19BK8024Q0002_SF-330.docx

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Architect/Engineer Inspection Services - Request for Qualifications
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19BK8024Q0002
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This document contains a Standard Form 330 for Architect-Engineer Qualifications. It requests qualifications from firms interested in providing architect-engineer inspection services under solicitation number 19BK8024Q0002 for the Department of State. Firms must complete all sections of the SF 330, including contract-specific qualifications in Part I such as key personnel resumes and example projects, as well as general qualifications in Part II including the firm's size, experience, and average revenue. Qualifications are due by the response date specified in the solicitation. The winning firm will be selected based on demonstrated competence and professional qualifications as required by the Brooks Act and negotiated at a fair and reasonable price.

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ARCHITECT-ENGINEER QUALIFICATIONSOMB No.:9000-0157
Expires:06/30/2007

Public reporting burden for this collection of information is estimated to average a total of 29 hours per response (25 hours for Part 1 and 4 hours for Part 2), including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (MVA), Regulatory and Federal Assistance Publications Division, GSA, Washington, DC 20405.

Federal agencies use this form to obtain information from architect-engineer (A-E) firms about their professional qualifications. Federal agencies select firms for A-E contracts on the basis of professional qualifications as required by the Brooks A-E Act (40 U.S.C. 1101 - 1104) and Part 36 of the Federal Acquisition Regulation (FAR).

The Brooks A-E Act requires the public announcement of requirements for A-E services (with some exceptions provided by other statutes), and the selection of at least three of the most highly qualified firms based on demonstrated competence and professional qualifications according to specific criteria published in the announcement. The Act then requires the negotiation of a contract at a fair and reasonable price starting first with the most highly qualified firm.

The information used to evaluate firms is from this form and other sources, including performance evaluations, any additional data requested by the agency, and interviews with the most highly qualified firms and their references.

GENERAL INSTRUCTIONS

Part I presents the qualifications for a specific contract.

Part II presents the general qualifications of a firm or a specific branch office of a firm. Part II has two uses:

1. An A-E firm may submit Part II to the appropriate central, regional or local office of each Federal agency to be kept on file. A public announcement is not required for certain contracts, and agencies may use Part II as a basis for selecting at least three of the most highly qualified firms for discussions prior to requesting submission of Part I. Firms are encouraged to update Part II on file with agency offices, as appropriate, according to FAR Part 36. If a firm has branch offices, submit a separate Part II for each branch office seeking work.

2. Prepare a separate Part II for each firm that will be part of the team proposed for a specific contract and submitted with Part I. If a firm has branch offices, submit a separate Part II for each branch office that has a key role on the team.

INDIVIDUAL AGENCY INSTRUCTIONS

Individual agencies may supplement these instructions. For example, they may limit the number of projects or number of pages submitted in Part I in response to a public announcement for a particular project. Carefully comply with any agency instructions when preparing and submitting this form. Be as concise as possible and provide only the information requested by the agency.

DEFINITIONS

Architect-Engineer Services: Defined in FAR 2.101.

Branch Office: A geographically distinct place of business or subsidiary office of a firm that has a key role on the team.

Discipline: Primary technical capabilities of key personnel, as evidenced by academic degree, professional registration, certification, and/or extensive experience.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 330 (6/2004) PAGE 1 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

Firm: Defined in FAR 36.102.

Key Personnel: Individuals who will have major contract responsibilities and/or provide unusual or unique expertise.

SPECIFIC INSTRUCTIONS

Part I - Contract-Specific Qualifications

Section A. Contract Information.

1. Title and Location. Enter the title and location of the contract for which this form is being submitted, exactly as shown in the public announcement or agency request.

2. Public Notice Date. Enter the posted date of the agency's notice on the Federal Business Opportunity website (FedBizOpps), other form of public announcement or agency request for this contract.

3. Solicitation or Project Number. Enter the agency's solicitation number and/or project number, if applicable, exactly as shown in the public announcement or agency request for this contract.

Section B. Architect-Engineer Point of Contact

4-8. Name, Title, Name of Firm, Telephone Number, Fax (Facsimile) Number and E-mail (Electronic Mail) Address. Provide information for a representative of the prime contractor or joint venture that the agency can contact for additional information.

Section C. Proposed Team.

9-11. Firm Name, Address, and Role in This Contract. Provide the contractual relationship, name, full mailing address, and a brief description of the role of each firm that will be involved in performance of this contract. List the prime contractor or joint venture partners first. If a firm has branch offices, indicate each individual branch office that will have a key role on the team. The named subcontractors and outside associates or consultants must be used, and any change must be approved by the contracting officer. (See FAR Part 52 Clause "Subcontractors and Outside Associates and Consultants (Architect-Engineer Services)".) Attach an additional sheet in the same format as Section C if needed.

Section D. Organizational Chart of Proposed Team.

As an attachment after Section C, present an organizational chart of the proposed team showing the names and roles of all key personnel listed in Section E and the firm they are associated with as listed in Section C.

Section E. Resumes of Key Personnel Proposed for This Contract.

Complete this section for each key person who will participate in this contract. Group by firm, with personnel of the prime contractor or joint venture partner firms first. The following blocks must be completed for each resume:

12. Name. Self-explanatory.

13. Role in This Contract. Self-explanatory.

14. Years Experience. Total years of relevant experience (block 14a), and years of relevant experience with current firm, but not necessarily the same branch office (block 14b).

15. Firm Name and Location. Name, city and state of the firm where the person currently works, which must correspond with one of the firms (or branch office of a firm, if appropriate) listed in Section C.

STANDARD FORM 330 (6/2004) PAGE 2 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

16. Education. Provide information on the highest relevant academic degree(s) received. Indicate the area(s) of specialization for each degree.

17. Current Professional Registration. Provide information on current relevant professional registration(s) in a State or possession of the United States, Puerto Rico, or the District of Columbia according to FAR Part 36.

18. Other Professional Qualifications. Provide information on any other professional qualifications relating to this contract, such as education, professional registration, publications, organizational memberships, certifications, training, awards, and foreign language capabilities.

19. Relevant Projects. Provide information on up to five projects in which the person had a significant role that demonstrates the person's capability relevant to her/his proposed role in this contract. These projects do not necessarily have to be any of the projects presented in Section F for the project team if the person was not involved in any of those projects or the person worked on other projects that were more relevant than the team projects in Section F. Use the check box provided to indicate if the project was performed with any office of the current firm. If any of the professional services or construction projects are not complete, leave Year Completed blank and indicate the status in Brief Description and Specific Role (block (3)).

Section F. Example Projects Which Best Illustrate Proposed Team's Qualifications for This Contract.

Select projects where multiple team members worked together, if possible, that demonstrate the team's capability to perform work similar to that required for this contract. Complete one Section F for each project. Present ten projects, unless otherwise specified by the agency. Complete the following blocks for each project:

20. Example Project Key Number. Start with "1" for the first project and number consecutively.

21. Title and Location. Title and location of project or contract. For an indefinite delivery contract, the location is the geographic scope of the contract.

22. Year Completed. Enter the year completed of the professional services (such as planning, engineering study, design, or surveying), and/or the year completed of construction, if applicable. If any of the professional services or the construction projects are not complete, leave Year Completed blank and indicate the status in Brief Description of Project and Relevance to This Contract (block 24).

23a. Project Owner. Project owner or user, such as a government agency or installation, an institution, a corporation or private individual.

23b. Point of Contact Name. Provide name of a person associated with the project owner or the organization which contracted for the professional services, who is very familiar with the project and the firm's (or firms') performance.

23c. Point of Contract Telephone Number. Self-explanatory.

24. Brief Description of Project and Relevance to This Contract. Indicate scope, size, cost, principal elements and special features of the project. Discuss the relevance of the example project to this contract. Enter any other information requested by the agency for each example project.

25. Firms from Section C Involved with This Project. Indicate which firms (or branch offices, if appropriate) on the project team were involved in the example project, and their roles. List in the same order as Section C.

Section G. Key Personnel Participation in Example Projects.

This matrix is intended to graphically depict which key personnel identified in Section E worked on the example projects listed in Section F. Complete the following blocks (see example below).

STANDARD FORM 330 (6/2004) PAGE 3 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

26. and 27. Names of Key Personnel and Role in This Contract. List the names of the key personnel and their proposed roles in this contract in the same order as they appear in Section E.

28. Example Projects Listed in Section F. In the column under each project key number (see block 29) and for each key person, place an "X" under the project key number for participation in the same or similar role.

29. Example Projects Key. List the key numbers and titles of the example projects in the same order as they appear in Section F.

Section H. Additional Information.

30. Use this section to provide additional information specifically requested by the agency or to address selection criteria that are not covered by the information provided in Sections A-G.

Section I. Authorized Representative

31. and 32. Signature of Authorized Representative and Date. An authorized representative of a joint venture or the prime contractor must sign and date the completed form. Signing attests that the information provided is current and factual, and that all firms on the proposed team agree to work on the project. Joint ventures selected for negotiations must make available a statement of participation by a principal of each member of the joint venture.

33. Name and Title. Self-explanatory.

SAMPLE ENTRIES FOR SECTION G (MATRIX)

26. NAMES OF KEY27. ROLE IN THIS28. EXAMPLE PROJECTS LISTED IN SECTION F
PERSONNELCONTRACTFill in "Example Projects Key" section below
(From Section E,(From Section E,before completing table. Place "X" under project
Block 12)Block 13)key number for participation in same or similar role.
________________________________________________
12 3 45 67 8 910
Jane A. Smith
Chief Architect
X

X

Joseph B. Williams
Chief Mech. Engineer
X
X
X
X
Tara C. Donovan
Chief Elec. Engineer
X
X

X

29. EXAMPLE PROJECTS KEY

NO.
TITLE OF EXAMPLE PROJECT

(FROM SECTION F)

NO.
TITLE OF EXAMPLE PROJECT

(FROM SECTION F)

1
Federal Courthouse, Denver, CO
6
XYZ Corporation Headquarters, Boston, MA
2
Justin J. Wilson Federal Building, Baton Rouge, LA
7
Founder's Museum, Newport, RI

STANDARD FORM 330 (6/2004) PAGE 4 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

Part II - General Qualifications

See the "General Instructions" on page 1 for firms with branch offices. Prepare Part II for the specific branch office seeking work if the firm has branch offices.

1. Solicitation Number. If Part II is submitted for a specific contract, insert the agency's solicitation number and/or project number, if applicable, exactly as shown in the public announcement or agency request.

2a-2e. Firm (or Branch Office) Name and Address. Self-explanatory.

3. Year Established. Enter the year the firm (or branch office, if appropriate) was established under the current name.

4. DUNS Number. Insert the Data Universal Numbering System number issued by Dun and Bradstreet Information Services. Firms must have a DUNS number. See FAR Part 4.6.

5. Ownership.

a. Type. Enter the type of ownership or legal structure of the firm (sole proprietor, partnership, corporation, joint venture, etc.).

b. Small Business Status. Refer to the North American Industry Classification System (NAICS) code in the public announcement, and indicate if the firm is a small business according to the current size standard for that NAICS code (for example, Engineering Services (part of NAICS 541330), Architectural Services (NAICS 541310), Surveying and Mapping Services (NAICS 541370)). The small business categories and the internet website for the NAICS codes appear in FAR Part 19. Contact the requesting agency for any questions. Contact your local U.S. Small Business Administration office for any questions regarding Business Status.

6a-6c. Point of Contact. Provide this information for a representative of the firm that the agency can contact for additional information. The representative must be empowered to speak on contractual and policy matters.

7. Name of Firm. Enter the name of the firm if Part II is prepared for a branch office.

8a-8c. Former Firm Names. Indicate any other previous names for the firm (or branch office) during the last six years. Insert the year that this corporate name change was effective and the associated DUNS Number. This information is used to review past performance on Federal contracts.

9. Employees by Discipline. Use the relevant disciplines and associated function codes shown at the end of these instructions and list in the same numerical order. After the listed disciplines, write in any additional disciplines and leave the function code blank. List no more than 20 disciplines. Group remaining employees under "Other Employees" in column b. Each person can be counted only once according to his/her primary function. If Part II is prepared for a firm (including all branch offices), enter the number of employees by disciplines in column c(1). If Part II is prepared for a branch office, enter the number of employees by discipline in column c(2) and for the firm in column c(1).

10. Profile of Firm's Experience and Annual Average Revenue for Last 5 Years. Complete this block for the firm or branch office for which this Part II is prepared. Enter the experience categories which most accurately reflect the firm's technical capabilities and project experience. Use the relevant experience categories and associated profile codes shown at the end of these instructions, and list in the same numerical order. After the listed experience categories, write in any unlisted relevant project experience categories and leave the profile codes blank. For each type of experience, enter the appropriate revenue index number to reflect the professional services revenues received annually (averaged over the last 5 years) by the firm or branch office for performing that type of work. A particular project may be identified with one experience category or it may be broken into components, as best reflects the capabilities and types of work performed by the firm. However, do not double count the revenues received on a particular project.

11. Annual Average Professional Services Revenues of Firm for Last 3 Years. Complete this block for the firm or branch office for which this Part II is prepared. Enter the appropriate revenue index numbers to reflect the professional services revenues received annually (averaged over the last 3 years) by the firm or branch office. Indicate Federal work (performed directly for the Federal Government, either as the prime contractor or subcontractor), non-Federal work (all other domestic and foreign work, including Federally-assisted projects), and the total. If the firm has been in existence for less than 3 years, see the definition for "Annual Receipts" under FAR 19.101.

12. Authorized Representative. An authorized representative of the firm or branch office must sign and date the completed form. Signing attests that the information provided is current and factual. Provide the name and title of the authorized representative who signed the form.

STANDARD FORM 330 (6/2004) PAGE 5 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

List of Disciplines (Function Codes) Code Description Code Description

01Acoustical Engineer32Hydraulic Engineer
02Administrative33Hydrographic Surveyor
03Aerial Photographer34Hydrologist
04Aeronautical Engineer35Industrial Engineer
05Archeologist36Industrial Hygienist
06Architect37Interior Designer
07Biologist38Land Surveyor
08CADD Technician39Landscape Architect
09Cartographer40Materials Engineer
10Chemical Engineer41Materials Handling Engineer
11Chemist42Mechanical Engineer
12Civil Engineer43Mining Engineer
13Communications Engineer44Oceanographer
14Computer Programmer45Photo Interpreter
15Construction Inspector46Photogrammetrist
16Construction Manager47Planner: Urban/Regional
17Corrosion Engineer48Project Manager
18Cost Engineer/Estimator49Remote Sensing Specialist
19Ecologist50Risk Assessor
20Economist51Safety/Occupational Health Engineer
21Electrical Engineer52Sanitary Engineer
22Electronics Engineer53Scheduler
23Environmental Engineer54Security Specialist
24Environmental Scientist55Soils Engineer
25Fire Protection Engineer56Specifications Writer
26Forensic Engineer57Structural Engineer
27Foundation/Geotechnical Engineer58Technician/Analyst
28Geodetic Surveyor59Toxicologist
29Geographic Information System Specialist60Transportation Engineer
30Geologist61Value Engineer
31Health Facility Planner62Water Resources Engineer

STANDARD FORM 330 (6/2004) PAGE 6 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

List of Experience Categories (Profile Codes) Code Description Code Description

A01Acoustics, Noise AbatementD01Dams (Concrete; Arch)
A02Aerial Photography; Airborne Data and ImageryD02Dams (Earth; Rock); Dikes; Levees
Collection and AnalysisD03Desalinization (Process and Facilities)
A03Agricultural Development; Grain Storage;D04Design-Build - Preparation of Requests for
Farm MechanizationProposals
A04Air Pollution ControlD05Digital Elevation and Terrain Model Develop-
A05Airports; Navaids; Airport Lighting;ment
Aircraft FuelingD06Digital Orthophotography
A06Airports; Terminals and Hangars; FreightD07Dining Halls; Clubs; Restaurants
HandlingD08Dredging Studies and Design
A07Arctic Facilities
A08Animal FacilitiesE01Ecological and Archeological
A09Anti-Terrorism/Force ProtectionInvestigations
A10Asbestos AbatementE02Educational Facilities; Classrooms
A11Auditoriums and TheatersE03Electrical Studies and Design
A12Automation; Controls; InstrumentationE04Electronics
E05Elevators; Escalators; People-Movers
B01Barracks; DormitoriesE06Embassies and Chanceries
B02BridgesE07Energy Conservation; New Energy
Sources
C01CartographyE08Engineering Economics
C02Cemeteries (Planning and Relocation)E09Environmental Impact Studies,
C03Charting; Nautical and AeronauticalAssessments or Statements
C04Chemical Processing and StorageE10Environmental and natural Resource
C05Child Care/Development FacilitiesMapping
C06Churches; ChapelsE11Environmental Planning
C07Coastal EngineeringE12Environmental Remediation
C08Codes; Standards; OrdinancesE13Environmental Testing and Analysis
C09Cold Storage; Refrigeration and
Fast FreezeF01Fallout Shelters; Blast-Resistant Design
C10Commercial Building (Low Rise);F02Field Houses; Gyms; Stadiums
Shopping CentersF03Fire Protection
C11Community FacilitiesF04Fisheries; Fish Ladders
C12Communications Systems; TV; MicrowaveF05Forensic Engineering
C13Computer Facilities; Computer ServiceF06Forestry and Forest Products
C14Conservation and Resource
ManagementG01Garages; Vehicles Maintenance Facilities;
C15Construction ManagementParking Decks
C16Construction SurveyingG02Gas Systems (Propane; Natural, Etc.)
C17Corrosion Control; Cathodic ProtectionG03Geodetic Surveying: Ground and Air-
Electrolysisborne
C18Cost Estimating; Cost Engineering andG04Geographic Information System
Analysis; Parametric Costing;Services: Development,
ForecastingAnalysis, and Data Collection
C19Cryogenic Facilities

STANDARD FORM 330 (6/2004) PAGE 7 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

Code Description Code Description

G05Geospatial Data Conversion: Scanning,M08Modular systems Design;
Digitizing, Compilation,Pre-Fabricated Structures or
Attributing, Scribing, DraftingComponents
G06Graphic Design
N01Naval Architecture; Off-Shore
H01Harbors; Jetties; Piers, ShipPlatforms
Terminal FacilitiesN02Navigation Structures; Locks
H02Hazardous Materials Handling andN03Nuclear Facilities; Nuclear Shielding
Storage
H03Hazardous, Toxic, RadioactiveO01Office Buildings; Industrial Parks
Waste RemediationO02Oceanographic Engineering
H04Heating; Ventilating; AirO03Ordnance; Munitions; Special
ConditioningWeapons
H05Health Systems Planning
H06High-rise; Air-Rights-Type BuildingsP01Petroleum Exploration; Refining
H07Highways; Streets; Airfield Paving;P02Petroleum and Fuel (Storage and
Parking LotsDistribution)
H08Historical PreservationP03Photogrammetry
H09Hospital and Medical FacilitiesP04Pipelines (Cross-Country - Liquid and
H10Hotels; MotelsGas)
H11Housing (Residential, Multi-Family;P05Planning (Community, Regional,
Apartments; Condominiums)Areawide and State)
H12Hydraulics and PneumaticsP06Planning (Site, Installation and Project)
H13Hydrographic SurveyingP07Plumbing and Piping Design
P08Prisons and Correctional Facilities
I01Industrial Buildings; ManufacturingP09Product, Machine Equipment Design
PlantsP10Pneumatic Structures, Air-Support
I02Industrial Processes; QualityBuildings
ControlP11Postal Facilities
I03Industrial Waste TreatmentP12Power Generation, Transmission,
I04Intelligent Transportation SystemsDistribution
I05Interior Design; Space PlanningP13Public Safety Facilities
I06Irrigation; Drainage
R01Radar; Sonar; Radio and Radar
J01Judicial and Courtroom FacilitiesTelescopes
R02Radio Frequency Systems and
L01Laboratories; Medical ResearchShieldings
FacilitiesR03Railroad; Rapid Transit
L02Land SurveyingR04Recreation Facilities (Parks,
L03Landscape ArchitectureMarinas, Etc.)
L04Libraries; Museums; GalleriesR05Refrigeration Plants/Systems
L05Lighting (Interior; Display; Theater,R06Rehabilitation (Buildings; Structures;
Etc.)Facilities
L06Lighting (Exteriors; Streets;R07Remote Sensing
Memorials; Athletic Fields, Etc.)R08Research Facilities
R09Resources Recovery; Recycling
M01Mapping Location/Addressing SystemsR10Risk Analysis
M02Materials Handling Systems;R11Rivers; Canals; Waterways; Flood
Conveyors; SortersControl
M03MetallurgyR12Roofing
M04Microclimatology; Tropical
EngineeringS01Safety Engineering; Accident
M05Military Design StandardsStudies; OSHA Studies
M06Mining and MineralogyS02Security Systems; Intruder and Smoke
M07Missile Facilities (Silos; Fuels;Detection
Transport)S03Seismic Designs and Studies

STANDARD FORM 330 (6/2004) PAGE 8 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

Code Description

S04Sewage Collection, Treatment and
Disposal
S05Soils and Geologic Studies;
Foundations
S06Solar Energy Utilization
S07Solid Wastes; Incineration; Landfill
S08Special Environments; Clean Rooms,
Etc.
S09Structural Design; Special
Structures
S10Surveying; Platting; Mapping; Flood
Plain Studies
S11Sustainable Design
S12Swimming Pools
S13Storm Water Handling and Facilities
T01Telephone Systems (Rural; Mobile;
Intercom, Etc.)
T02Testing and Inspection Services
T03Traffic and Transportation Engineering
T04Topographic Surveying and Mapping
T05Towers (Self-Supporting and Guyed
Systems)
T06Tunnels and Subways
U01Unexploded Ordnance Remediation
U02Urban renewals; Community
Development
U03Utilities (Gas and Steam)

V01 Value Analysis; Life-Cycle Costing

W01Warehouse and Depots
W02Water Resources; Hydrology;
Ground Water
W03Water Supply; Treatment and
Distribution
W04Wind Tunnels; Research/Testing
Facilities Design

Z01 Zoning; Land Use Studies

STANDARD FORM 330 (6/2004) PAGE 9 OF INSTRUCTIONSSENSITIVE BUT UNCLASSIFIED

ARCHITECT - ENGINEER QUALIFICATIONS

PART I - CONTRACT-SPECIFIC QUALIFICATIONS

A. CONTRACT INFORMATION

1. TITLE AND LOCATION (City and State):

2. PUBLIC NOTICE DATE:

3. SOLICITATION OR PROJECT NUMBER:

B. ARCHITECT-ENGINEER POINT OF CONTACT

4. NAME AND TITLE:

5. NAME OF FIRM:

6. TLEPHONE NUMBER:

7. FAX NUMBER:

8. E-MAIL ADDRESS:

C. PROPOSED TEAM

(Complete this section for the prime contractor and all key subcontractors.)

9a. PRIME (CHECK HERE):

9a. JOINT-VENTURE PARTNER (CHECK HERE):

9a. SUBCONTRACTOR (CHECK HERE):

9a. FIRM NAME:

9a. IF BRANCH OFFICE CHECK HERE:

10a. ADDRESS

11a. ROLE IN THIS CONTRACT 9b. PRIME (CHECK HERE):

9b. JOINT-VENTURE PARTNER (CHECK HERE):

9b. SUBCONTRACTOR (CHECK HERE):

9b. FIRM NAME:

9b. IF BRANCH OFFICE CHECK HERE:

10b. ADDRESS

11b. ROLE IN THIS CONTRACT

9c. PRIME (CHECK HERE):

9c. JOINT-VENTURE PARTNER (CHECK HERE):

9c. SUBCONTRACTOR (CHECK HERE):

9c. FIRM NAME:

9c. IF BRANCH OFFICE CHECK HERE:

10c. ADDRESS

11c. ROLE IN THIS CONTRACT 9d. PRIME (CHECK HERE):

9d. JOINT-VENTURE PARTNER (CHECK HERE):

9d. SUBCONTRACTOR (CHECK HERE):

9d. FIRM NAME:

9d. IF BRANCH OFFICE CHECK HERE:

10d. ADDRESS

11d. ROLE IN THIS CONTRACT 9e. PRIME (CHECK HERE):

9e. JOINT-VENTURE PARTNER (CHECK HERE):

9e. SUBCONTRACTOR (CHECK HERE):

9e. FIRM NAME:

9e. IF BRANCH OFFICE CHECK HERE:

10e. ADDRESS

11e. ROLE IN THIS CONTRACT 9f. PRIME (CHECK HERE):

9f. JOINT-VENTURE PARTNER (CHECK HERE):

9f. SUBCONTRACTOR (CHECK HERE):

9f. FIRM NAME:

9f. IF BRANCH OFFICE CHECK HERE:

10f. ADDRESS

11f. ROLE IN THIS CONTRACT D. ORGANIZATIONAL CHART OF PROPOSED TEAM (Attached; check here)

E. RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT

(Complete one Section E for each key person.)

12. NAME:

13. ROLE IN THIS CONTRACT:

14a. YEARS EXPERIENCE - TOTAL:

14b. YEARS EXPERIENCE - WITH CURRENT FIRM:

15. FIRM NAME AND LOCATION (City and State):

16. EDUCATION (DEGREE AND SPECIALIZATION):

17. CURRENT PROFESSIONAL REGISTRATION (STATE AND DISCIPLINE):

18. OTHER PROFESSIONAL QUALIFICATIONS (Publications, Organizations, Training, Awards, etc.):

19a(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):

19a(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19a(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable):

19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE:

19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm:

19b(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):

19b(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19b(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable):

19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE:

19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm:

19c(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):

19c(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19c(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable):

19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE:

19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm:

19d(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):

19d(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19d(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable):

19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE:

19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm:

19e(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):

19e(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19e(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable):

19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE:

19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm:

F. EXAMPLE PROJECTS WHICH BEST ILLUSTRATE PROPOSED TEAM'S

QUALIFICATIONS FOR THIS CONTRACT

(Present as many projects as requested by the agency, or 10 projects, if not specified.

Complete one Section F for each project.)

D. EXAMPLE PROJECT KEY NUMBER:

E. TITLE AND LOCATION (City and State):

F. YEAR COMPLETED - PROFESSIONAL SERVICES:

G. YEAR COMPLETED - CONSTRUCTION (If applicable):

23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER:

23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME:

23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER:

24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost):

25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT

(1) FIRM NAME
(2) FIRM LOCATION (City and State)
(3) ROLE

G. KEY PERSONNEL PARTICIPATION IN EXAMPLE PROJECTS

26. NAMES OF KEY PERSONNEL

(From Section E, Block 12)

27. ROLE IN THIS CONTRACT

(From Section E, Block 13)

28. EXAMPLE PROJECTS LISTED IN SECTION F

(Fill in “Example Projects Key” section below before completing table. Place “X” under project key number for participation in same or similar role.)

1
2
3
4
5
6
7
8
9
10

29. EXAMPLE PROJECTS KEY

NO.
TITLE OF EXAMPLE PROJECT (FROM SECTION F)
NO.
TITLE OF EXAMPLE PROJECT (FROM SECTION F)

H. ADDITIONAL INFORMATION

29. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS

NEEDED:

9. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

30. SIGNATURE OF AUTHORIZED REPRESENTATIVE:

31. DATE SIGNED:

32. NAME AND TITLE OF SIGNER:

ARCHITECT-ENGINEER QUALIFICATIONS

PART II - GENERAL QUALIFICATIONS

(If a firm has branch offices, complete for each specific branch office seeking work.)

1. SOLICITATION NUMBER (If any):

2a. FIRM (OR BRANCH OFFICE) NAME:

2b. FIRM (OR BRANCH OFFICE) STREET:

2c. FIRM (OR BRANCH OFFICE) CITY:

2d. FIRM (OR BRANCH OFFICE) STATE:

2e. FIRM (OR BRANCH OFFICE) ZIP CODE:

3. YEAR ESTABLISHED:

4. DUNS NUMBER:

5a. OWNERSHIP - TYPE:

5b. OWNERSHIP - SMALL BUSINESS STATUS:

6a. POINT OF CONTACT NAME AND TITLE:

6b. POINT OF CONTACT TELEPHONE NUMBER:

6c. POINT OF CONTACT E-MAIL ADDRESS:

7. NAME OF FIRM (If block 2a is a branch office):

8a. FORMER FIRM NAME(S) (If any)
8b. YR. ESTABLISHED
8c. DUNS NUMBER

9. EMPLOYEES BY DISCIPLINE

a. Function Code
b. Discipline
c(1). No. of Employees

- Firm c(2). No. of Employees - Branch

Other Employee

Total

10.

PROFILE OF FIRM'S EXPERIENCE AND ANNUAL AVERAGE REVENUE FOR LAST 5 YEARS

a. Profile Code
b. Experience
c. Revenue Index Number (see below)

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

1. Less than $100,0006.$2 million to less than $5 million
2. $100,000 to less than $250,0007.$5 million to less than $10 million
3. $250,000 to less than $500,008.$10 million to less than $25 million
4. $500,000 to less than $1 million9.$25 million to less than $50 million
5. $1 million to less than $2 million10.$50 million or greater

11. ANNUAL AVERAGE PROFESSIONAL SERVICES REVENUES OF FIRM FOR LAST 3 YEARS

(Insert revenue index number shown above)

11a. Federal Work:

11b. Non-Federal Work:

11c. Total Work:

12. AUTHORIZED REPRESENTATIVE. The foregoing is a statement of facts.

12a. SIGNATURE:

12b.DATE SIGNED:
STANDARD FORM 330 (6/2004) PAGE 9SENSITIVE BUT UNCLASSIFIED

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