SF_330_Part_I_ _II.doc

ARCHITECT-ENGINEER QUALIFICATIONS

OMB No.: 9000-0157 Expires: 12/31/2006

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.

PURPOSE

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:

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.

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.

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.

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.

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 330 (6/2004) PAGE 1 OF INSTRUCTIONS

Prescribed by GSA - FAR (48 CFR) 53.236-2(b)

STANDARD FORM 330 (6/2004) PAGE OF INSTRUCTIONS

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:

Name. Self-explanatory.

Role in This Contract. Self-explanatory.

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).

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.

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

Current Professional Registration. Provide informa- tion 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.

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:

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

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

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 Contact Telephone Number Self-explanatory.

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).

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.

Section H. Additional Information.

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.

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 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 first, before completing table. Place "X" under project key number for participation in same or similar role.)

Jane A. Smith

Chief Architect X

Joseph B. Williams

Chief Mech. Engineer X X

Tara C. Donovan

Chief Elec. Engineer X file_0.png

29. EXAMPLE PROJECTS KEY

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

Federal Courthouse, Denver, CO XYZ Corporation Headquarters, Boston, MA Justin J. Wilson Federal Building, Baton Rouge, LA

Founder's Museum, Newport RI 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.

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

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.

Ownership.

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

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.

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).

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.

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.

Authorized Representative. An authorized represent- ative 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

Description 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)

STANDARD FORM 330 (6/2004) PAGE OF INSTRUCTIONS

A01 Description Acoustics, Noise Abatement Code E01 Description Ecological & Archeological A02 Aerial Photography; Airborne Data and Imagery

Investigations

Collection and Analysis E02 Educational Facilities; Classrooms A03 Agricultural Development; Grain Storage;

E03 Electrical Studies and Design

Farm Mechanization E04 Electronics A04 Air Pollution Control E05 Elevators; Escalators; People-Movers A05 Airports; Navaids; Airport Lighting;

E06 Embassies and Chanceries

Aircraft Fueling E07 Energy Conservation; New Energy A06 Airports; Terminals and Hangars; Freight

Sources

Handling E08 Engineering Economics A07 Arctic Facilities E09 Environmental Impact Studies, A08 Animal Facilities

Assessments or Statements A09 Anti-Terrorism/Force Protection E10 Environmental and Natural Resource A10 Asbestos Abatement

Mapping A11 Auditoriums & Theaters E11 Environmental Planning A12 Automation; Controls; Instrumentation E12 Environmental Remediation

E13 Environmental Testing and Analysis B01 Barracks; Dormitories

B02 Bridges F01 Fallout Shelters; Blast-Resistant Design

F02 Field Houses; Gyms; Stadiums C01 Cartography F03 Fire Protection C02 Cemeteries (Planning & Relocation) F04 Fisheries; Fish ladders C03 Charting: Nautical and Aeronautical F05 Forensic Engineering C04 Chemical Processing & Storage F06 Forestry & Forest products C05 Child Care/Development Facilities

C06 Churches; Chapels G01 Garages; Vehicle Maintenance Facilities;

C07 Coastal Engineering

Parking Decks C08 Codes; Standards; Ordinances G02 Gas Systems (Propane; Natural, Etc.)

C09 Cold Storage; Refrigeration and G03 Geodetic Surveying: Ground and Air-

Fast Freeze borne C10 Commercial Building (low rise);

G04 Geographic Information System

Shopping Centers

Services: Development, C11 Community Facilities

Analysis, and Data Collection C12 Communications Systems; TV; Microwave G05 Geospatial Data Conversion: Scanning, C13 Computer Facilities; Computer Service

Digitizing, Compilation, C14 Conservation and Resource

Attributing, Scribing, Drafting

Management G06 Graphic Design C15 Construction Management

C16 Construction Surveying H01 Harbors; Jetties; Piers, Ship C17 Corrosion Control; Cathodic Protection;

Terminal Facilities

Electrolysis H02 Hazardous Materials Handling and C18 Cost Estimating; Cost Engineering and

Storage

Analysis; Parametric Costing;

H03 Hazardous, Toxic, Radioactive

Forecasting

Waste Remediation C19 Cryogenic Facilities H04 Heating; Ventilating; Air

D01 D02 D03 D04

D05

D06 D07 D08

Dams (Concrete; Arch) Dams (Earth; Rock); Dikes; Levees Desalinization (Process & Facilities) Design-Build - Preparation of Requests for Proposals Digital Elevation and Terrain Model Develop- ment Digital Orthophotography Dining Halls; Clubs; Restaurants Dredging Studies and Design

H05 H06 H07

H08 H09 H10 H11

H12 H13 Conditioning Health Systems Planning Highrise; Air-Rights-Type Buildings Highways; Streets; Airfield Paving;

Parking Lots Historical Preservation Hospital & Medical Facilities Hotels; Motels Housing (Residential, Multi-Family; Apartments; Condominiums) Hydraulics & Pneumatics Hydrographic Surveying

Code Description Code Description I01 I02 I03 I04 I05 I06

J01 L01 L02 L03 L04 L05

L06

M01 M02

M03 M04

M05 M06 M07

M08

N01

N02 N03

O01 O02 O03

P01 P02

P03 P04

P05

P06 P07 P08 Industrial Buildings; Manufacturing Plants Industrial Processes; Quality Control Industrial Waste Treatment Intelligent Transportation Systems Interior Design; Space Planning Irrigation; Drainage Judicial and Courtroom Facilities Laboratories; Medical Research Facilities Land Surveying Landscape Architecture Libraries; Museums; Galleries Lighting (Interior; Display; Theater, Etc.)

Lighting (Exteriors; Streets; Memorials; Athletic Fields, Etc.)

Mapping Location/Addressing Systems Materials Handling Systems;

Conveyors; Sorters Metallurgy Microclimatology; Tropical Engineering Military Design Standards Mining & Mineralogy Missile Facilities (Silos; Fuels; Transport) Modular Systems Design;

Pre-Fabricated Structures or Components

Naval Architecture; Off-Shore Platforms Navigation Structures; Locks Nuclear Facilities; Nuclear Shielding

Office Buildings; Industrial Parks Oceanographic Engineering Ordnance; Munitions; Special Weapons

Petroleum Exploration; Refining Petroleum and Fuel (Storage and Distribution) Photogrammetry Pipelines (Cross-Country - Liquid & Gas) Planning (Community, Regional, Areawide and State) Planning (Site, Installation, and Project) Plumbing & Piping Design Prisons & Correctional Facilities P09 P10

P11 P12

P13 R01 R02 R03 R04

R05 R06

R07 R08 R09 R10 R11

R12 S01 S02 S03 S04

S05

S06 S07 S08

S09 S10 S11 S12 S13

T01

T02 T03 T04 T05

T06 Product, Machine Equipment Design Pneumatic Structures, Air-Support Buildings Postal Facilities Power Generation, Transmission, Distribution Public Safety Facilities

Radar; Sonar; Radio & Radar Telescopes Radio Frequency Systems & Shieldings Railroad; Rapid Transit Recreation Facilities (Parks, Marinas, Etc.) Refrigeration Plants/Systems Rehabilitation (Buildings; Structures; Facilities) Remote Sensing Research Facilities Resources Recovery; Recycling Risk Analysis Rivers; Canals; Waterways; Flood Control Roofing

Safety Engineering; Accident Studies; OSHA Studies Security Systems; Intruder & Smoke Detection Seismic Designs & Studies Sewage Collection, Treatment and Disposal Soils & Geologic Studies; Foundations Solar Energy Utilization Solid Wastes; Incineration; Landfill Special Environments; Clean Rooms, Etc.

Structural Design; Special Structures Surveying; Platting; Mapping; Flood Plain Studies Sustainable Design Swimming Pools Storm Water Handling & Facilities

Telephone Systems (Rural; Mobile; Intercom, Etc.)

Testing & Inspection Services Traffic & Transportation Engineering Topographic Surveying and Mapping Towers (Self-Supporting & Guyed Systems) Tunnels & Subways List of Experience Categories (Profile Codes)

STANDARD FORM 330 (6/2004) PAGE 8 OF INSTRUCTIONS

Code Description U01 U02

U03 V01 W01 W02

W03 W04

Z01 Unexploded Ordnance Remediation Urban Renewals; Community Development Utilities (Gas and Steam) Value Analysis; Life-Cycle Costing Warehouses & Depots Water Resources; Hydrology;

Ground Water Water Supply; Treatment and Distribution Wind Tunnels; Research/Testing Facilities Design

Zoning; Land Use Studies

ARCHITECT - ENGINEER QUALIFICATIONS

PART I - CONTRACT-SPECIFIC QUALIFICATIONS

CONTRACT INFORMATION

TITLE AND LOCATION (City and State)

PUBLIC NOTICE DATE 3. SOLICITATION OR PROJECT NUMBER

ARCHITECT-ENGINEER POINT OF CONTACT

NAME AND TITLE

NAME OF FIRM

6. TELEPHONE NUMBER

7. FAX NUMBER

8. E-MAIL ADDRESS

PROPOSED TEAM

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

a.

(Check)

9. FIRM NAME

10. ADDRESS

11. ROLE IN THIS CONTRACT

PRIME

J-V PARTNER

SUBCON- TRACTOR

CHECK IF BRANCH OFFICE

b.

c.

d.

e.

f.

ORGANIZATIONAL CHART OF PROPOSED TEAM (Attached)

STANDARD FORM 330 (6/2004) PAGE 1

STANDARD FORM 330 (6 2004) PAGE 2

RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT

(Complete one Section E for each key person.)

12. NAME

13. ROLE IN THIS CONTRACT

14. YEARS EXPERIENCE

a. TOTAL

b. WITH CURRENT FIRM FIRM NAME AND LOCATION (City and State)

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

19. RELEVANT PROJECTS

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE

Check if project performed with current firm b.

c.

d.

e.

STANDARD FORM 330 (6/2004) PAGE 3

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.)

20. EXAMPLE PROJECT KEY

NUMBER

21. TITLE AND LOCATION (City and State)

22. YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

23. PROJECT OWNER'S INFORMATION

a. PROJECT OWNER

b. POINT OF CONTACT NAME

c. POINT OF CONTACT TELEPHONE NUMBER

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

25. FIRMS FROM SECTION C INVOLVED WITH THIS PROJECT

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

b.

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

c.

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

d.

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

e.

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

f.

(1) FIRM NAME

(2) FIRM LOCATION (City and State)

(3) ROLE

STANDARD FORM 330 (6/2004) PAGE 4

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

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

ADDITIONAL INFORMATION

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

AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

SIGNATURE 32. DATE

NAME AND TITLE

STANDARD FORM 330 (6/2004) PAGE 5

ARCHITECT-ENGINEER QUALIFICATIONS

SOLICITATION NUMBER (If any)

PART II - GENERAL QUALIFICATIONS

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

2a. FIRM (OR BRANCH OFFICE) NAME

3. YEAR ESTABLISHED

4. DUNS NUMBER

2b. STREET

5. OWNERSHIP

a. TYPE 2c. CITY 2d. STATE 2e. ZIP CODE

b. SMALL BUSINESS STATUS 6a. POINT OF CONTACT NAME AND TITLE

7. NAME OF FIRM (If block 2a is a branch office) 6b. TELEPHONE NUMBER 6c. E-MAIL ADDRESS

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

9. EMPLOYEES BY DISCIPLINE

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

a. Function Code

b. Discipline

c. No. of Employees

a. Profile Code

b. Experience

c. Revenue Index Number (see below)

(1) FIRM

(2) BRANCH

Other Employees

Total

11. ANNUAL AVERAGE PROFESSIONAL SERVICES REVENUES OF FIRM

FOR LAST 3 YEARS

(Insert revenue index number shown at right)

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

a. Federal Work

b. Non-Federal Work

c. Total Work

SIGNATURE

12. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

DATE

NAME AND TITLE

STANDARD FORM 330 (6/2004) PAGE 6