2012awardsappformword2003

							                                                       20th Annual
                                                MdQI Awards of Excellence
                                                 2012 Project Application

Project Name: Enter text here

Project Location/Limits: Enter text here

Date of substantial completion or acceptance for maintenance: Enter text here
(If planning project, date of substantial completion of Record of Decision or equivalent)


Nominate this project in the following category: (please fill out a separate form for each category you would
like to nominate a project in)

☐ Modal Award (Over $5m)              ☐ Planning

☐ Modal Award (Under $5m)             ☐ MBE/WBE

                                       ☐ Subcontractor

                                       ☐ Green/Sustainability/Environmental


If this submission is by a Consulting Firm or a Construction Contractor, please CLICK HERE to enter the name and
contact information of a person within the agency who agrees that this project is a worthy candidate for an
MdQI award.

Agency:
☐ CEAM         ☐ MPA

☐ MAA          ☐ MTA

☐ MDTA         ☐ SHA



Contact person(s) concerning any questions about this nomination:

Name:                                      Phone #:                       Email:

Name:                                      Phone #:                       Email:

Project Owner:

Project Manager for Owner:

Project Manager for Designer/Contractor:

Firm or Agency Submitting Application:
Project Evaluation (Construction)

1. Project Milestones

   Proposed: Enter text here

   Actual: Enter text here

2. Budget:

   Proposed: Enter text here

   Actual: Enter text here

   Owner Directed Changes: Enter text here

   Contractor Changes: Enter text here


3. Was original budget met? ☐ Yes ☐ No (if no, please explain)
   Enter text here



4. Any penalties for MOT, Environmental, Materials, etc.? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



5. Any contractor value engineering proposals? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



6. Any incentives or disincentives in contract? ☐ Yes ☐ No (if yes, for what and what was the outcome?)
   Enter text here



7. Any liquidated damages assessed? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



8. Any claims files? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



9. Partnering on project? ☐ Yes ☐ No (if yes, please explain extent of partnering on project effort)
   Enter text here




                                                                                                   Page 2 of 4
Project Evaluation (Engineering)
1. Were scheduled milestones met? ☐ Yes ☐ No (if no, please explain)
   Enter text here



2. Was original budget met? ☐ Yes ☐ No (if no, please explain)
   Enter text here



3. Any design error or omission? ☐ Yes ☐ No (if yes, any comments?)
   Enter text here



4. Any innovative approaches? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



5. Were DBE/MBE goals met? ☐ Yes ☐ No (if no, please explain)
   Enter text here



6. Any significant stakeholder involvement? ☐ Yes ☐ No (if yes, please explain)
   Enter text here



Please answer the following four questions for any project nominated in the
“Green/Sustainability/Environmental” category.
1. Explain how your project uses recycled materials to eliminate waste or reduce the energy required to build
   and maintain the project.
   Enter text here



2. Explain how your project resulted in a suite of targeted environmental outcomes based upon local
   environmental needs.
   Enter text here



3. Explain how your project ensures sustainability.
   Enter text here



4. Explain how your project goes beyond the minimum standards set forth by the environmental
   laws/regulations and provides net increase in environmental functions.
   Enter text here
                                                                                                    Page 3 of 4
Project Summary: Please give up to a (2) two page summary of the reason this project has been
nominated. Feel free to include photos and/or graphics in your project summary. In addition, if you are
submitting this application via email, please include (4) four photos as attachments to the email message.
If you are submitting via hard copy, please include (4) four photos, up to 8x10 in size, and in color.

Please enter Project Summary here




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