May This document is not a public record. Amador Water Agency

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1 Gravity Supply Line Project PRE-QUALIFICATION QUESTIONNAIRE May 2013 Amador Water Agency Ridge Road Sutter Creek, California Phone:(209) Fax:(209)

2 INVITATION TO PRE-QUALIFY FOR BID Sealed s will be received at the Amador Water Agency office, Ridge Road, Sutter Creek, California 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. s are available at the Amador Water Agency office, Ridge Road, Sutter Creek, California 95685, at or by phone at (209) 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 s. 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.

3 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

4 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 Entity Type: Corporation Partnership Joint Venture Sole Proprietorship Date 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? 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? 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? 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.? 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. 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)? *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

5 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? 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? 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? 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? 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? 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? 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

6 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: Name Position Years with Company %Ownership Taxpayer 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 - 5 -

7 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: Name Position Years with Company %Ownership Taxpayer 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 - 6 -

8 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. Name Position Years with Company %Ownership Taxpayer 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

9 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 - 8 -

10 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? (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? (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? (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? (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? (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? (If Yes, explain on a separate signed page) - 9 -

11 9. What is your firm s Dunn & Bradstreet Rating? 10. In the last five years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? (If Yes, explain on a separate signed page. Name the insurance carrier, the form of insurance and the year of the refusal.) Bonding 11. List your firm s surety s A.M. Best Rating: 12. What percentage rate does Bidder pay for bonds? 13. During the last five years, has your firm ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public construction project when one was required? (If Yes, provide details on a separate signed page indicating the date when your firm was denied coverage and the name of the company or companies that denied coverage; and the period during which you had no surety bond in place.) Licenses 14. List all California contractor license numbers, classifications and expiration dates held by your firm and its Persons: 15. If any of your firm s license(s) are held in the name of a corporation or partnership, list the names of the qualifying individual(s) listed on the CSLB records who meet(s) the experience and examination requirements for each license. 16. In the last five (5) years, has your firm changed names or license numbers? (If Yes, explain on a separate signed page, including the reason for the change.) 17. In the last five (5) years, has any Person in your firm operated a construction firm under any other name? (If Yes, list and explain on a separate signed page.) 18. In the last five (5) years, has any California State Licensing Board (CSLB) license held by your firm for its Responsible Managing Employee (RME) or Responsible Managing Officer (RMO) been suspended or revoked? (If Yes, explain on a separate signed page.)

12 Disputes 19. In the last five (5) years, has your firm been assessed and paid liquidated damages after completion of a project under construction contract with either a public or private owner because of a delay not contemplated during the bid process? (If Yes, explain on a separate signed page, identifying all such projects by owner, owner s address, the date of completion of the project, amount of liquidated damages assessed and all other information necessary to fully explain the assessment of liquidated damages.) 20. In the last five (5) years, has your firm, or any firm associated with your firm s Persons, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason? (If Yes, explain on a separate signed page. State whether the firm involved was the firm applying for pre-qualification here or another firm. Identify by name of the company, the Person in your firm who was associated with that company, the year of the event, the owner of the project and the basis for the action.) NOTE: Associated with refers to another construction firm in which a Person in your firm held a similar position, as listed in response to Section A in Part II of this form. 21. In the last five (5) 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? (If Yes, explain on a separate signed page. Identify the year of the event, the owner, the project and the basis for the finding by the public agency.) NOTE: Questions 22 and 23 refer only to disputes between your firm and the owner of a project. Do not include information about disputes between your firm and the supplier, another contractor, or subcontractor. Do not include information about pass-through disputes in which the actual dispute is between a sub-contractor and a project owner. 22. In the last five (5) years, have any complaints been filed in court against your firm concerning your firm s work on a construction project? (If Yes, on separate signed pages, identify the complaint(s) by providing the project name, date of the complaint, name of the plaintiff, a brief description of the nature of the complaint, the court in which the case was filed and a brief description of the status of the complaint pending or, if resolved, of the resolution.) 23. In the last five (5) years, has your firm filed a complaint in court against a project owner concerning work on a project or payment for a contract? (If Yes, on separate signed pages, identify the complaint(s) by providing the project name, date of the complaint, name of the entity (or entities) against whom the complaint was filed, a brief description of the nature of the complaint, the court in which the case was filed and a brief description of the status of the claim pending or, if resolved, of the resolution.)

13 24. In the last five (5) years, has any surety company made any payments, on your firm s behalf, to satisfy any claims made against a performance or payment bond issued in connection with a construction project, either public or private? (If Yes, explain on separate signed pages.) 25. Has your firm, or any Person, ever been found liable in a civil action for making any false claim or material misrepresentation to any public agency or entity? (If Yes, explain on separate signed pages.) C. Compliance with Safety, Workers Compensation, Prevailing Wage, Apprentice Laws and EEO. 26. In the last five (5) years, has CAL OSHA cited and assessed penalties against your firm for any serious, willful or repeated violations of its safety or health regulations? (If Yes, explain on separate signed pages describing each citation.) NOTE: If you have filed an appeal of a citation, and the Occupational Health Appeals Board has not yet ruled on the appeal, you must answer Yes to this question. 27. In the last five (5) years, has the Federal Occupational Safety and Health Administration cited and assessed penalties against your firm? (If Yes, explain on separate signed pages describing each citation.) 28. In the last five (5) years, has the EPA, any Air Quality Management District, or any Regional Water Quality Control Board cited and assessed penalties against your firm? (If Yes, explain on separate signed pages describing each citation.) 29. How often do you hold documented safety meetings for construction employees and field supervisors during the course of a project? 30. List your firm s Experience Modification Rate (EMR) - California workers compensation insurance - for each of the past three (3) premium years: Current year: Last year: Two years ago: 31. In the last five (5) years, was there any occasion(s) which your firm was required, by a compliance agency, to pay either back wages or penalties for your own firm s failure to comply with the state s prevailing wage laws? (If Yes, explain on separate signed pages.) NOTE: 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

14 32. In the last five (5) years, was there any occasion(s) which your firm was required, by a compliance agency, to pay either back wages or penalties for failure to comply with the Federal Davis-Bacon prevailing wage requirements? (If Yes, explain on separate signed pages.) 33. If your firm operates its own State-approved apprenticeship program: a. Identify the craft(s) which your firm provided apprenticeship training in the past year. b. State the year in which each apprenticeship program was approved, and attach evidence of the most recent California Apprenticeship Council approval(s) of your apprenticeship program(s). c. State the number of individuals who were employed by your firm as apprentices at any time during the past three (3) years in each apprenticeship, and the number of persons who, during the past three (3) years, completed apprenticeships in each craft(s) while employed by your firm. 34. Provide the name, address and telephone number of the apprenticeship program sponsor(s) approved by the California Division of Apprenticeship Standards that will provide apprentices to your company for use on any public works project if you are awarded a prevailing wage contract by the Amador Water Agency. 35. In the last five (5) years, was your firm found in violation of any provision of California apprenticeship laws or regulations, or the laws pertaining to the use of apprentices on public works? (If Yes, provide the date(s) of such findings, and attach copies of the final decision(s).) Non-Discrimination 36. List all instances within the past ten (10) years where a finding of discrimination was made against your firm or any of its Persons in a legal or administrative proceeding alleging that the firm discriminated against its employees, subcontractors, vendors, or suppliers, and a description of the status or resolution of that complaint, including remedial action taken

15 PART III: RECENT CONSTRUCTION PROJECTS COMPLETED 37. Using the form provided, please provide the following information for: a. The two (2) largest public work projects completed within the last five years; and, b. The five (5) largest projects, not including the two listed above, completed within the last five years. Names, references and phone numbers must be current and verifiable. References will be contacted and interviewed. If the Agency is not able to contact a reference at the given phone number, that reference will not be used or considered in the evaluation. Project Name Location Owner Owner Contact (name and phone number) Architect or Engineer Architect or Engineer Contact (name and phone number) Construction Manager (name and phone number) Description of Project, Scope of Work Performed Performed Work as Prime Contractor or Sub Contractor Total Value of Construction (including change orders) Original Scheduled Completion Date Actual Completion Date Time Extension Granted (number of days) * * * * * * * * I, the undersigned, certify and declare that I have read the pre-qualification questionnaire and all its contents. I further declare, under penalty of perjury, that I have answered, or caused to be answered, all questions, based on my knowledge and belief, and that they are true and correct. I further acknowledge and accept that any misstatements, misrepresentations or falsehoods shall result in an automatic and immediate disqualification. Name and Title Date If this form is completed by someone other than the above signer, please print name and title here: Name Title

16 Firm Name RECENT CONSTRUCTION PROJECTS COMPLETED Names, references and phone numbers must be current and verifiable References will be contacted and interviewed (If the Agency is not able to contact a reference at the given phone number, that reference will not be used or considered in the evaluation.) Copy this sheet as necessary and provide the following information regarding: a. The two (2) largest public work projects completed within the last five years; and, b. The five (5) largest projects, not including the two listed above, completed within the last five years. Project Name: Location: Owner: Contact: Architect/Engineer: Contact: Construction Manager: Description of Project, Scope of Work Performed: Phone: Phone: Phone: Performed Work as: Prime Contractor Sub Contractor Total Value of Construction (including change orders):* Original Scheduled Actual Date Completion Date: Of Completion: Extension Time Granted (number of Days): *Verifiable dollar amounts will be used as part of the bidding capacity calculation. Note: Amador Water Agency reserves the right to check all other sources available

17 PART IV: CONTRACTOR DISQUALIFICATION APPEAL PROCEDURE 1. Within forty-five calendar days after receipt of prequalification questionnaires, the Agency shall determine if prospective bidders possess the minimum qualifications necessary to submit bids on the Agency s competitively bid public works construction contract. If the minimum qualifications are not met, the prospective bidder shall not be considered a responsible bidder for purposes of bidding on the subject contract. The prospective bidder will be notified in writing of that decision. The Agency shall provide the basis for the prospective bidder s disqualification and any supporting evidence that has been received from others or obtained through an investigation conducted by the Agency. 2. Once notified, a disqualified prospective bidder may appeal the Agency s proposed disqualification. The Agency will provide the following two-tier appeal process: a. The disqualified prospective bidder ( Appellant ) must file a written protest in writing by 3:30 p.m. on the seventh calendar day following certified mailing of the notification that the Appellant has been determined to be non-responsible. The protest must be submitted to the Agency s Administrative Office, Attention: General Manager, Ridge Road, Sutter Creek, California In the protest, the Appellant shall rebut any evidence used as a basis for disqualification and present evidence to the Agency concerning why the Appellant should be qualified. b. The Agency s General Manager will review and investigate the written protest and will issue a written decision to the Appellant within three calendar days of receipt. If the original decision is upheld, the General Manager will provide the basis for the Appellant s disqualification. c. If the Appellant is dissatisfied with the General Manager s decision, then the Appellant may file an appeal to the Agency Board of Directors. The Appellant must file a written request for a hearing with the Board of Directors within four calendar days of certified mailing of the General Manager s written decision

18 d. A Special Meeting of the Agency s Board of Directors shall be scheduled within fourteen calendar days of receiving the Appellant s request for a hearing. At that meeting, the Appellant will be provided an opportunity to present any and all evidence that should be considered in the Board s decision-making process. Following the hearing, the Board of Directors will consider the evidence and determine whether the Appellant is to be considered responsible or non-responsible for the purposes of bidding on the contract. All decisions made by the Agency Board of Directors are final. e. If the Appellant does not appeal its disqualification, the Agency s proposed disqualification rating will be adopted without further proceedings. All disqualifications shall remain confidential, unless appealed before the Board of Directors whose review and determination shall be at a publicly noticed meeting. 3. An Appellant s failure to comply with these appeal procedures shall constitute a waiver of its right to appeal the Agency s prequalification decision, including filing a Government Code claim or legal proceedings challenging a disqualification