36C25619R0079-001.doc

ARCHITECT-ENGINEER QUALIFICATIONS

OMB No.:

9000-0157

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.

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.

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.

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.

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).

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 KEY

27. ROLE IN THIS

28. EXAMPLE PROJECTS LISTED IN SECTION F

PERSONNEL

CONTRACT

Fill 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.

2 3 4 5 6 7 8 9

X

X

29. EXAMPLE PROJECTS KEY

(FROM SECTION F)

(FROM SECTION F)

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.

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.

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.

List of Disciplines (Function Codes)

Code

Description

Acoustical Engineer

Hydraulic Engineer

Administrative

Hydrographic Surveyor

Aerial Photographer

Hydrologist

Aeronautical Engineer

Industrial Engineer

Archeologist

Industrial Hygienist

Architect

Interior Designer

Biologist

Land Surveyor

CADD Technician

Landscape Architect

Cartographer

Materials Engineer

Chemical Engineer

Materials Handling Engineer

Chemist

Mechanical Engineer

Civil Engineer

Mining Engineer

Communications Engineer

Oceanographer

Computer Programmer

Photo Interpreter

Construction Inspector

Photogrammetrist

Construction Manager

Planner: Urban/Regional

Corrosion Engineer

Project Manager

Cost Engineer/Estimator

Remote Sensing Specialist

Ecologist

Risk Assessor

Economist

Safety/Occupational Health Engineer

Electrical Engineer

Sanitary Engineer

Electronics Engineer

Scheduler

Environmental Engineer

Security Specialist

Environmental Scientist

Soils Engineer

Fire Protection Engineer

Specifications Writer

Forensic Engineer

Structural Engineer

Foundation/Geotechnical Engineer

Technician/Analyst

Geodetic Surveyor

Toxicologist

Geographic Information System Specialist

Transportation Engineer

Geologist

Value Engineer

Health Facility Planner

Water Resources Engineer

List of Experience Categories (Profile Codes)

A01 Acoustics, Noise Abatement

D01 Dams (Concrete; Arch)

A02 Aerial Photography; Airborne Data and Imagery

D02 Dams (Earth; Rock); Dikes; Levees

Collection and Analysis

D03 Desalinization (Process and Facilities) A03 Agricultural Development; Grain Storage;

D04 Design-Build - Preparation of Requests for

Farm Mechanization

Proposals A04 Air Pollution Control

D05 Digital Elevation and Terrain Model Develop- A05 Airports; Navaids; Airport Lighting;

ment

Aircraft Fueling

D06 Digital Orthophotography A06 Airports; Terminals and Hangars; Freight

D07 Dining Halls; Clubs; Restaurants

Handling

D08 Dredging Studies and Design

A07 Arctic Facilities

A08 Animal Facilities

E01 Ecological and Archeological

A09 Anti-Terrorism/Force Protection

Investigations

A10 Asbestos Abatement

E02 Educational Facilities; Classrooms

A11 Auditoriums and Theaters

E03 Electrical Studies and Design

A12 Automation; Controls; Instrumentation

E04 Electronics

E05 Elevators; Escalators; People-Movers

B01 Barracks; Dormitories

E06 Embassies and Chanceries

B02 Bridges

E07 Energy Conservation; New Energy

Sources

C01 Cartography

E08 Engineering Economics

C02 Cemeteries (Planning and Relocation)

E09 Environmental Impact Studies, C03 Charting; Nautical and Aeronautical

Assessments or Statements

C04 Chemical Processing and Storage

E10 Environmental and natural Resource

C05 Child Care/Development Facilities

Mapping

C06 Churches; Chapels

E11 Environmental Planning

C07 Coastal Engineering

E12 Environmental Remediation

C08 Codes; Standards; Ordinances

E13 Environmental Testing and Analysis

C09 Cold Storage; Refrigeration and

Fast Freeze

F01 Fallout Shelters; Blast-Resistant Design

C10 Commercial Building (Low Rise);

F02 Field Houses; Gyms; Stadiums

Shopping Centers

F03 Fire Protection

C11 Community Facilities

F04 Fisheries; Fish Ladders

C12 Communications Systems; TV; Microwave

F05 Forensic Engineering

C13 Computer Facilities; Computer Service

F06 Forestry and Forest Products

C14 Conservation and Resource

Management

G01 Garages; Vehicles Maintenance Facilities;

C15 Construction Management

Parking Decks

C16 Construction Surveying

G02 Gas Systems (Propane; Natural, Etc.)

C17 Corrosion Control; Cathodic Protection

G03 Geodetic Surveying: Ground and Air-

Electrolysis borne

C18 Cost Estimating; Cost Engineering and

G04 Geographic Information System

Analysis; Parametric Costing;

Services: Development, Forecasting

Analysis, and Data Collection

C19 Cryogenic Facilities

G05 Geospatial Data Conversion: Scanning, M08 Modular systems Design;

Digitizing, Compilation, Pre-Fabricated Structures or

Attributing, Scribing, Drafting

Components

G06 Graphic Design

N01 Naval Architecture; Off-Shore

H01 Harbors; Jetties; Piers, Ship

Platforms

Terminal Facilities

N02 Navigation Structures; Locks

H02 Hazardous Materials Handling and

N03 Nuclear Facilities; Nuclear Shielding

Storage

H03 Hazardous, Toxic, Radioactive

O01 Office Buildings; Industrial Parks

Waste Remediation

O02 Oceanographic Engineering

H04 Heating; Ventilating; Air

O03 Ordnance; Munitions; Special

Conditioning

Weapons

H05 Health Systems Planning

H06 High-rise; Air-Rights-Type Buildings

P01 Petroleum Exploration; Refining

H07 Highways; Streets; Airfield Paving;

P02 Petroleum and Fuel (Storage and

Parking Lots

Distribution) H08 Historical Preservation

P03 Photogrammetry

H09 Hospital and Medical Facilities

P04 Pipelines (Cross-Country - Liquid and H10 Hotels; Motels

Gas) H11 Housing (Residential, Multi-Family;

P05 Planning (Community, Regional, Apartments; Condominiums)

Areawide and State) H12 Hydraulics and Pneumatics

P06 Planning (Site, Installation and Project) H13 Hydrographic Surveying

P07 Plumbing and Piping Design

P08 Prisons and Correctional Facilities

I01 Industrial Buildings; Manufacturing

P09 Product, Machine Equipment Design

Plants

P10 Pneumatic Structures, Air-Support

I02 Industrial Processes; Quality

Buildings

Control

P11 Postal Facilities

I03 Industrial Waste Treatment

P12 Power Generation, Transmission, I04 Intelligent Transportation Systems

Distribution

I05 Interior Design; Space Planning

P13 Public Safety Facilities

I06 Irrigation; Drainage

R01 Radar; Sonar; Radio and Radar

J01 Judicial and Courtroom Facilities

Telescopes

R02 Radio Frequency Systems and

L01 Laboratories; Medical Research

Shieldings

Facilities

R03 Railroad; Rapid Transit

L02 Land Surveying

R04 Recreation Facilities (Parks, L03 Landscape Architecture

Marinas, Etc.)

L04 Libraries; Museums; Galleries

R05 Refrigeration Plants/Systems

L05 Lighting (Interior; Display; Theater, R06 Rehabilitation (Buildings; Structures;

Etc.)

Facilities L06 Lighting (Exteriors; Streets;

R07 Remote Sensing

Memorials; Athletic Fields, Etc.)

R08 Research Facilities

R09 Resources Recovery; Recycling

M01 Mapping Location/Addressing Systems

R10 Risk Analysis

M02 Materials Handling Systems;

R11 Rivers; Canals; Waterways; Flood

Conveyors; Sorters

Control

M03 Metallurgy

R12 Roofing

M04 Microclimatology; Tropical

Engineering

S01 Safety Engineering; Accident

M05 Military Design Standards

Studies; OSHA Studies

M06 Mining and Mineralogy

S02 Security Systems; Intruder and Smoke

M07 Missile Facilities (Silos; Fuels;

Detection

Transport)

S03 Seismic Designs and Studies

S04 Sewage Collection, Treatment and

Disposal

S05 Soils and Geologic Studies;

Foundations

S06 Solar Energy Utilization

S07 Solid Wastes; Incineration; Landfill

S08 Special Environments; Clean Rooms, Etc.

S09 Structural Design; Special

Structures

S10 Surveying; Platting; Mapping; Flood

Plain Studies

S11 Sustainable Design

S12 Swimming Pools

S13 Storm Water Handling and Facilities

T01 Telephone Systems (Rural; Mobile;

Intercom, Etc.)

T02 Testing and Inspection Services

T03 Traffic and Transportation Engineering

T04 Topographic Surveying and Mapping

T05 Towers (Self-Supporting and Guyed

Systems) T06 Tunnels and Subways

U01 Unexploded Ordnance Remediation

U02 Urban renewals; Community

Development

U03 Utilities (Gas and Steam) V01 Value Analysis; Life-Cycle Costing

W01 Warehouse and Depots

W02 Water Resources; Hydrology;

Ground Water

W03 Water Supply; Treatment and

Distribution

W04 Wind Tunnels; Research/Testing

Facilities Design

Z01 Zoning; Land Use Studies

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

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.)

29. EXAMPLE PROJECTS KEY

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):

EMPLOYEES BY DISCIPLINE

- Firm c(2). No. of

Employees - Branch

Other Employee

Total

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

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

1. Less than $100,000

6.

$2 million to less than $5 million

2. $100,000 to less than $250,000

7.

$5 million to less than $10 million

3. $250,000 to less than $500,00

8.

$10 million to less than $25 million

4. $500,000 to less than $1 million

$25 million to less than $50 million

5. $1 million to less than $2 million

10.

$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:

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 330 (6/2004) PAGE 1 OF INSTRUCTIONS