ESBD_353839_1717717671461_Exhibit I A-E Questionnaire Form.pdf
PDF 133 KB Posted
- Solicitation number
- 808-24-241098
- Issued by
- Brazoria County, Brownsville City, Texas
About this file
The document is an A/E Questionnaire Form related to a state and local contract opportunity for Museum Architectural and Exhibit Design/Fabrication at Levi Jordan Plantation State Historic Site in Brazoria County, Texas. The Texas Historical Commission (THC) is seeking Statements of Qualifications from qualified individuals or firms to provide professional architectural/engineering services for this project. The form requests information about the firm's name, address, tax ID, contact details, organization, key personnel, services provided, professional liability coverage, and past project experience. Respondents must be registered/licensed in at least one of the professional services disciplines required to perform the requested services.
The form also includes schedules for the respondent to provide details on the design and construction phases, as well as budget compliance information, for their 5 most relevant completed projects. Respondents must complete and return this form with their response to the contract opportunity.
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Text version
A/E QUESTIONNAIRE FORM
1. Firm Name:
2. Address:
3. Tax Payer ID #:
4. E-mail Address:
5. Web Address:
6. Telephone: Fax:
7. Other Locations:
8. Organization Class: Individual Partnership
Corporation
Association
9. Date Established:
10. Former Business Name:
11. Date of Dissolution:
12. Subsidiary of:
13. Historically Underutilized Business Information: HUB? Yes No
Black American Hispanic American Native American American Woman
Other (specify)
14. Principals & Officers: (Names & Responsibilities: Management, Design, Production, Specification, Construction Administration, Business Development) Name Responsibility Name Responsibility
15. Key Personnel & Responsibilities:
Name Responsibility
16. Number of Personnel by Discipline*:
Discipline Number Number Registered Discipline Number Number Registered
Administration Interior Arch Architects Civil
Landscape Arch Environmental
Planning Drafting Programming Inspection
Structural Other (specify) Mechanical
Electrical
HVAC Net Total:
**Respondent must be registered/licensed, or have personnel on direct staff that are registered/licensed in at least one of the professional services discipline required to perform the services requested in this RFQ. Professional Services are defined in TGC 2254.002(A) (2).
17. Services Provided by Firm: (Please Check) Administration Architectural Drafting Inspection
Interior Arch Landscape Arch Planning Programming
Structural Mechanical Electrical HVAC
Civil Other (specify):
18. Professional Liability Coverage Errors & Omissions, etc.: Yes No
Amount:
19. Services Provided through Consultant (Please Check):
Administration Architectural Drafting Inspection
Interior Arch Landscape Arch Planning Programming Structural Mechanical Electrical HVAC
Civil Other (specify):
Name of Consultants Address
20. Geographical Limits:
21. Work Type Distribution by Proportion of Annual Average:
Work Type (Facility Use) % by Fee % by No. of Projects
Commercial, Office, Retail Industrial
Educational
Medical Other Institutional
Other (specify) Type:
New Building Design Restoration
Renovation
Interior Design Urban or Site Planning
Prime Engineering
Other (specify)
22. Projects in Last Five Years: See Attached
23. Date of Questionnaire:
24. Preparer Name:
Title:
Signature:
Schedule Compliance 5 most relevant completed projects
Design Phases Construction Phase
Insert Name of Project Here Study/ Analysis
Preliminary Design
Design Working Drawings
Construction Start
Substantial Completion
Contract Completion Date Actual Completion Date
Explanatory Note
Analysis
Preliminary
Design
Design Working
Drawings
Construction
Start
Substantial
Completion
Contract Completion Date
Analysis
Preliminary Design
Design Working Drawings
Construction Start
Substantial Completion
Contract Completion Date
Analysis
Preliminary Design
Design Working Drawings
Construction Start
Substantial Completion
Contract Completion Date
Analysis
Preliminary Design
Design Working Drawings
Construction Start
Substantial Completion
Contract Completion Date
Budget Compliance 5 most relevant completed projects
Insert Name of Project Here Comments:
Owner's Budget $ -
A/E Cost Estimate $ -
Successful Respondent Amount $ -
Construction Contract Amount $ -
Final Construction Cost $ -
Difference Between Initial Owner Budget and Contract Award
Insert Name of Project Here Comments:
Owner's Budget $ -
A/E Cost Estimate $ -
Successful Respondent Amount $ -
Construction Contract Amount $ -
Final Construction Cost $ -
Difference Between Initial Owner Budget and Contract Award
Insert Name of Project Here Comments:
Owner's Budget $ -
A/E Cost Estimate $ -
Successful Respondent Amount $ -
Construction Contract Amount $ -
Final Construction Cost $ -
Difference Between Initial Owner Budget and Contract Award
Insert Name of Project Here Comments:
Owner's Budget $ -
A/E Cost Estimate $ -
Successful Respondent Amount $ -
Construction Contract Amount $ -
Final Construction Cost $ -
Difference Between Initial Owner Budget and Contract Award
Insert Name of Project Here Comments:
Owner's Budget $ -
A/E Cost Estimate $ -
Successful Respondent Amount $ -
Construction Contract Amount $ -
Final Construction Cost $ -
Difference Between Initial Owner Budget and Contract Award
NOTE: THIS FORM MUST BE COMPLETED & RETURNED WITH THE RESPONSE
File details come from the government source that posted it. Updated .