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A/E QUESTIONNAIRE – RFQ #PR-0004731
Texas Facilities Commission
Facilities Design and Construction
P.O. Box 13047
Austin, Texas 78711-3047
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 |
| FORMCHECKBOX |
9. Date Established:
10. Former Business Name:
11. Date of Dissolution:
12. Subsidiary of:
| 13. Historically Underutilized Business Information: |
| HUB? |
| Yes |
| FORMCHECKBOX |
| Black American |
| FORMCHECKBOX |
| Hispanic American |
| FORMCHECKBOX |
| Native American |
| FORMCHECKBOX |
| American Woman |
| FORMCHECKBOX |
| Disable Veteran |
| FORMCHECKBOX |
| Other (specify) |
| FORMCHECKBOX |
| 14. Principals & Officers: |
| (Names & Responsibilities: Management, Design, Production, Specification, |
Construction Administration, Business Development)
| Name |
| Responsibility |
| Name |
| Responsibility |
15. Key Personnel & Responsibilities:
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 |
| FORMCHECKBOX |
| Architectural |
| FORMCHECKBOX |
| Interior Arch |
| FORMCHECKBOX |
| Landscape Arch |
| FORMCHECKBOX |
Other (specify):
| 18. Professional Liability Coverage Errors & Omissions, etc.: |
| Yes |
| FORMCHECKBOX |
Amount:
19. Services Provided through Consultant (Please Check):
| Administration |
| FORMCHECKBOX |
| Architectural |
| FORMCHECKBOX |
| Interior Arch |
| FORMCHECKBOX |
| Landscape Arch |
| FORMCHECKBOX |
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 10 most relevant completed projects
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
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
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
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
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
Schedule Compliance
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
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
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
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
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
Budget Compliance
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Budget Compliance
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |
Insert Name of Project Here
| Successful Respondent Amount |
| $ - |
| Construction Contract Amount |
| $ - |
| Final Construction Cost |
| $ - |
| Difference Between Initial Owner Budget and Contract Award |
| $ - |