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Yuba Water Agency Prequalification Questionnaire

  1. PART 1 - Essential Requirements for Qualification

  2. Note: Contractor will be disqualified if any of the answers to questions 1 through 3 are "NO"

  3. Do you have a liability insurance policy with a policy limit of at least $2 million per occurrence and $5 million aggregate?

  4. Do you have a current workers compensation insurance policy as required by the State of California labor code or is the contractor legally self-insured pursuant to Labor Code 3700 et seq?

  5. Do you have a current DIR Registration Number as required by the Department of Internal Relations under SB854?

  6. Note: Contractor will be disqualified if any of the answers to questions 4 through 6 are "YES"

  7. Has your license been revoked at any time in the last five years?

  8. Has the Surety firm completed a contract on your behalf, or paid for the completion because your firm was default terminated by the owner within the last five years?

  9. At the time of submitting this prequalification form, is your firm ineligible to bid on or be awarded a public works contract, or perform as a sub-contractor on a public works contract, pursuant to either Labor Code Section 1777.1 (violation of public works labor laws) or Labor Code Section 1777.7 (violation of apprenticeship requirements)?

  10. *A contractor disqualified solely because of a "Yes" answer given to question 4, 5, or 6 may appeal the disqualification and provide and explanation of the relevant circumstances during the appeal procedure.

  11. PART 2 - Organization, History, Performance Compliance with Civil and Criminal Law

  12. Note: If answer to any of the following questions is "Yes", please explain on a separate signed sheet.

  13. Is your firm currently the debtor in a bankruptcy case?

  14. Has your firm been in a bankruptcy case at any time during the last five years?

  15. Has your license been suspended by the California State License Board or have any of your Responsible Managing Employees or Officers been suspended within the last five years?

  16. Has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either public or private owner within the last five years?

  17. In the last five years, has your firm, or any firm with which any of your company's owners, officers, or partners are or were 'affiliated with', been debarred, disqualified, removed, or otherwise prevented from bidding on, or competing at any government agency or public works project for any reason?

  18. *'Affiliated with' refers to another construction firm in which an owner, partner, or officer of your firm held an ownership interest in or similar position.

  19. In the last fiver years, has your firm been denied an award of a public works contract based on a finding by a public agency that your firm was NOT a responsible bidder?

  20. In the last five years, has any claim against your firm concerning your firm's work on a construction project been filed in court or arbitration?

  21. At any time during the last five 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?

  22. in the last five years, has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm?

  23. During the last five years, has your firm ever been denied bond coverage by a surety company, or has there been a period of time when your firm had no surety bond in place during a public construction project when one was required?

  24. 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 five years?

  25. * 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

  26. Has the federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past five years?

  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 five years?

  28. *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

  29. Has there been more than one occasion during the last five 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?

  30. *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

  31. During the last five years, has there been more than one occasion in which your firm has been penalized or required to pay back wages for failure to comply with the Federal Davis-Bacon prevailing wage requirements?

  32. At any time during the last five years, has your firm been found to violate any provision of California apprenticeship laws or regulations, or the laws pertaining to use of apprentices on public works?

  33. *You may omit reference to any incident that occurred prior to January 1, 1998, if the violation was by a subcontractor and your firm, as general contractor on a project, had no knowledge of the subcontractor’s violation at the time they occurred

  34. PART 3 - Completed Projects Information

  35. NOTE: Contractor shall provide information about five most recently completed public works projects within the last three years. Names and references must be current and verifiable. Use separate sheets that contain ALL of the following information or use this form to list all project information.

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  42. This field is not part of the form submission.