CUPCCAA Pre-Qualification Form
As a condition of bidding and in accordance with the provisions of section 22034 of the California Uniform Public Construction Cost Accounting Commission and Orinda Union School District Board Policy, prospective bidders on projects with an estimated cost of $175,000.00 or less are required to submit to the District a completed pre-qualification questionnaire. The Contractors pre-qualification is valid for one year. The District may, at any time, specifically request updated information and the Contractor must comply within 30 days or District may consider the qualified rating expired.
A Contractor may file a new questionnaire at any time to reflect any substantial changes to status and a newly qualified rating based upon updated information will be issued.
CONTRACTOR'S STATEMENT OF EXPERIENCE
The questionnaire is not public record and is not open to public inspection.
Name as it appears on license *
Your answer
Address *
Your answer
Phone Number *
Your answer
Fax Number *
Your answer
Email Address *
Your answer
Type of Firm *
License No. *
Your answer
License Classes *
Your answer
Tax I.D. No *
Your answer
Department of Industrial Relations registration # *
Your answer
Date Business Formed: *
MM
/
DD
/
YYYY
Date Incorporated *
MM
/
DD
/
YYYY
Have you ever been licensed under a different name or license number? *
Your answer
Has there been any recent change in control of the company? *
Your answer
Is the company or any of its owners connected with other companies or subsidiary, parent, holding or affiliate? *
If yes, explain.
Your answer
How many years in business under present name? *
Your answer
Corporate Officers-Partners-Proprietor-Owners-Key Personnel: Name, Years with Firm, Position, % of Ownership *
Your answer
Have officers or principals of firm ever had their Contractor's License suspended or revoked? *
If yes, please explain.
Your answer
What size projects do you feel your company can undertake: (Single job: $____________ ) *
Your answer
In what type of construction do you specialize? *
Your answer
How many years’ experience in construction work does your organization have? (A. As a general contractor B. As a subcontractor) *
Your answer
List categories of work that your organization normally performs with its own forces. *
Your answer
Name of present and prior sureties: List company, largest bond.*Company/ Representative/ Phone/ Largest Bond *
Your answer
Has your company ever been unable to obtain a bond or been denied a bond for a contract? *
If yes, explain.
Your answer
Have you been in litigation or arbitration on a question related to your performance on a contract during the past five years? *
If yes, explain.
Your answer
Do you have $1,000,000.00 or more of Comprehensive General Liability Insurance Coverage combined single limit for bodily injury and property damage per occurrence and aggregate, of $2,000,000.00? *
If no, explain.
Your answer
Has your company ever failed to complete a contract in the past five years? *
If yes, explain.
Your answer
Has this company, an affiliated company, or any owner ever declared bankruptcy or been in receivership? *
If yes, explain.
Your answer
Within the past 5 years, has any officer or principal of your organization ever been an officer or principal of another organization, when it failed to complete a construction contract? *
If yes, explain.
Your answer
What amount of Errors and Omissions Insurance, if any, does your firm carry? *
Your answer
List references for the three largest contracts completed in the past 5 years. (Name of Agency/ Contact Person/Phone Number/Project Description/ Contract Price/ Date Completed) *
Your answer
List any projects awarded to your firm by the Orinda Union School DistrictName of School/Project Title/ Contact Person/ Contract Price/ Year *
Your answer
List all other contracts pursuant to California Public Code awarded to your firm in the past 2 years. (Name of Agency/Project Title/Contact Person Contract Price / Year) *
Your answer
Has your company ever failed to complete an Orinda Union School District contract within the authorized contract time? *
If yes, explain.
Your answer
Are there any outstanding liens/stop notices for labor and /or material filed against your company on any contracts which have been done or are being done by your company? *
If yes, explain.
Your answer
Certification
Corporation: Questionnaires must list legal corporation name, followed by the name of state of incorporation and designation of the chairman of the board, president or any vice president, and then followed by second listed name secretary, assistant secretary, chief financial officer or assistant treasurer. Satisfactory evidence of the authority of each officer listed on behalf of a corporation shall be furnished on request.

Partnership: Questionnaires List full name of all partners and general contractors with authority to bind the partnership in such matters, followed by the name and designation of the listed authorized signers.
The person certifying below makes the following representations under penalty of perjury: The submitter of the foregoing answers, to this questionnaire know their contents and attests to, the answers are true of his or her own personal knowledge. I declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct. (Please type your name below) *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Orinda.k12.ca.us. Report Abuse