Consultant and Design Professional Business Information Form
Individuals or firms that wish to be considered for selection as consultants by the University of California, Berkeley to provide such services should submit this Consultant and Design Professional Business Information Form. The form will be accepted at any time and will be kept on file.

There is no need to file this form each year unless your firm’s information or status has changed.

If you have any questions about completing this form please email contractadmin-cp@berkeley.edu.
Email address *
General Information
Firm Name *
DBA
Primary Mailing Address, City, State and Zip (include 9 digit zip code if known) and Country *
Contact Person (Indicate Ms., Mr., etc.) *
Contact Person's Title *
Contact Person's EMail *
Contact Person's Telephone (Office) *
Contact Person's Telephone (Cell)
Firm's Fax
Firm's Website
Firm's Employer Tax Identification Number *
Firm's License Number
Firm's License Number Expiration Date
Firm Experience
Firm's Areas of Expertise (check all that apply) *
Required
PRIVACY NOTIFICATIONS
The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University of California to provide the following information to individuals who are asked to supply information about themselves:

Failure to provide all requested information may delay or prevent evaluation of your firm’s ability to do business with the University.

I hereby certify under penalty of perjury under the laws of the State of California that I have read this application and know the contents thereof, and that the business category and ethnicity indicated above reflect the true and correct status of the business in accordance with Federal Small Business Administration criteria and Federal Acquisition Regulations, FAR 19, pertaining to small, disadvantaged, woman-owned, and disabled veteran-owned business enterprises. I understand that falsely certifying the status of this business, obstructing, impeding, or otherwise inhibiting any University of California official who is attempting to verify the information on this form may result in suspension from participation in University of California business contracts for a period up to five years and the imposition of any civil penalties allowed by law. In addition, I understand that this business must notify the University of California in writing 30 days in advance of any changes in size, ownership, control, or operation which may affect this business’s continued eligibility as an SBE, DBE, WBE, DVBE, SDBE, SWBE or SDVBE.

By submitting this profile form electronically, your submission of this form will be considered as to represent your signature and you may be asked to sign a hard copy at a later date.

The University of California is an affirmative action/equal opportunity employer.
University policy is intended to be consistent with the provisions of applicable State and Federal law.
INSURANCE REQUIREMENTS FOR CONSULTANT FIRMS WORKING WITH THE UNIVERSITY OF CALIFORNIA
The companies affording policies must have a Best rating of A- or better and a financial classification of VIII or better, or a rating by Standard & Poor’s of AA or better, or a rating by Moody of AA or better.

TYPES OF INSURANCE
1) General Liability Insurance (Commercial Form): $1,000,000 coverage for each of the following: Each Occurrence, Products/Completed Operations Aggregate, Personal and Advertising Injury, and General Aggregate.
2) Business Automobile Liability Insurance: For owned, scheduled, nonowned, or hired automobiles, a combined single limit of no less than $1,000,000 per accident.
3) Worker’s Compensation: As required by the laws of the state in which Consultant will conduct the majority of its business for the University.
4) Professional Liability Insurance: Required for Consultants who will be preparing design or construction documents. Amount of coverage required is determined by size of project; major capital projects require minimum coverage of $1,000,000 per claim and $1,000,000 in the aggregate. Insurance policy must include Contractual Liability Coverage or endorsements to the policy for Contractual Liability Coverage.

ADDITIONAL REQUIREMENTS
1) Insurance company must complete University's Certificate of Insurance form. This form provides that Consultant's insurance shall be the primary insurance as respects to the University and that any insurance or self-insurance maintained by the University shall be in excess of and non-contributory with Consultant's insurance.
2) Coverage may not be cancelled without 10 days' advance written notice to University.
3) If insurance policies are cancelled for non-payment, University reserves the right to maintain policies in effect by continuing to make the policy payments; cost of so maintaining the policies will be assessed against Consultant.
4) The General Liability Insurance policy and the Business Automobile Liability Insurance policy must name The Regents of the University of California as an Additional Insured.
5) All insurance policies shall apply to the negligent acts or omissions of Consultant, its officers, agents, and employees, and to Consultant's legal responsibility for the negligent acts or omissions of its subconsultants and anyone directly or indirectly under the control, supervision, or employ of Consultant or subconsultants.
A copy of your responses will be emailed to the address you provided.
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