMPLIANCE WITH CIVIL AND CRIMINAL LAWS
A. Current Organization and Structure of the Business
For Firms that Are Corporations:
1. Date incorporated:
2. Under the laws of what state:
3. Is the status of your corporation still valid?
4. 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:

Years with Taxpayer
Name Position Company %Ownership Identification

5. Identify every construction firm that any Person listed above has been associated with (as
owner, general partner, limited partner or officer) in 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.
Name Construction Firm Date of Participation w/Firm

This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
For Firms that Are Partnerships:
1. Date of formation:
2. Under the laws of what state:
3. Is the status of your partnership still valid?
4. Provide all the following information for each Person who owns ten percent (10%) or
more of the firm:

Years with Taxpayer
Name Position Company %Ownership Identification

5. Identify every construction firm that any Person listed above has been associated with (as
owner, general partner, limited partner or officer) in 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.
Name Construction Firm Date of Participation w/Firm

This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
For Firms With a Joint Venture License:
1. Date of commencement of joint venture:
2. Is the status of your joint venture still valid?
3. Provide all of the following information for each firm that is a member of the joint
venture that expects to bid on one or more projects:

Name Position

4. Provide all the following information for each Person who owns ten percent (10%) or
more of the joint venture.
Years with Taxpayer
Name Position Company %Ownership Identification

NOTE: New joint ventures are not excluded from forming after the
pre-qualification process. However, in such cases, all parties to the joint venture must have
individually pre-qualified in order to bid with the Amador Water Agency as a joint
venture.
This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
For Firms That Are Sole Proprietorships:
1. Date of commencement of business:
2. Social Security number of company owner
3. Identify every construction firm that the business owner has been associated with (as
owner, general partner, limited partner or officer) in the last five (5) years.:

Name Construction Firm Date of Participation w/Firm

This document is not a public record.
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Amador Water Agency Pre-Qualification Questionnaire
B. History of the Business and Organizational Performance
1. In the last five (5) years, have there been any changes in ownership of the firm?
□ Yes □ No
(If Yes, explain on a separate signed page)
NOTE: A corporation whose shares are publicly traded is not required to answer this
question.
2. Is the firm a subsidiary, parent, holding company or Person of another construction firm?
□ Yes □ No
(If Yes, explain on a separate signed page)
NOTE: Include information about other firms if one firm owns fifty percent (50%) or
more of another, or if a Person of your firm holds a similar position in another firm.
3. Are any Persons in your firm associated with any other construction firms?
□ Yes □ No
(If Yes, explain on a separate signed page)
NOTE: Include information about other firms if any Person in your firm holds a
similar position in another firm.
4. State your firm’s gross revenues for the last three (3) years:
Year Ended Gross Revenue

5. How many years has your firm been doing business in California as a contractor under your
present business name and license number? years.
6. Is your firm currently in bankruptcy proceedings?
□ Yes □ No
(If Yes, attach a copy of the bankruptcy petition, showing the case number, and the date on
which the petition was filed.)
7. If your firm is not currently in bankruptcy proceedings, has your firm filed for bankruptcy in
the last five (5) 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, a copy of the Bankruptcy Court’s discharge order, or if no
discharge order was issued, any other document that ended the case.)
8. Are there any current claims against your firm or claims that your firm has filed against
others, that should the claim(s) not be paid or any action upon the claim be unsuccessful,
would adversely affect your firm’s financial position or the ability to meet your firm’s
obligations if awarded the contract for this project?
□ Yes □ No
(If Yes, explain on a separate signed page)
This document is not a public record.
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