Qualification Questionnaire Prime.pdf
PDF 285 KB Posted
- Solicitation number
- RFP 360 2026052 1
- Issued by
- Palm Beach County, Florida
About this file
This is a Prime Consultant Qualification Questionnaire form issued by Palm Beach County, Florida for the Street Lighting Professional Continuing Services Contract. The form requires prime consultants to provide detailed information including firm name, business structure, employee count, office location, contact information, and scope of work details. Consultants must specify their total project participation percentage and the portion of work to be performed within Palm Beach County versus outside the county. The questionnaire requires prime consultants to document all relevant small business enterprise certifications, including Palm Beach County Certified Small Business Enterprise (SBE) and State of Florida Certified Minority/Women Business Enterprise (M/WBE) designations, with copies of valid certification letters or certificates required at the time of submission.
The form includes a volume of work section requiring consultants to list all projects awarded by the Palm Beach County Board of County Commissioners across four fiscal years (October 1 to September 30), with fees weighted by age—current fiscal year at 1.00 factor, previous year at 0.75, fiscal year once removed at 0.50, and fiscal year twice removed at 0.25. Prime's fees are calculated as amounts awarded minus any fees subcontracted to subconsultants, plus any fees for which the consultant served as a subconsultant. The questionnaire requires certification by an authorized representative of the prime consultant firm, including signature, printed name, title, and date. Submission must follow the specified format exactly, with additional pages provided as needed for complete responses.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Prime Firms SBE Past Participation Statement.pdf | ||
| RFI Form.pdf | ||
| 2026052 RFP Package.pdf | ||
| Qualification Questionnaire Subconsultant.pdf | ||
| OSBD Schedules and Instructions.pdf | ||
| RFI Form.docx | DOCX document | |
| Conflict of Interest.pdf |
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Text version
PRIME CONSULTANT QUALIFICATION QUESTIONNAIRE
The detailed data requested here must be submitted in this format only.
Use as many pages as needed to provide the following required information:
PROJECT
Name:___________________________________________________ Proj. # ______________
PRIME CONSULTANT (Prime)
Firm Name: ___________________________________________________________________
The undersigned intends to perform work in connection with the above project as (check one):
an individual a corporation a partnership a joint venture
Number of Employees __________ Website: ________________________________________
Office Location
Street Address: _________________________________________________________________
City, State and Zip Code: _________________________________________________________
Contact Person
Name:____________________________________ Title: _______________________________
Email:______________________________________ Telephone # _______________________
SBE CERTIFICATION
Check all that apply and attach applicable copy of certification letter(s) or certificate(s).
Certifications must be valid on RFP or other type of submittal due date.
Palm Beach County (PBC) Certified Small Business Enterprise (SBE)
State of Florida Certified Minority/Women Business Enterprise (M/WBE)
SCOPE OF SERVICE
Prime’s Scope of Work: __________________________________________________________
(A) ________% of Team: Prime’s Total Project Participation (TPP)
(B) ________% Local: Portion of Prime’s TPP to be performed in PBC office(s)
(C) ________% Non-Local: Portion of Prime’s TPP to be performed outside of PBC office(s)
Note: (A) = (B) + (C) [(A) will only equal 100% if there are no subconsultants]
PRIME CONSULTANT QUALIFICATION QUESTIONNAIRE
VOLUME OF WORK
List all projects with associated contract and supplement fees awarded by the Palm Beach County
Board of County Commissioners in the fiscal years (October 1 to September 30) indicated.
Includes any fees awarded as a subconsultant.
FY Period Prime’s Fee * Factor Fees Considered
(1) Current Fiscal Year: $__________________ x 1.00 = $________________________
(2) Previous Fiscal Year: $__________________ x 0.75 = $________________________
(3) Fiscal Year Once Removed: $__________________ x 0.50 = $________________________
(4) Fiscal Year Twice Removed: $__________________ x 0.25 = $________________________
Total Fees Considered $________________________
* Palm Beach County fees awarded to the consultant, minus fees subcontracted out by consultant to sub-consultant, plus any fees for which the consultant is a sub-consultant.
CERTIFICATION
Prime Consultant Firm: __________________________________________________________
Signature: _____________________________________________________________________
Printed Name: _________________________________________________________________
Title: _________________________________________________________________________
Date: _________________________________________________________________________
| Untitled |
| PROJECT |
PRIME CONSULTANT (Prime)
SBE CERTIFICATION
SCOPE OF SERVICE
VOLUME OF WORK
CERTIFICATION
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