SF 255.pdf

STANDARD

FORM (SF)

Architect-Engineer and Related Services Questionnaire for Specific Project

1. Project Name/Location for which Firm is Filing:

2a. Commerce Business Daily Announcement Date, if any:

2b. Agency Identification Number, if any:

SOL *

3. Firm (or Joint-Venture) Name & Address

3a. Name, Title & Telephone Number of Principal to Contact:

3b. Address of office to perform work, if different from item 3.

4. Personnel by Discipline: (List each person only once, by primary function.) Enter proposed consultant personnel to be utilized on this project on line (A) and in-house personnel on line (B).

A B A B A B A B _ Administrative _ Architects __ __ __ Chemical Engineers _ Civil Engineers _ __ Construction Inspectors _ Draftsmen __ _ ____ _ Ecologists __ _ _____ Economists

_ Electrical Engineers _ Estimators _ _____ Geologists __ _____ Hydrologists __ _____ Interior Designers _ Landscape Architects __ Mechanical Engineers ___ ____ _ Mining Engineers

_____ _____ Oceanographers __ __ Planners Urban/Regional __ Sanitary Engineers ____ _____ Soils Engineers ___ _ _____ Specification Writers __ Structural Engineers __ _____ Surveyors _ __ ____ Transportation Engineers

__ CAD Operators __ Construction Managers __ Project Managers _ __ IT Specialists __ _ Total Personnel

5. If submittal is by joint-venture list participating firms and outline specific areas of responsibility (including administrative, technical and financial) for each firm:

(Attach SF 254 for each if not on file with Procuring Office.)

5a. Has this Joint-Venture previously worked together? Yes No

STANDARD FORM 255 PAGE 3 (Rev. 11-92)

6. If respondent is not a joint venture, list outside key Consultants/Associates anticipated for this project (Attach SF 254 for Consultants/Associates listed, if not already on file with the Contracting Office).

Name & Address

Specialty

Worked with Prime before (Yes or No) x)

6. If respondent is not a joint venture, list outside key Consultants/Associates anticipated for this project (Attach SF 254 for Consultants/Associates listed,

6. If respondent is not a joint venture, list outside key Consultants/Associates anticipated for this project (Attach SF 254 for Consultants/Associates listed,

6. If respondent is not a joint venture, list outside key Consultants/Associates anticipated for this project (Attach SF 254 for Consultants/Associates listed, STANDARD FORM 255 PAGE 4 (Rev. 11-92)

7. Brief resume of key persons, specialists, and individual consultants anticipated for this project.

a. Name & Title:

b. Project Assignment:

c. Name of Firm with which associated:

d. Years experience: With This Firm

With Other Firms

e. Education: Degree(s)/Year/ Specialization

f. Active Registration: Year First Registered/Discipline

g. Other Experience and Qualifications relevant to the proposed project:

STANDARD FORM 255 PAGE 5 (Rev. 11-92)

7. Brief resume of key persons, specialists, and individual consultants anticipated for this project.

STANDARD FORM 255 PAGE 5 (Rev. 11-92)

8. Work by firm or joint-venture members which best illustrates current qualifications relevant to this project (list no more than 10 projects).

a. Project Name & Location

b. Nature of Firm’s Responsibility

c. Project Owner’s Name & Address and Project Manager’s Name & Phone Number

d. Completion Date (actual or estimated)

e. Estimated Cost (in thousands)

Entire Project

Work for which firm was/is responsible

STANDARD FORM 255 PAGE 9 (Rev. 11-92)

9. All work by firms or joint-venture members currently being performed directly for Federal agencies.

a. Project Name & Location

b. Nature of Firm’s Responsibility

c. Agency (Responsible Office) Name and Address and Project Manager's Name & Phone Number

d. Percent Complete

e. Estimated Cost (in thousands)

Entire Project Work for which firm was/is responsible

STANDARD FORM 255 PAGE 9 (Rev. 11-92)

10. Use this space to provide any additional information or description of resources (including any computer design capabilities) supporting your firm’ qualifications for the proposed project.

11. The foregoing is a statement of facts.

Signature: ____________________________________________________ Typed Name and Title:

Date:

STANDARD FORM 255 PAGE 11 (Rev. 11-92)