TORRES CONSTRUCTION CORPORATION PRE-QUALIFICATION QUESTIONNAIRE FOR SUBCONTRACTORS

I. GENERAL COMPANY INFORMATION
Firm Name	--select-- Corporation LLC Partnership Sole Prop. (as it appears on license)
Contact Person	Phone
Title	Website
Address	Fax
	E-mail
If Subcontractor is a sole proprietor or partnership
Owner(s) of Company
Type of Company  --select-- Subcontractor Supplier	Employee ID No.
Labor Affiliation --select-- Union Non-Union	Other
Design/Build Experience
YesNo
Is this company a Disadvantaged Business Enterprise?
YesNo	Type --select-- Minority Owned Woman Owned Hub Zone Veteran Owned Small Business Section 3 Other
Please list the agencies certifying you for each category and the expiration date of your certification.
Minority Type (If Minority):
Expiration
Expiration
Expiration

PART I.           ESSENTIAL REQUIREMENTS FOR QUALIFICATION
Subcontractor will be immediately disqualified if the answer to any of questions 1 through 3 is “No.” Subcontractor will be immediately disqualified if the answer to any of questions 4, 5, 6, or 7 is “Yes. ” If the answer to question 6 is “Yes,” and if debarment would be the sole reason for denial of pre-qualification, any pre-qualification issued will exclude the debarment period.
1. Subcontractor possesses a valid and current California Contractor’s license for the project or projects for which it intends to submit a bid.
YesNo
Please attach a copy of your California Contractor’s License.
2. Subcontractor has a commercial general liability insurance policy with a combined single limit of at least $1,000,000 per occurrence and $2,000,000 aggregate.
YesNo
Please attach a certificate from your insurance carrier certifying your commercial general liability insurance.
3. Subcontractor has current workers’ compensation insurance policy as required by the Labor Code with statutory limits.
YesNo
Please attach a certificate from your insurance carrier certifying your workers’ compensation insurance policy.
4. Has your contractor’s license been revoked at any time in the last five years?
YesNo
5. Has a surety firm completed a contract on your behalf, or paid for completion because your firm was default terminated by the project owner within the last five (5) years?
YesNo
6. At the time of submitting this pre-qualification form, is your firm eligible to bid on or be awarded a public works contract, or perform as a subcontractor on a public works contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7?
YesNo
If the answer is “Yes,” state the beginning and ending dates of the period of debarment:
Beginning Date	Ending Date
7. At any time during the last five years, has your firm or any of its owners or officers 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?
YesNo
8. Project is subject to Cal. Labor Code sections 1771, 1775, 1776, 1777.5, 1813, and 1815 requiring Subcontractor to pay prevailing wages to its employees, to employ apprentices, and to submit certified payroll records weekly. Has Subcontractor complied with these requirements on other projects?
YesNo
9. Subcontracting is not permitted unless approved in advance by Torres Construction Corporation. Does Subcontractor intend to perform the work solely with its own salaried and craft employees?
YesNo
If the answer is “No”, please submit a list of sub-subcontractors that Subcontractor proposes to use. Torres Construction Corporation will require current certificates at the time of award which reference the applicable project and where applicable Torres and Owner must be designated as beneficiaries or as additional insured as appropriate.

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: 1a. Date incorporated 1b. Under the laws of what state 1c. 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 per cent of the corporation’s stock. Name Position Years with Co. % Ownership 1d. Identify every construction firm that any person listed above has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. NOTE: For this question, “owner” and “partner” refer to ownership of ten per cent or more of the business, or 10 per cent or more of its stock, if the business is a corporation. Person’s Name Construction Firm Dates of Person’s Participation with Firm 1e. Is the firm a subsidiary, parent, holding company or affiliate of another construction firm? NOTE: Include information about other firms if one firm owns 50 per cent or more of another, or if an owner, partner, or officer of your firm holds a similar position in another firm. YesNo If “yes,” explain on a separate signed page.

For Firms That Are Partnerships 1a. Date of formation 1b. Under the laws of what state 1c. Provide all the following information for each partner who owns 10 per cent or more of the firm. Name Position Years with Co. % Ownership Social Security # 1d. Identify every construction company that any partner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. NOTE: For this question, “owner” and “partner” refer to ownership of ten per cent or more of the business, or ten per cent or more of its stock, if the business is a corporation. Person’s Name Construction Company Dates of Person’s Participation with Company

For Firms That Are Sole Proprietorships 1a. Date of commencement of business. 1b. Social security number of company owner. 1c. Identify every construction firm that the business owner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. NOTE: For this question, “owner” and “partner” refer to ownership of ten per cent or more of the business, or ten per cent or more of its stock, if the business is a corporation. Person’s Name Construction Company Dates of Person’s Participation with Company

For Firms That Intend to Make a Bid as Part of a Joint Venture 1a. Date of commencement of joint venture. 1b. 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: Person’s Name % Ownership of Joint Venture

B. History of the Business and Organizational Performance 1. Has there been any change in ownership of the firm during the last three years? YesNo   If “yes,” explain on a separate signed page. 2. State your firm’s gross revenues for each of the last three years: 3. Is your firm currently the debtor in a bankruptcy case?  YesNo If “yes,” please attach a copy of the bankruptcy petition, showing the case number, and the date on which the petition was filed. 4. Was your firm in bankruptcy at any time during the last 10 years? (This question refers only to a bankruptcy action that was not described in answer to question 7, above.)  YesNo If “yes,” please attach a copy of the bankruptcy petition, showing the case number and the date on which the petition was filed, and a copy of the Bankruptcy Court’s discharge order, or of any other document that ended the case, if no discharge order was issued.   Licenses 1. List all California construction license numbers, classifications and expiration dates of the California contractor licenses held by your firm 2. If any of your firm’s license(s) are held in the name of a corporation or partnership, list below the names of the qualifying individual(s) listed on the CSLB records who meet(s) the experience and examination requirements for each license. 3. Has your firm changed names or license number in the past five years? YesNo If “yes,” explain on a separate signed page, including the reason for the change. 4. Has any CSLB license held by your firm or its Responsible Managing Employee (RME) or Responsible Managing Officer (RMO) been suspended within the last five years?  YesNo If “yes,” please explain on a separate signed sheet.   Disputes 1. At any time in the last five years has your firm been assessed and paid liquidated damages after completion of a project under a construction contract with either a public or private owner? YesNo 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. 2. In the last five years has your firm, or any firm with which any of your company’s owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason? NOTE: “Associated with” refers to another construction firm in which an owner, partner or officer of your firm held a similar position, and which is listed in response to question 1c or 1d on this form.  YesNo 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 name of the person within your firm who was associated with that company, the year of the event, the owner of the project, the project and the basis for the action. 3. In the last five years has your firm been denied an award of a public works contract based on a finding by a public agency that your company was not a responsible bidder?  YesNo 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: The following two questions refer only to disputes between your firm and the owner of a project. You need not include information about disputes between your firm and a supplier, another contractor, or subcontractor. You need not include information about “pass-through” disputes in which the actual dispute is between a sub-contractor and a project owner. Also, you may omit reference to all disputes about amounts of less than $25,000. 4. In the past five years has any claim against your firm concerning your firm’s work on a construction project been filed in court or arbitration?  YesNo If “yes,” on separate signed sheets of paper identify the claim(s) by providing the project name, date of the claim, name of the claimant, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution). 5. In the past five years has your firm made any claim against a project owner concerning  work on a project or payment for a contract and filed that claim in court or arbitration? YesNo If “yes,” on separate signed sheets of paper identify the claim by providing the project name, date of the claim, name of the entity (or entities) against whom the claim was filed, a brief description of the nature of the claim, the court in which the case was filed and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution).

Criminal Matters and Related Civil Suits 1. Has your firm or any of its owners, officers or partners ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public agency or entity? YesNo If “yes,” explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the investigation and the grounds for the finding. 2. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? YesNo If “yes,” explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the conviction and the grounds for the conviction. 3. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? YesNo If “yes,” identify on a separate signed page the person or persons convicted, the court (the county if a state court, the district or location of the federal court), the year and the criminal conduct.

Bonding/Surety 1. Bonding capacity: Provide documentation from your surety identifying the following Name of bonding company/surety   Years associated with bonding company and  maximum amount of bonding capacity.   Name of surety agent, address and telephone number   2. List all other sureties (name and full address) that have written bonds for your firm during the last five years, including the dates during which each wrote the bonds       3. 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? YesNo If yes, provide details on a separate signed sheet indicating the date when your firm was denied coverage and the name of the company or companies which denied coverage; and the period during which you had no surety bond in place. 4. At any time during the past 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? YesNo If “yes,” explain on a separate signed page the amount of each such claim, the name and telephone number of the claimant, the date of the claim, the grounds for the claim, the present status of the claim, the date of resolution of such claim if resolved, the method by which such was resolved if resolved, the nature of the resolution and the amount, if any, at which the claim was resolved. 5. In the last five years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? YesNo If “yes,” explain on a separate signed page. Name the insurance carrier, the form of insurance and the year of the refusal. Banking Name & Branch   Since?    City, State, Zip Contact Person

C. Compliance with Occupational Safety and Health Laws and with Other Labor Legislation Safety 1. 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? NOTE: If you have filed an appeal of a citation, and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal, you need to include information about it. YesNo If “yes,” attached a separate signed page describing the citations, including information about the dates of the citations, the nature of the violation, the project on which the citation(s) was or were issued, the amount of penalty paid, if any. If the citation was appealed to the Occupational Safety and Health Appeals Board and a decision has been issued, state the case number and the date of the decision. 2. Has the federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past five years? NOTE: 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 to include information about the citation. YesNo   If “yes,” attach a separate signed page describing each citation. 3. Project requires that Subcontractor must have a safety program that complies with all local, state, and federal safety standards, and any safety standards established by Owner for the Project, including but not limited to the Cal/OSHA Construction Safety Standards. Does Subcontractor currently have such a safety program? YesNo Please submit a copy of Subcontractor’s safety program. 4. 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? NOTE: 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. YesNo If “yes,” attach a separate signed page describing each citation. 5. List your firm’s Experience Modification Rate (EMR) (California workers’ compensation insurance) for each of the past three premium years: NOTE: An Experience Modification Rate is issued to your firm annually by your workers’ compensation insurance carrier. Current year                                Anniversary Date                                        Previous year                           Year prior to previous year   If your EMR for any of these three years is or was 1.25 or higher you may, if you wish, attach a letter of explanation. 6. Within the last five years has there ever been a period when your firm had employees but was without workers’ compensation insurance or state-approved self-insurance? YesNo If “yes,” please explain the reason for the absence of workers’ compensation insurance on a separate signed page. If “No,” please provide a statement by your current workers’ compensation insurance carrier that verifies periods of workers’ compensation insurance coverage for the last five years. (If your firm has been in the construction business for less than five years, provide a statement by your workers’ compensation insurance carrier verifying continuous workers’ compensation insurance coverage for the period that your firm has been in the construction

Prevailing Wage and Apprenticeship Compliance Record 1. 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 or federal prevailing wage laws? 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. YesNo If “yes,” attach a separate signed page or pages, describing the nature of each violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid and the amount of back wages and penalties that you were required to pay. 2. During the last five years, has there been more than one occasion in which your own firm has been penalized or required to pay back wages for failure to comply with the federal or state Davis-Bacon prevailing wage requirements? YesNo   If “yes,” attach a separate signed page or pages describing the nature of the violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid, the amount of back wages you were required to pay along with the amount of any penalty paid. 3. Provide the name, address and telephone number of the apprenticeship program (approved by the California Apprenticeship Council) from whom you intend to request the dispatch of apprentices to your company for use on any public work project for which you are awarded a contract. 4. At any time during the last five years, has your firm been found to have violated any provision of California apprenticeship laws or regulations, or the laws pertaining to use of apprentices on public works? YesNo If “yes,” provide the date(s) of such findings, and attach copies of the Department of Industrial Relation’s final decision(s).

PART III. RECENT CONSTRUCTION PROJECTS COMPLETED 1. Subcontractor shall provide information about their six most recently completed public works projects and its three largest completed private projects within the last three years.Names and references must be current and verifiable. Use separate sheets of paper that contain all of the following information: Project Name Location Owner Owner Contact (name and current phone number) Architect or Engineer (name and current phone number) Architect or Engineer Contact Construction Manager (name and current phone number) Description of Project, Scope of Work Performed Total Value of Construction Original Scheduled Completion Date Time Extensions Granted (number of days) Actual Date of Completion * * * * * * * I, the undersigned, certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct. Dated Name Notarized  If you wish, you may, using the same format, also provide information about other projects that you have completed that are similar to the project(s) for which you expect to bid.