2025 Statement of Interest Form~2.pdf
PDF 451 KB Posted
- Contract number
- 25-422DNR-REALT-P-86069
- Issued by
- Illinois
About this file
This document is a Professional Services Qualifications - Statement of Interest (SOI) Form issued by the Illinois Department of Natural Resources (IDNR), located in Springfield, Illinois. The form is designed for architectural, engineering, and professional consulting firms to submit qualifications for potential state-level design and professional service contracts. The document appears to be a standardized template for prequalification and assessment of firms seeking to provide professional services to the state of Illinois.
The form requires detailed information about the submitting firm, including team personnel, project experience, subcontractors, and certifications. It includes sections for minority and veteran-owned business enterprise (MBE/WBE/VOSB/SDVOSB) participation, with firms required to disclose percentages of work to be performed by certified businesses. The document is structured to capture comprehensive details about a firm's capabilities, including personnel qualifications, previous project experiences, professional licenses, and specific project-related expertise. Firms must provide information about their team's professional credentials, years of experience, educational background, and relevant project history within the past 10 years.
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Text version
1. Attach Prequalification Letter from CDB or IDOT to SOI Form
2. Firm Name, address, phone & fax numbers: For Joint Venture (“JV”), include information for all members, design discipline of each member, and percentage (of total design team) of services of each member.
3. Contact Person:
4. IPB Bulletin Number: Project Number:
Email Address:
5. Approximate distance to project location: Miles (Enter n/a if location has not been determined.)
6. Percentage of work to be completed by Prime/JV: Certified by CMS?: MBE WBE VOSB SDVOSB
7. Percentage of work to be performed by Consultants that are CMS Certified MBE/WBE firms:
Percentage of work to be performed by Consultants that are CMS Certified VOSB/SDVOSB (VBE) firms:
*% shall reflect the total of all consultants that are MBE/WBE and VOSB/SDVOSB (VBE) in item
8. Certifications & Disclosures.
Submit Forms A or B.
Forms A Forms B (only if vendor is registered in the Illinois Procurement Gateway (“IPG”))
Approved IPG Registration No.:
9. DNR Standard Business Terms and Conditions Enclosed:
10. Team personnel, by discipline, to be designated for this project including all consultants. Indicate personnel licensed in Illinois. Submit a résumé for each individual listed below in Item 15. DO NOT include clerical and support staff.
# Assigned to this project
# Licensed in Illinois
# Assigned to this project
# Licensed in Illinois
Mechanical Engineers
Firm Name:
Address:
Phone:
Fax:
Architects Asbestos Project Designers Civil Engineers Electrical Engineers
Other:
Structural Engineers
Surveyors Construction Observers
TOTALS
N/A
SOI Form - Revised April, 2025
Project Description:
Professional Services Qualifications - Statement of Interest (SOI) Form rschwart Line
11. Form must be signed by the Firm’s President, Vice President, Partner or Sole Owner, Joint Venture Designee or any other person authorized to execute business for the firm/JV.
Signature: Date:
Typed:
12. Subcontractors: Please list the subcontractors that will be performing any portion of basic design services for this project. Any firm providing architectural, engineering, or land surveying must be prequalified with CDB or IDOT. The firms listed below are considered first tier consultants and shall hold a contract directly with the firm submitting this SOI Form.
• Failure of the consultants, providing regulated design services, to be prequalified, will result in rejection of the Prime A/E’s submittal(s).
Firm Name & Address Percentage* Worked with Prime (Yes or No)
Prequalification or
Registration No.
Detailed Scope of Services Only One Certified by CMS?
MBE
WBE
VOSB
SDVOSB
N/A
MBE
WBE
VOSB
SDVOSB
N/A
MBE
WBE
VOSB
SDVOSB
N/A
MBE
WBE
VOSB
SDVOSB
N/A
MBE
WBE
VOSB
SDVOSB
N/A
SOI Form - Revised April, 2025 rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Sticky Note Unmarked set by rschwart rschwart Sticky Note Unmarked set by rschwart
13. RELEVANT PROJECT EXPERIENCE: (On completed projects within the past 10 years, limit to 8 projects for the submitting firm and 4 for each consultant. One project per page, add additional pages as needed.)
Firm Name:
Project Description & Location Level of Responsibility & Detailed
Description of Services Owners Name & Address
Prime Contact – Phone & Fax No.
(Consultants, identify the Prime A/E)
CompletionDate
(Actual or Estimated)
Total Project Cost
SOI Form - Revised April, 2025 rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Rectangle
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14. TEAM PERSONNEL: Any contract awarded in response to this submittal is conditioned on the qualifications of the firm and the project team individuals as stated below. Therefore, the team listed below shall be assigned to this project if a contract is awarded to the submitting firm
Name Project Assignment Associated Firm Individual Professional
License(s) or Certification(s)
Licensed or Certified in
Illinois?
SOI Form - Revised April, 2025 rschwart Rectangle rschwart Rectangle rschwart Rectangle rschwart Rectangle
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15. TEAM PERSONNEL RESUMES: (Insert additional copies of this page as neeed for each team member)
(a) Name and Title (b) Project Assignment
(c) Complete Office Address for this Individual (d) Years of Experience with this Firm (with other firms)
(e) Education: Institution/Field of Study/Degree/Year Obtained (f) Active Licenses/Certifications/Type/Year
(g) Specific Relevant Project Experience Including Individual's Level of Responsibility
SOI Form - Revised April, 2025
| SOI FORM |
| Standard Business Terms and Conditions |
| Firm Name: |
| Phone 1-1: |
| Address: |
| Fax 1-1: |
| Contact Person: |
| Email Address: |
| IPB Bulletin Number: |
| Project Number: |
| Project Description: |
| Approximate distance to project location: |
| Percentage of work to be completed by PrimeJV: |
| Group1Page1: Off |
| CMS Certified MBEFBE firms: |
| Forms B only if vendor is registered in the: |
| Group2FormA: Off |
| Registration No: |
| No: |
| 9: Off |
| this project 1: |
| # Licensed in IL 1: |
| this project 1_2: |
| # Licensed in IL 6: |
| this project 2: |
| # Licensed in IL 2: |
| this project 2_2: |
| # Licensed in IL 7: |
| this project 3: |
| # Licensed in IL 3: |
| this project 3_2: |
| # Licensed in IL 8: |
| this project 4: |
| # Licensed in IL 4: |
| this project 4_2: |
| # Licensed in IL 9: |
| Other: |
| this project 5: |
| # Licensed in IL 5: |
| this project 5_2: 0 |
| # Licensed in IL 10: 0 |
| Date: |
| Typed: |
| Firm Name AddressRow 1: |
| Percentage 1: |
| Dropdown1Page2: |
| 0: [Select One] |
| 1: |
| 1: [Select One] |
| 2: [Select One] |
| 3: [Select One] |
| Prequalification or Registration NoRow 1: |
| Detailed Scope of ServicesRow 1: |
| Group1: NA |
| Firm Name Address Row 2: |
| Percentage 2: |
| Dropdown2Page2: [Select One] |
| Prequalification or Registration No 2: |
| Detailed Scope of Service 2: |
| Group2: Off |
| Firm Name Address Row 3: |
| Percentage 3: |
| Prequalification or Registration No: |
| 3: |
| 4: |
| 5: |
| Detailed Scope of Service 3: |
| Group3: Off |
| Firm Name Address Row 4: |
| Percentage 4: |
| Detailed Scope of Service 4: |
| Group4: Off |
| Firm Name Address Row 5: |
| Percentage 5: |
| Detailed Scope of Service 5: |
| Group5: Off |
| FirmNameTextBox: |
| Project Description LocationRow1: |
| Level of Responsibility Detailed Description of ServicesRow1: |
| Owners Name Address Prime Contact Phone Fax No Consultants identify the Prime AERow1: |
| Completion Date MMYY Actual or EstimatedRow1: |
| Total Project CostRow1: |
| Button1: |
| NameRow1: |
| Project AssignmentRow1: |
| Associated FirmRow1: |
| Individual Professional Licenses or CertificationsRow1: |
| Licensed or Cert in IL Dropdown1: [Select One] |
| NameRow2: |
| Project AssignmentRow2: |
| Associated FirmRow2: |
| Individual Professional Licenses or CertificationsRow2: |
| Licensed or Cert in IL Dropdown 2: [Select One] |
| NameRow3: |
| Project AssignmentRow3: |
| Associated FirmRow3: |
| Individual Professional Licenses or CertificationsRow3: |
| Licensed or Cert in IL Dropdown 3: [Select One] |
| NameRow4: |
| Project AssignmentRow4: |
| Associated FirmRow4: |
| Individual Professional Licenses or CertificationsRow4: |
| Licensed or Cert in IL Dropdown 4: [Select One] |
| NameRow5: |
| Project AssignmentRow5: |
| Associated FirmRow5: |
| Individual Professional Licenses or CertificationsRow5: |
| Licensed or Cert in IL Dropdown 5: [Select One] |
| NameRow6: |
| Project AssignmentRow6: |
| Associated FirmRow6: |
| Individual Professional Licenses or CertificationsRow6: |
| Licensed or Cert in IL Dropdown 6: [Select One] |
| NameRow7: |
| Project AssignmentRow7: |
| Associated FirmRow7: |
| Individual Professional Licenses or CertificationsRow7: |
| Licensed or Cert in IL Dropdown 7: [Select One] |
| NameRow8: |
| Project AssignmentRow8: |
| Associated FirmRow8: |
| Individual Professional Licenses or CertificationsRow8: |
| Licensed or Cert in IL Dropdown 8: [Select One] |
| Button3: |
| Delete: |
| a Name and TitleRow1: |
| b Project AssignmentRow1: |
| c Complete Office Address for this IndividualRow1: |
| d Years of Experience with this Firm with other firmsRow1: |
| e Education InstitutionField of StudyDegreeYear ObtainedRow1: |
| f Active LicensesCertificationsTypeYearRow1: |
| g Specific Relevant Project Experience Including Individuals Level of ResponsibilityRow1: |
| Button2: |
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