ARCHITECT - ENGINEER QUALIFICATIONS

PART I - CONTRACT-SPECIFIC QUALIFICATIONS

A.  CONTRACT INFORMATION

1. TITLE AND LOCATION (City and State)

2. PUBLIC NOTICE DATE                                                                                                     

3. SOLICITATION OR PROJECT NUMBER

B. ARCHITECT-ENGINEER POINT OF CONTACT

4. NAME AND TITLE

5. NAME OF FIRM

6. TELEPHONE NUMBER                                         

7. FAX NUMBER                               

8. E-MAIL ADDRESS

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

(Check)

PRIME

J - V PARTNER

SUBCONTRACTOR

9. FIRM NAME

10. ADDRESS

11. ROLE IN THIS CONTRACT

a.

CHECK IF BRANCH OFFICE

b.

CHECK IF BRANCH OFFICE

c.

CHECK IF BRANCH OFFICE

d.

CHECK IF BRANCH OFFICE

e.

CHECK IF BRANCH OFFICE

f.

CHECK IF BRANCH OFFICE

D. ORGANIZATIONAL CHART OF PROPOSED TEAM

 (Attached)

E. 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

15. FIRM NAME AND LOCATION (City and State)

16. EDUCATION (DEGREE AND SPECIALIZATION)

17. CURRENT PROFESSIONAL REGISTRATION (STATE AND DISCIPLINE)

18. 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)

a.

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

Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

b.

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

Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

c.

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

Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

d.

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

Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED

PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

e.

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

Check if project performed with current firm

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

a.

(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

G. KEY PERSONNEL PARTICIPATION IN EXAMPLE PROJ ECTS

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.)

1

2

3

4

5

6

7

8

9

10

29. EXAMPLE PROJECTS KEY

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

NO.

TITLE OF EXAMPLE PROJECT (FROM SECTION F)

1

6

2

7

3

8

4

9

5

10

H. ADDITIONAL INFORMATION

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

I. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

31. SIGNATURE

32. DATE

33. NAME AND TITLE

ARCHITECT-ENGINEER QUALIFICATIONS

1. 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 REVENUE OF FIRM FOR LAST 3 YEARS
(Insert revenue index number shown at right)

a. Federal Work

3.  $250,000 to less than $500,000

8.  $10 million to less than $25 million

b. Non-Federal Work

4.  $500,000 to less than $1 million

9.  $25 million to less than $50 million

c. Total Work

5.  $1 million to less than $2 million

10.  $50 million or greater

12. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts

a. SIGNATURE

b. DATE

c. NAME AND TITLE

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 330 (6/2004)