CUPCCAA

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CUPCCAA

PLEASE READ:
This application is for projects that total $60,000-$199,999. If you are not interested in smaller projects, please do not complete this application and proceed to the Prequalification Application when it becomes available.

Applications will be accepted for the current year up until 09/30. Applications shall expire each year on 12/31. Applications for the following year will be accepted starting 11/01.

It will be the contractor's responsibility to contact the District's Purchasing Department if any information within this application needs to be updated. Please do not submit a duplication application unless instructed to do so as it will be rejected.

Email *

Firm Name (as shown on contractor's license): *

Contact Person: *

Mailing Address: *

Phone Number: *

Email Address (for receiving prequalification inquiries): *

Email Address (for receiving leads): *

License Number: *

License Classification (select all those in which you would like to perform work with): *

A-General Engineering Contractor

B-General Building Contractor

C-2

C-4

C-5

C-6

C-7

C-8

C-9

C-10

C-11

C-12

C-13

C-15

C-16

C-17

C-20

C-21

C-23

C-27

C-28

C-29

C-31

C-32

C-33

C-34

C-35

C-36

C-38

C-39

C-42

C-43

C-45

C-46

C-47

C-50

C-51

C-53

C-54

C-55

C-57

C-60

C-61

C-22

HAZ

ASB

Required

Business Certifications (select all that apply): *

Minority Business

Disadvantaged Business

Disabled Veteran Business

Women Owned Business

Small Business

N/A

Required

Does Contractor have a liability insurance policy in accordance with minimum CA requirements? *

Yes

Does Contractor have 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

Has your firm or any of its owners or officers ever 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

Has any contractor’s license held by your firm, or its responsible managing employee (“RME”) or responsible managing officer (“RMO”) been suspended or revoked at any time in the last five years? *

Yes

What is your Contractor Registration Number given by the Department of Industrial Relations Public Works Contractor Online Application System? *

Send me a copy of my responses.

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