Subcontractor / Vendor Qualification Questionnaire Subcontractor Pre-Qualification Questionnaire

The Walsh Group 929 West Adams Street, Chicago, Illinois 60607 Phone: 312.563.5400 Fax: 312.429.0651 Complete this form (adding attachments as needed) to provide a basis for evaluation of your firms qualifications.
1. General Information: Company Name: ___________________________________________________________________________ Contact Person: ___________________________________________ Title: ____________________________________________

Address: _____________________________________________________________________________________________________ City: __________________________________________________________ Telephone: _______________________________________________ Email Address: ____________________________________________ Type Of Business (check all that apply): [ ] Testing Agency [ ] Subcontractor [ [ ] Architecture ] Vendor/Supplier State: ____________ Zip: ___________________

Fax: ____________________________________________ Website: _________________________________________ [ ] Engineering [ ] Consulting [ ] GC/CM [ ] Other: ___________________________________

Type of Work Qualified to Self Perform: Check all that apply from the list of Codes and Descriptions provided. Primary NAICS Code: __________________ Year Business Started: _________________ Geographic Area(s) Can Work: ___________________________________________ State of Origin: _______ No. of Employees: ___________ Union (Y/N): _____

Contractors License State(s)/Number(s): State: _________ No.: ______________ State: __________ No.: ________________ Have you ever worked for The Walsh Group (Y/N)? _________ Project(s): ______________________________________________ 2. Business Classifications: Check ALL that apply (provide proof of certification*). Refer to definitions provided. 2a. Small Business Administration (SBA) Classifications: (refer to www.sba.gov/size for size standards) [ ] SB (if you did not check SB, then proceed to section 2b of this pre-qualification without checking the remaining options within section 2a) [ ] VOSB [ ] SD-VOSB [ ] WOSB [ ] HUBZoneSB* [ ] SDB [ ] SDB8(a)* 2b. Other Business Classifications: [ ] ANC [ ] TO (Tribally Owned) (ANC & TO auto qualify as SB & SDB, regardless of size. If you checked either ANC or
TO, verify you have also checked SB & SDB in section 2a above)

[ [

] DBE*

] MBE*

[ [

] WBE*

] VOB

] DVBE

] HBCU/MI

] NHO

] AbilityOne

] Other: ___________________ Proj Limit: $ ___________________ Aggregate Limit: $ __________________ Since: _________ A.M. Best Rating: _________

3. Bonding & Insurance: Bondable (Y/N): ______

Bonding Co.: ___________________________________________________

Surety Broker / Agent: ________________________________________________________ Insurance Co.: __________________________________________________

Phone: _________________________ A.M. Best Rating: _________

Since: _________

Insurance Broker / Agent: _____________________________________________________ 4. Safety: OSHA Incident Rate:

Phone: _________________________

Current: _______________ Prior Yr: _______________ 2 Yrs Prior: ________________

Workers Compensation EMR: Current: _______________ Prior Yr: _______________ 2 Yrs Prior: ________________ 5. Financial: D&B Number: _______________ 6. Companys Gov. Clearances: Smallest/Largest Proj. Comfortable Handling: $ /$ .

FCL - Facility Clearance (Y/N): _______

(Name)

PCL - Personal Clearances (Y/N - Qty):______ / ______ _____________________________________________

(E-Mail)

FSO - Facility Security Officer: _________________________________

7. Additional Info (Attach): (a) Owner / Client references for recently completed projects (Company, Contact Name, Phone, Fax, E-Mail) (b) Brief Capabilities Statement (optional, max 2 pages).
Undersigned certifies, under penalty of perjury, that the information contained herein is true and correct, and agrees to supplement this Pre-Qualification Questionnaire with additional information upon request: ___________________________________________________________________________________ (Print Name) ___________________________________________________________________________________ (Signature) _________________________________________________________________________ (Title) _________________________________________________________________________ (Date)

See Page 4 of 4 For Signature

Please e-mail your pre-qualification directly to (e-mail must be < 8MB):

Form: PRE-QUAL

sbdevelopment@walshgroup.com
Revision Date: August 1, 2011

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)

GCs/CMs: Only Select Items You Self-Perform With Own Employees.

Vendor Qualification Questionnaire Subcontractor / Pre-Qualification Questionnaire

01 GENERALCONDITIONS 0121 0123 MobileTrailers TempUtilities Gas/Propane RubbishBoxes PortableToilets 04 05 051 052 053 054 055 057 06 061 062 SafetyConsulting SafetyEquip/Supplies 064 065 066 067 068 07 071 072 073 074 075 MASONRY METALS StructuralMetalFraming MetalJoists MetalDecking ColdFormedMetalFraming MiscMetals DecorativeMetals WOODS,PLASTICS,COMPOSITES RoughCarpentry FinishCarpentry ArchWoodworkorCasework(FaborSales) StructuralPlastics(FaborSales) Plastics(FaborSales) StructuralComposites(FaborSales) Composites(FaborSales) THERMAL&MOISTUREPROTECTION Damproofing&Waterproofing ThermalProtection&WeatherBarriers SteepSlopeRoofing Roofing&SidingPanels MembraneRoofing 07.5100 07.5200 07.5300 07.5400 07.5500 07.5600 07.5700 07.5800 078 BuiltUpBituminousRoofing ModifiedBituminousMembraneRoofing ElastomericMembraneRoofing ThermoplasticMembraneRoofing ProtectedMembraneRoofing FluidAppliedRoofing CoatedFoamedRoofing RoolRoofing

01.2343 01.2356 01.2356 0133 0135

Cleaning/JanitorialServices SiteProtection Rodent/PestControl SecurityServices

01.3503 01.3509 0137 Safety

01.3700 01.3703 0139 0161

QAQCConsulting OfficeSupplies&Equip MessengerServices OfficeFurniture

01.6133 01.6136 0163 0164 0165

Printing/DocMgmtServices PhotographicServices Architectural/Engineering/ConsultingServices Surveying Scheduling Geotechnical Structural Testing Legal Architectural MEP Civil Specialty:

01.6513 01.6516 01.6519 01.6543 01.6549 01.6553 01.6559 01.6563 01.6566 01.65xx 0170 02

EquipmentRentals

Fire&SmokeProtection 07.8100 07.8400 07.8600 AppliedFireproofing Firestopping SmokeSeals

EXISTINGCONDITIONS 0241 026 Demolition

ContamSiteMtlRemoval(SpecialWasteorContamSoils) 0262 UndergroundStorageTankRemoval 079

JointProtection 07.9100 07.9200 07.9500 PreformedJointSeals JointSealants ExpansionControl

027 028 03 033

WaterRemediation(TreatmentorDecontamination) FacilityRemediation(Asbestos,Lead,Mold,etc.) CONCRETE CastInPlaceConcrete 03.3713 Shotcrete 08 081

OPENINGS Doors&Frames 08.1100 08.1400 083 MetalDoors&Frames WoodDoors

034

PrecastConcrete 0341 PrecastStructuralConcrete PrecastConcHollowCorePlank PrecastConcSlabs PrecastConcTee's PrecastConcStairs PrecastConcGirders

03.4113 03.4116 03.4119 03.4123 03.4140 0345 0347

SpecialtyDoors&Frames 08.3100 08.3200 08.3300 08.3400 08.3500 08.3600 08.3800 08.3900 AccessDoors&Panels SlidingGlassDoors CoilingDoors&Grilles SpecialtyFunctionDoors FoldingDoors&Grilles PanelDoors TrafficDoors PressureResistantDoors

PrecastArchitecturalConcrete SiteCastConcrete TiltUpConcrete LiftSlabConcrete

03.4713 03.4716 0353 038

ConcreteToppings

ConcreteCutting&Boring

Undersigned certifies, under penalty of perjury, that the information contained herein is true and correct, and agrees to suppliment this Pre-Qualification Questionnaire with additional information upon request:

(Print Name)

(Title)

See Page 4 of 4 For Signature

(Signature) (Date)

Please e-mail your pre-qualification directly to:

Form:CSIDiv

sbdevelopment@walshgroup.com
Page 1of of4 3 Page 2 RevisionDate:March08,2010

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)

GCs/CMs: Only Select Items You Self-Perform With Own Employees.

Subcontractor / Pre-Qualification Questionnaire Vendor Qualification Questionnaire

084 Entrances,Storefronts,&CurtainWalls 08.4100 08.4400 085 Windows 08.5100 08.5200 08.5400 08.5500 08.5600 086 087 088 089 09 092 MetalWindows WoodWindows CompositeWindows PressureResistantWindows SpecialFunctionWindows 103 104 Entrances&Storefronts CurtainWall&GlazedAssemblies 102 InteriorSpecialties 10.2113 10.2116 10.2123 10.2200 10.2500 10.2600 10.2800 ToiletCompartments Shower&DressingCompartments Cubicles Partitions ServiceWalls Wall&DoorProtection Toilet,Bath,&LaundryAccessories

Fireplaces&Stoves SafetySpecialties 10.2800 10.2800 10.2800 EmergencyAccess&InfoCabinets EmergencyAidSpecialties FireProtectionSpecialties

RoofWindows&Skylights Hardware Glazing Louvers&Vents FINISHES Plaster&GypsumBoardAssemblies 09.2113 09.2116 PlasterAssemblies GypsumBoardAssemblies

105

StorageSpecialties 10.5100 10.5500 10.5600 10.5700 Lockers PostalSpecialties StorageAssemblies Wardrobe&ClosetSpecialties

093 095

Tiling Ceilings 09.5100 09.5300 09.5400 09.5600 09.5700 AcousticalCeilings AcousticalCeilingSuspensionAssemblies SpecialtyCeilings TexturedCeilings SpecialtyFunctionCeilings 108 MasonryFlooring WoodFlooring ResilientFlooring TerrazzoFlooring FluidAppliedFlooring Carpeting AccessFlooring 11 107

ExteriorSpecialties 10.7100 10.7300 10.7400 ExteriorProtection(SunControlorStormPanels) ProtectiveCovers,Awnings,&Canopies ManufactExtSpecialties(ExtClocks,Cupolas,Spires, Steeples,Weathervanes,&WindowWells) 10.7500 Flagpoles

096

Flooring 09.6300 09.6400 09.6500 09.6600 09.6700 09.6800 09.6900

OtherSpecialties 10.8000 EQUIPMENT: 1112 1113 1116 1119 1123 1131 1133 1140 1152 1153 1161 1166 1168 1182 1190 ParkingControlEquipment LoadingDockEquipment VaultEquipment DetentionEquipment CommercialLaundry&DryCleaningEquipment ResidentialAppliances RetractableStairs FoodserviceEquipment AudioVisualEquipment LaboratoryEquipment Theater&StageEquipment AthleticEquipment PlayFieldEquip&Structures SolidWasteHandlingEquipment OtherEquip: Other:

097

WallFinishes 09.7200 09.7300 09.7400 09.7500 09.7600 09.7700 WallCoverings WallCarpeting FlexibleWoodSheets StoneFacing PlasticBlocks SpecialWallSurfacing

098

AcousticTreatment 09.8100 09.8300 09.8400 AcousticInsulation AcousticFinishes AcousticRoomComponents&Panels 12 122 123

FURNISHINGS WindowTreatments Casework&Countertops 12.3000 12.3600 12.3653 Casework Countertops LaboratoryCountertops

099 10 101

Painting&Coating SPECIALTIES InformationSpecialties 10.1100 10.1200 10.1300 10.1400 10.1700 10.1800 VisualDisplaySurfaces DisplayCases Directories Signage TelephoneSpecialties InformationKiosks

Undersigned certifies, under penalty of perjury, that the information contained herein is true and correct, and agrees to suppliment this Pre-Qualification Questionnaire with additional information upon request:

(Print Name)

(Title)

See Page 4 of 4 For Signature

(Signature) (Date)

Please e-mail your pre-qualification directly to:

Form:CSIDiv

sbdevelopment@walshgroup.com
Page3 2of of4 3 Page RevisionDate:March08,2010

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)

GCs/CMs: Only Select Items You Self-Perform With Own Employees.

Subcontractor / Pre-Qualification Questionnaire Vendor Qualification Questionnaire

124 Furnishings&Accessories 12.4633 12.4643 12.4813 12.4819 126 WasteReceptacles MonitorSupportSystems EntranceFloorMats&Frames EntranceFloorGrilles 32 ExteriorImprovements 32.1216 32.1313 32.1400 32.1613 32.1800 32.3100 32.3200 32.8400 32.9000 33 34 35 40 41 42 43 44 45 48 UTILITIES TRANSPORTATION WATERWAY&MARINECONTRUCTION PROCESSINTEGRATION MATERIALPROCESSING&HANDLINGEQUIPMENT PROCESSHEATING,COOLING,&DRYINGEQUIPMENT PROCESSGAS&LIQUIDHANDLING,PURIFICATION&STORAGEEQUIP POLLUTIONCONTROLEQUIPMENT INDUSTRYSPECIFICMANUFACTURINGEQUIPMENT ELECTRICALPOWERGENERATION AsphaltPaving ConcretePaving UnitPaving ConcreteCurbs&Gutters Athletic&RecreationalSurfacing Fences&Gates RetainingWalls LandscapeIrrigation Landscaping,Exterior

MultipleSeating 12.6100 12.6313 12.6613 12.6700 FixedAudienceSeating Stadium&ArenaBenchSeating TelescopingBleachers Pews&Benches

129

OtherFurnishings 12.9200 12.9300 InteriorPlanters&Plantings SiteFurnishings

13

SPECIALCONTRUCTION 1311 1312 1313 1318 1321 1327 1331 1332 1333 SwimmingPools Fountains Aquariums IceRinks ControlledEnvironmentRooms Vaults FabricStructures SpaceFrames GeodesicStructures

14 141 142 143 144 147 148 149

CONVEYINGSYSTEMS Dumbwaiters Elevators Escalators&MovingWalks Lifts Turntables Scaffolding OtherConveyingEquipment 1491 1492 FacilityChutes PneumaticTubeSystems

21 22 23 25 26 27 28 31

FIRESUPPRESSION PLUMBING HVAC INTEGRATEDAUTOMATION ELECTRICAL COMMUNICATION ELECTRONICSAFETY&SECURITY EARTHWORK 31.2319 31.2336 31.2513 31.3200 31.6200 31.6300 31.7300 Dewatering Trucking SiltFencing SoilStabilization DrivenPiles Bored/DrilledPiles&Caissons Tunneling

Undersigned certifies, under penalty of perjury, that the information contained herein is true and correct, and agrees to suppliment this Pre-Qualification Questionnaire with additional information upon request:

(Print Name)

(Title)

(Signature)

(Date)

Please e-mail your pre-qualification directly to:

Form:CSIDiv

sbdevelopment@walshgroup.com
Page4 3of of4 3 Page RevisionDate:March08,2010

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)

Subcontractor Pre-Qualification Subcontractor / Vendor QualificationQuestionnaire Questionnaire

Business Classifications: Descriptions and Definitions Business classifications indicated on the Subcontractor Pre-Qualification Questionnaire shall be based on the Primary NAICS Code indicated and the definitions herewith. For companies that use more than one NAICS code, the Primary NAICS code shall represent the scope of work most often provided. The definitions provided herewith are not guaranteed and shall not waive the certifying company's responsibility to review and understand the definitions pursuant to the Federal Acquisition Regulation (FAR) part 19.7 or 52.219-8 (www.arnet.gov/far). Where the below definitions conflict with those provided in the FAR, the FAR definition shall govern. If you have difficulty ascertaining your size status, refer to SBA's website at www.sba.gov/size or contact your local SBA office. Small Business Administration (SBA) Classifications: Refer to definitions provided on The Walsh Group Small Business Self-Certification Form for the following SBA classifications: SB, VOSB, SD-VOSB, WOSB, HUBZoneSB, SDB, and SDB8(a).

Other Business Classifications: ANC: "Alaskan Native Corporation". Refer to definition provided on The Walsh Group Small Business Self-Certification Form. TO: "Tribally Owned". Refer to definition provided on The Walsh Group Small Business SelfCertification Form. DBE: "Disadvantaged Business Enterprise" is a broader business classification, which generally includes MBE's, WBE's, and Small Businesses. Referenced mostly by transportation authorities, DBE certification is controlled by varying agencies across the United States and certification requirements may vary between agencies. MBE: "Minority Business Enterprise" is an independent business concern that is at least 51% owned and controlled by one or more socially and economically disadvantaged individuals who are U.S. citizens or Legal Resident Aliens, whose business formation and principal place of business are in the US or its territories, whereby the individual minority applicants have technical expertise and experience relating to specific products and services provided by the firm as well as the authority to make day-to-day and long term business decisions for the firm. MBE certification is controlled by varying agencies across the United States and certification requirements vary between agencies. To obtain MBE certification, most agencies dictate caps on personal net worth for each minority applicant as well as size standards for the business. WBE: "Women's Business Enterprise" is an independent business concern that is at least 51% owned and controlled by one or more women who are U.S. citizens or Legal Resident Aliens, whose business formation and principal place of business are in the US or its territories, where the individual women applicants have technical expertise and experience relating to specific products and services provided by the firm as well as the authority to make day-to-day and long term business decisions for the firm. WBE certification is controlled by varying agencies across the United States and certification requirements vary between agencies. Typically, there are no size standards.

Page1of2 RevisionDate:August01,2011

Form:CLASSDESC

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)

Subcontractor Pre-Qualification Subcontractor / Vendor QualificationQuestionnaire Questionnaire

VOB: "Veteran Owned Business" is similar to "Veteran Owned Small Business" (VOSB), except there is no size standard. DVBE: "Disabled Veteran Business Enterprise" (also referred to as SDVBE Service Disabled Veteran Business Enterprise) is similar to "Service-Disabled Veteran-Owned Small Business" (SDVOSB), except there is no size standard. A DVBE automatically qualifies as a VOB.

HBCU/MI: Means "Historically Black Colleges and Universities/Minority Institution". Refer to definition provided on The Walsh Group Small Business Self-Certification Form. NHO: "Native Hawaiian Organizations" means any community service organization serving Native Hawaiians in the State of Hawaii which is a not-for-profit organization chartered by the State of Hawaii, is controlled by Native Hawaiians, and whose business activities will principally benefit such Native Hawaiians. AbilityOne: Refer to definition provided on The Walsh Group Small Business Self-Certification Form.

Page2of2 RevisionDate:August01,2011

Form:CLASSDESC

VA261-13-R-1360 VA Bldg 24 Seismic Corrections, Fresno, CA (VA261-13-R-2411)