Revision : Last Updated:
Original 12/17/98
Appendix I Contents
Forms & Templates
• Introduction • Adobe Acrobat Automated forms - Professional Services Authorization Request Form - Professional Services Processing Checklist - M/W/DVBE Status Disclosure Form - Form 11 Contract Attachment - Design Review Routing Sheet - Letter of Transmittal • Microsoft Excel Templates - Consultant Evaluation Rating Form - Consultant Evaluation Summary Form - Fee & Manhour Proposal Worksheets + Invoice Template + Progress Report Template - Preliminary Cost Estimate Template • Microsoft Word Templates - Design Review Comments Form + Request for Proposal Boilerplate + Contract Boilerplates + Terms & Conditions + Scope of Services (see also Appendix J) + Schedule & Deliverables + Budget (see also Appendix B) • Other Forms (Printable only) - Consultant Prequalification Vendor Information Form - Federal Form 254 (RFQ Questionnaire) - Federal Form 255 (RFP Questionnaire) - County RFQ/RFP Questionnaire (combines some of 254 & 255)
Note: Forms and Templates proceeded with a plus sign ( + ) are not included in the printed appendix. Please read the introduction on the following page for further clarification.
Riverside County Transportation Department • Consulting Services Manual
I
Revision : Last Updated:
Original 12/17/98
Introduction
Various forms and templates are identified throughout the Consultant Services Manual and are necessary for the use and management of consultants. To simplify the process of locating a form and/or template, they have been compiled into a single location for easy reference. This appendix is that single location. Most of the forms and templates have been developed to be filled out electronically. These forms are provided on the internet and can be downloaded for your use. Some of the forms and templates can be completed by hand if desired and some can not. Forms that are not intended to be completed by hand are not included in this appendix in the printed manual. These forms and templates are identified in the Appendix I - table of contents with the use of a plus ( + ) sign. These forms and templates will, however, be compiled with the rest on the internet site.
Riverside County Transportation Department • Consulting Services Manual
I
Professional Services Authorization Request Form
The approval of the Deputy Director is required prior to advertisement or dissemination of Requests for Qualifications (RFQ) and/or Requests for Proposals (RFP). This requirement is intended to assure coordination with the Directors Office on matters of consulting services.
PROJECT: PROJECT NO.:
DESCRIPTION OF SERVICES:
CONTRACT COST ESTIMATE:
AVAILABLE FUNDING:
FUNDING SOURCE(S):
PROJECTED TIME FRAME:
PROPOSED SELECTION PROCESS: RFQ RFP SOLE SOURCE OTHER
METHOD OF NOTICE: NOTICE WILL BE ADVERTISED ONLY DISTRIBUTED TO PRE-DEFINED LIST
TYPE OF CONTRACT: ACTUAL COST PLUS FIXED FEE COST PER UNIT OF WORK SPECIFIC RATES OF COMPENSATION LUMP SUM
OTHER
OTHER
PROPOSED SELECTION TEAM MEMBERS: (MIN 3 MEMBERS) Include name of Agency if other than County
SUBMITTED BY:
APPROVAL:
CONTRACT ADMINISTRATOR
DATE
DEPUTY DIRECTOR OF TRANSPORTATION
DATE
INSTRUCTION FOR PROCESSING: Contract Administrators forward this form to the Deputy Director for review and approval prior to soliciting consultant services. If approved, the form is returned to the Contract Administrator and fyi copies are forwarded to the Director and the TLMA Purchase Agent.
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Professional Services Processing Checklist
Project Data
PROJECT NAME WO #
DESCRIPTION OF PROPOSED CONTRACT
Directors Office Approval
Professional Services Authorization Form approved & copy attached. YES NO 1
Federal Policy Compliance
Are Federal Funds going to be used for this Contract or any related project activities... IF YES; What are the proposed DBE % Usage Goals... YES NO 2 3
0.00%
Solicitation / Advertisement
Is this RFQ/RFP going to be issued by Advertisement... IF YES; Will be advertised in the Press Enterprise... Will be advertised in the Desert Sun... IF NO; Provide a list of the companies expected to receive solicitations to bid. COMPANY ADDRESS 7 8 9 10 11 YES YES YES NO NO NO 4 5 6
Financial Details
What is the projected cost/budget for this Contract/PO? 12
Processing Options
Sole Source - TLMA Agency Buyer (< $25,000) Sole Source - Board of Supervisors (≥ $25,000) Competitively Bid - Purchasing Department (< $100,000 ) Competitively Bid - Board of Supervisors (≥ $100,000 ) 13 14 15 16
RFQ/RFP/Contract Inclusions
Pre-Qualification Vendor Information form included in RFQ/RFP. Local preference clause included in RFQ/RFP. Contract includes M/W/DVBE promotional clause. Recommended for Approval This package is recommend for Approval... SIGNATURE DATE 20 YES YES YES NO NO NO 17 18 19
Purchasing Department Notification (completed by TLMA Agency Buyer)
Notice of pending Contract sent to Purchasing Department on. Are the firms solicited from a Prequalified list... YES NO 21 22
Approval This package is approved by the TLMA Agency Buyer. SIGNATURE DATE 23
M/W/DVBE Status Disclosure Form (Consultants)
PROJECT:
PREPARED ON:
PROJECT NO.:
Riverside County's M/W/DVBE Contract Participation Program affirms the utilization and participation of qualified minority, women and disabled veteran firms in its contracting and procurement activities. The County encourages general and prime contractors to afford competitive subcontracting opportunities to minority, women and disabled veteran firms, where possible, in their contracting and procurement activities with the County of Riverside.
Prime Consultants
NAME OF COMPANY M/W/DVBE STATUS MBE WBE DVBE N/A CERTIFIED BY $ VALUE
Sub Consultants
NAME OF COMPANY M/W/DVBE STATUS
MBE WBE DVBE N/A
CERTIFIED BY
$ VALUE
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE
WBE
DVBE
N/A
MBE: Minimum 51% owned by minority persons actively participating in day to day management, or if publicly owned, min. 51% of stock owned by minority person. WBE: Minimum 51% owned by women who are actively participating in day to day management. DVBE: Disabled Veteran as determined by State or U.S. Government. Total MBE % Total DBE % Total DVBE %
Prime M/W/DVBE $ value Sub M/W/DVBE $ value Total M/W/DVBE $ value Total Contract $ value % M/W/DVBE of Contract
RIVERSIDE COUNTY TLMA • M/W/DVBE Status Disclosure Form
FORM 11 ATTACHMENT
Contract / Lease / Purchase Summary Data
CONTRACT Approval / Renewal Sole Source Personal Services Independent Contractor Other than low bid Change Order Public Works LEASE Approval / Renewal Multi-year Lease Equipment Real Property Change Order PURCHASE Sole Source Other than low bid Change Order
User Department:
TLMA / Transportation
Selection Committee Members Names:
Vendor / Lessor Name: Vendor / Lessor Location:
Minority Status:
M
W Yes Yes
DV No No
None
Local Preference Applied: Effected Award:
Applicable Board Policy No.
Comments:
RFQ/RFP Process: Date Mailed: Response Date: Number of Responses: Qualified Recipients:
Bidding Process: Bid Range: Local Bid Range: Responsive & Responsible Bid Range: Local Preference Award cost: Local Preference FYTD cost: EXISTING AGREEMENT ITEMS to to to
(5% maximum preference)
# of orders: PROPOSED AGREEMENT ITEMS
1. Rate 2. Terms 3. Conditions 4. Legal Issues 5. Accountability 6. Other Other Comments:
This is a test of the american broadcast sytem.
Design Review Routing Sheet
PROJECT NAME: WO #: DATE:
SUBMITTAL:
PROJECT MANAGER:
DATE COMMENTS ARE DUE:
TECHNICAL DISCIPLINES (CHECK AS APPROPRIATE)
REVIEW OF DESIGN SUBMITTAL
REVIEW OF CONSOLIDATED COMMENTS
Initials Directors Office Project Development Group A Project Development Group B Project Development Group C Development Plan Check Highway Operations Construction Inspection Traffic Engineering Transportation Planning Materials Laboratory Survey Administration Utilities Specifications & Special Prov. Environmental FHWA Caltrans Flood Control
Date
Initials
Date
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
to: from: sender: date:
LETTER OF TRANSMITTAL
copies to:
instructions: document: letter report drawing / plan specifications other please note: revisions originals copies submitted: at your request for your information / use for your review / comment for your action for your approval / signature via: mail express mail messenger pickup
additions
deletions
other
enclosure list: description: revision: date: copies:
comments:
4080 Lemon Street, 8th Floor • PO Box 1090 • Riverside, CA Phone: (909) 955-6748 • Fax: (909) 955-3164
92502-1090
CONSULTANT SERVICES EVALUATION RATING FORM
PROJECT: Written Qualifications Written Proposal Interview EVALUATOR: DATE: FIRM: SCORE:
(0-100)
CRITERIA
WEIGHT (1-3)
SCORE (0-10)
TOTAL (WxS) (0-30)
COMMENTS
Notes:
For projects other than architectural, engineering, environmental, land surveying, or construction management services, cost should be one of the criteria. For Federal projects, demonstrated DBE intent should be an evaluation criteria.
CONSULTANT SERVICES EVALUATION SUMMARY FORM
Number of Interviewers TOTALS Score Rank Score Rank Score Rank Score Rank Score Rank Score Rank Score Rank Date:
Project:
CONSULTANTS
NOTE:
Total Score = addition of all scores (higher is better) Total Rank = addition of all ranks divided by the number of reviewers
FEE PROPOSAL SUMMARY PHASE 1 PHASE II PHASE III PHASE IV PHASE V TOTALS
TOTALS
Phase I: Phase II: Phase III: Phase IV: Phase V:
FEE PROPOSAL WORKSHEET
COMPANY: SCOPE OF WORK DATE: REV: PROJECT: MILESTONE/PHASE/PROJECT SUMMARY:
DIRECT LABOR PERSONNEL
FUNCTION
HOURS
RATE
AMOUNT
TOTAL HOURS MULTIPLIERS ESCALATION @ OVERHEAD @ PAYROLL ADDITIVES @ (Rate) (of Total Direct Labor + Escalation) (of Total Direct Labor + Escalation)
TOTAL DIRECT LABOR
TOTAL MULTIPLIERS OTHER DIRECT EXPENSES ITEM ¥¥¥ Billed at Actual Cost ¥¥¥ QUANTITY
UNIT
UNIT COST
AMOUNT
TOTAL OTHER DIRECT EXPENSES OUTSIDE SERVICES (w/o fee) COMPANY LABOR MULTIPLIER EXPENSES TOTAL
TOTAL OUTSIDE SERVICES FEES OUTSIDE SERVICES ADMIN FEE @ 0@ OUTSIDE SERVICES @ (of Total Outside Services & Outside Services Fees) 10.00% (of Total Direct Labor + Total Multipliers) 10.00% (of Total Labor + Total Multiplier for Outside Services) TOTAL FEES TOTAL COST
MANHOUR WORKSHEET
SCOPE OF WORK MILESTONE/PHASE/PROJECT SUMMARY: DATE: REVISION:
COMPANY:
PROJECT:
0 Summary
TOTAL
TASK
Phase 1 Subtotal
Phase 2 Subtotal
Phase 3 Subtotal
Phase 4 Subtotal
Phase 5 Subtotal
Totals
0 Summary
TOTAL
0 Summary
TOTAL
0 Summary
TOTAL
0 Summary
TOTAL
0 Summary
TOTAL
0 Summary
TOTAL
MANHOUR WORKSHEET
SCOPE OF WORK MILESTONE/PHASE/PROJECT SUMMARY: DATE: REVISION:
COMPANY:
PROJECT:
TASK
TOTAL
Total Manhours
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: SCOPE: BY: DATE:
PRINTED:
PROJECT NO.: LABOR TYPE: LENGTH (miles) WIDTH (feet) NO. OF LANES: TOTAL ESTIMATE
RCTD TASK TOTAL PROJECT COSTS ADMINISTRATION Project Management / General Administration / Contract Prep. NOTE STAFF
CONSULTANT / CONTRACTOR
OTHER FEE
SPECIAL DISTRICTS Formation / Assessment Engineer / Counsel / Bonds
DESIGN
Preliminary Survey / Alternative Concepts / Project Study Report Technical Studies / Permits / Preliminary Engineering / Project Report Design Survey / Plan Checking / Final Plans, Specs & Estimates / Award Processing Other
ENVIRONMENTAL
Environmental Assessment Studies Mitigations Permit Fees Other
RIGHT-OF-WAY
Right-of-Way Engineering / Research / Appraisal Fees / Title Fees / Certs Acquisition, Condemnation Settlements, Base Cost Clearance/Demolition Acquisition of Off-site Mitigation Sites Other
UTILITIES
Research / Plans / Coordination Relocation Other
CONSTRUCTION
Construction Management Construction Survey Materials Testing Construction Inspection Roadway Construction Items Structure Construction Items
COST ANALYSIS Administration cost as a percentage of Design & Environmental Design cost as a percentage of Construction Environmental cost as a percentage of Construction Construction Cost Per Mile Construction Cost Per Lane Mile Construction Cost Per Square foot
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: RCTD TASK PROJECT MANAGEMENT & ADMINISTRATION Project Management (Pre Construction ) Administrative Engineering Contract Preparation / Legal Counsel Other DESIGN SURVEY Preliminary Survey Field Survey Aerial Survey Design Survey Other DESIGN ENGINEERING Project Study Report / Alternative Concepts Permits / Agreements Technical Studies Traffic Study Materials Report Hydrology Analysis and / or Drainage Report Utility Relocation Plans Design Exception Project Report / Preliminary Engineering Final Plans Contract Documents (Specs & Estimates) Plan Checking Award Processing Other ENVIRONMENTAL ENVIRONMENTAL ASSESSMENT Documentation Processing Fee Other SPECIAL STUDIES Air Quality Analysis Historical Evaluation Archaeological Survey Hazardous Waste Survey Biological Survey(s) Paleontological Survey Mitigation Plan Land Use/Noise/Relocation/Etc... MITIGATIONS Habitat Replacement/Protection Fossil Recovery Noise Abatement Air Quality Landscaping PERMITS / AGREEMENTS Fish & Game 1601 Permit Corp. of Engineers 404 Permit Stevens Kangaroo Rat Take Section 10a / Section 7 NPDES Other Other NOTE STAFF CONSULTANT / CONTRACTOR
PRINTED: PROJECT NO.: OTHER FEE TOTAL ESTIMATE
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: RCTD TASK RIGHT-OF-WAY NOTE STAFF CONSULTANT / CONTRACTOR
PRINTED: PROJECT NO.: OTHER FEE TOTAL ESTIMATE
Research Right-of-Way Engineering Legals Plats Maps Certifications Title & Escrow Fees Appraisals Acquisition Condemnation Costs Base Right-of-Way Costs Clearance/Demolition Off-Site Mitigation Areas Other
UTILITIES
Research Coordination Plans Relocation Other
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: ROADWAY CONSTRUCTION ITEM EARTHWORK Roadway Excavation Imported Borrow Clearing & Grubbing Develop Water Supply NOTE UNITS QUANTITIES
PRINTED: PROJECT NO.:
UNIT COSTS
COST
STRUCTURAL SECTION PCC Pavement Asphalt Concrete AC Base Aggregate Base Aggregate Subbase Pavement Reinforcing Fabric Curb & Gutter AC Dike Sidewalk
DRAINAGE Large Drainage Facilities / Pumping Plants Storm Drains Project Drainage (X-Drains, Overside, Slotted Pipes) Rock Slope Protection Headwalls Concrete Channel Lining
TRAFFIC ITEMS Lighting Traffic Signals Permanent Signing Traffic Controls Traffic Management Plan
SPECIALTY ITEMS Retaining Walls Soundwalls Remove / Relocate Existing Facilities Landscaping / Irrigation / Establishment Erosion Control Slope Paving Barriers & GuardRails Hazardous Waste Fencing SUBTOTAL (A): MINOR ITEMS 10% of SUBTOTAL (A) 10% SUBTOTAL (B): ROADWAY MOBILIZATION ROADWAY ADDITIONS CONTINGENCIES 10% of SUBTOTAL (B) 5 - 10% of SUBTOTAL (B) 10 - 50% of SUBTOTAL (B) 10% 10% 25%
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: STRUCTURES CONSTRUCTION ITEM NOTE UNITS QUANTITIES
PRINTED: PROJECT NO.:
UNIT COSTS
COST
Structure Construction Structure Type Footing Type Width Span Length Structure Depth Total Area
Remove Existing Bridge Railroad Related Costs Other
Structure Construction Structure Type Footing Type Width Span Length Structure Depth Total Area
Remove Existing Bridge Railroad Related Costs Other
Structure Construction Structure Type Footing Type Width Span Length Structure Depth Total Area
Remove Existing Bridge Railroad Related Costs Other
Structure Construction Structure Type Footing Type Width Span Length Structure Depth Total Area
Remove Existing Bridge Railroad Related Costs Other
PRELIMINARY PROJECT COST ESTIMATE
PROJECT: RCTD TASK SPECIAL DISTRICTS Administration Assessment Engineering Engineers Report Public Hearings Formation Processing Bonds Counsel Paying Agent or Treasure Printing Discount NOTE STAFF CONSULTANT / CONTRACTOR
PRINTED: PROJECT NO.: OTHER FEE TOTAL ESTIMATE
Contingency Other
Design Review Comments
PROJECT NAME: SUBMITTAL: DISCIPLINE: REVIEWED BY: PROJECT NUMBER
ACTION CODE:
ITEM NO.
A = WILL COMPLY
B = NEED TO EVALUATE
C = NEED CLARIFICATION
D = DELETE COMMENT
REVIEW CONF. ACTION FINAL DISPOS
DWG., CA. SPEC.
COMMENTS
7/15/99
Page: 1 of 2
STANDARD FORM (SF)
254
Architect-Engineer and Related Services Questionnaire
Form Approved OMB No. 9000-0004
Public reporting burden for this collection of information is estimated to average 1 hour per response, 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 (VRS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, D.C. 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0004), Washington, D.C. 20503.
Purpose: The policy of the Federal Government in acquiring architectural, engineering, and related professional services is to encourage firms lawfully engaged in the practice of those professions to submit annually a statement of qualifications and performance data. Standard Form 254, "Architect-Engineer and Related Services Questionnaire," is provided for that purpose. Interested A-E firms (including new, small, and/or minority firms) should complete and file SF 254's with each Federal agency and with appropriate regional or district offices for which the A-E is Qualified to perform services. The agency head for each proposed project shall evaluate these qualification resumes, together with any other performance data on file or requested by the agency, in relation to the proposed project. The SF 254 may be used as a basis for selecting firms for discussions, or for screening firms preliminary to inviting submission of additional information. Definitions: "Architect-Engineer Services" are defined in Part 36 of the Federal Acquisition Regulation. "Parent Company" is that firm, company, corporation, association or conglomerate which is the major stockholder or highest tier owner of the firm completing this questionnaire, i.e., Firm A is owned by Firm B which is, in turn, a subsidiary of Corporation C. The "parent company" of Firm A is Corporation C. "Principals" are those individuals in a firm who possess legal responsibility for its management. They may be owners, partners, corporate offices, associates, administrators, etc. "Discipline" as used in this questionnaire, refers to the primary technological capability of individuals in the responding firm. Possession of an academic degree, professional registration, certification, or extensive experience in a particular field of practice normally reflects an individual's primary technical discipline. "Joint Venture" is a collaborative undertaking by two or more firms or individuals for which the participants are both jointly and individually responsible. "Consultant," as used in this questionnaire, is a highly specialized individual or firm having significant input and responsibility for certain aspects of a project and possessing unusual or unique capabilities for assuring success of the finished work. "Prime" refers to that firm which may be coordinating the concerted and complementary inputs of several firms, individuals or related services to produce a completed study or facility. The "prime" would normally be regarded as having full responsibility and liability for quality of performance by itself as well as by subcontractor professionals under its jurisdiction.
"Branch Office" is a satellite, or subsidiary extension, of a headquarters office of a company, regardless of any differences in name or legal structure of such a branch due to local or state laws. "Branch offices" are normally subject to the management decisions, bookkeeping, and policies of the main office. Instructions of Filing (Numbers below correspond to numbers contained in form): 1. Type accurate and complete name of submitting firm, its address, and zip code. 1a. Indicate whether form is being submitted in behalf of a parent firm or a branch office. (Branch office submissions should list only personnel in, and experience of, that office.) 2. Provide date the firm was established under the name shown in question 1. 3. Show date on which form is prepared. All information submitted shall be current and accurate as of this date. 4. Enter type of ownership, or legal structure, of firm (sole proprietor, partnership, corporation, joint venture, etc.). Check appropriate boxes indicating if firm is (a) a small business concern; (b) a small business concern owned and operated by socially and economically disadvantaged individuals; and (c) Woman-owned (See 48 CFR 19.101 and 52.219-9). 5. Branches of subsidiaries of large or parent companies, or conglomerates, should insert name and address of highest-tier owner. 5a. If present firm is the successor to, or outgrowth of, one or more predecessor firms, show name(s) of former entity(ies) and the year(s) of their original establishment. 6. List not more than two principals from submitting firm who may be contacted by the agency receiving this form. (Different principals may be listed on forms going to another agency.) Listed principals must be empowered to speak for the firm on policy and contractual matters. 7. Beginning with the submitting office, list name, location, total number of personnel, and telephone numbers for all associated or branch offices, (including any headquarters or foreign offices) which provide A-E and related services. 7a. Show total personnel in all offices. (Should be sum of all personnel, all branches.) 8. Show total number of employees, by discipline, in submitting office. (*If form is being submitted by main or headquarters office, form should list total employees, by discipline, in all offices.) While some personnel may be qualified in several disciplines, each person should be counted only once in accord with his or her primary function. Include clerical personnel as "administrative." Write in any additional disciplines -- sociologists, biologists,etc. -- and number of people in each, in blank spaces.
NSN 7540-01-152-8073
254-104
STANDARD FORM 254
(REV. 11-92)
STANDARD FORM (SF)
254
Architect-Engineer and Related Services Questionnaire
of that project (if government agency indicate responsible office); (d) show the estimated construction cost (or other applicable cost) for that portion of the project for which the firm was primarily responsible. (Where no construction was involved, show approximate cost of firm's work); and (e) state year work on that particular project was, or will be, completed. 12. The completed SF 254 should be signed by a principal of the firm, preferably the chief executive officer. 13. Additional data, brochures, photos, etc. should not accompany this form unless specifically requested. NEW FIRMS (not reorganized or recently-amalgamated firms) are eligible and encouraged to seek work from the Federal Government in connection with performance of projects for which they are qualified. Such firms are encouraged to complete and submit Standard Form 254 to appropriate agencies. Questions on the form dealing with personnel or experience may be answered by citing experience and capabilities of individuals in the firm, based on performance and responsibility while in the employee of others. In so doing, notation of this fact should be made on the form. In question 9, write in "N/A" to indicate "not applicable" for those years prior to firm's organization.
9. Using chart (below) insert appropriate index number to indicate range of professional services fees received by submitting firm each calendar year for last five years, most recent year first. Fee summaries should be broken down to reflect the fees received each year for (a) work performed directly for the Federal Government (not including grant and loan projects) or as a sub to other professionals performing work directly for the Federal Government; (b) all other domestic work, U.S. and possessions, including Federally-assisted projects, and (c) all other foreign work.
Ranges of Professional Services Fees INDEX
1. 2. 3. 4. Less than $100,000 $100,000 to $250,000 $250,000 to $500,000 $500,000 to $1 million
INDEX
5. 6. 7. 8. $1 million to $2 million $2 million to $5 million $5 million to $10 million $10 million or greater
10. Select and enter, in numerical sequence, not more than thirty (30) "Experience Profile Code" numbers from the listing (next page) which most accurately reflect submitting firm's demonstrated technical capabilities and project experience. Carefully review list. (It is recognized some profile codes may be part of other services or projects contained on list; firms are encouraged to select profile codes which best indicate type and scope of services provided on past projects.) For each code number, show total number of projects and gross fees (in thousands) received for profile projects performed by firm during past few years. If firm has on or more capabilities not included on list, insert same in blank spaces at end of list and show numbers in question 10 on the form. In such cases, the filled-in listing must accompany the complete SF 254 when submitted to the Federal agencies. 11. Using the "Experience Profile Code" numbers in the same sequence as entered in item 10, give details of at least one recent (within last five years) representative project for each code number, up to a maximum of thirty (30) separate projects, or portions of projects, for which firm was responsible. (Project examples may be used more than once to illustrate different services rendered on the same job. Example: a dining hall may be part of an auditorium or educational facility.) Firms which select less than thirty "profile codes" may list two or more project examples (to illustrate specialization) for each code number so long as total of all project examples does not exceed thirty (30). After each code number in question 11, show: (a) whether firm was "P," the prime professional, or "C," a consultant, or "JV," part of a joint venture on that particular project (new firms, in existence less than five (5) years may use the symbol "IE" to indicate "Individual Experience" as opposed to firm experience); (b) provide name and location of the specific project which typifies firm's (or individual's) performance under that code category; (c) give name and address of the owner
STANDARD FORM 254
PAGE 2
(REV. 11-92)
Experience Profile Code Numbers for use with questions 10 and 11
001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020 021 022 023 024 025 026 027 028 029 030 031 032 033 034 035 036 037 038 039 040 Acoustics, Noise Abatement Aerial photogrammetry Agricultural Development; Grain Storage: Farm Mechanization Air Pollution Control Airports; Navaids; Airport Lighting: Aircraft Fueling Airports; Terminals & Hangars; Freight Handling Arctic Facilities Auditoriums & Theatres Automation; Controls; Instrumentation Barracks; Dormitories Bridges Cemeteries (Planning & Relocation) Chemical Processing & Storage Churches; Chapels Codes; Standards; Ordinances Cold Storage; Refrigeration; Fast Freeze Commercial Building (low rise): Shopping Centers Communication Systems; TV: Microwave Computer Facilities; Computer Service Conservation and Resource Management Construction Management Corrosion Control; Cathodic Protection; Electrolysis Cost Estimating Dams (Concrete:Arch) Dams (Earth; Rock); Dikes; Levees Desalinization (Process & Facilities) Dining Halls: Clubs; Restaurants Ecological & Archeological Investigations Educational Facilities; Classrooms Electronics Elevators; Escalators; People-Movers Energy Conservation; New Energy Sources Environmental Impact Studies, Assessments or Statements Fallout Shelters; Blast-Resistant Design Field Houses; Gyms; Stadiums Fire Protection Fisheries; Fish Ladders Forestry & Forest Products Garages: Vehicle Maintenance Facilities Parking Decks Gas Systems (Propane; Natural, Etc.)
041 042 043 044 045 046 047 048 049 050 051 052 053 054 055 056 057 058 059 060 061 062 063 064 065 066 067 068 069 070 071 072 073 074 075 076 077 078 079 080 081 082 083 084
Graphic Design Harbors; Jetties; Piers, Ship Terminal Facilities Heating; Ventilating; Air Conditioning Health Systems Planning Highrise; Air-Rights-Type Buildings Highways; Streets; Airfield Paving Parking Lots Historical Preservation Hospital & Medical Facilities Hotels; Models Housing (Residential, Multi-Family; Apartments; Condominiums) Hydraulics & Pneumatics Industrial Buildings; Manufacturing Plants Industrial Processes; Quality Control Industrial Waste Treatment Interior Design; Space Planning Irrigation; Drainage Judicial and Courtroom facilities Laboratories; Medical Research Facilities Landscape Architecture Libraries; Museums; Galleries Lighting (Interiors; Display: Theatre, Etc.) Lighting (Exteriors; Streets; Memorials; Athletic Fields, Etc.) 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 Nuclear Facilities; Nuclear Shielding Office Building; Industrial Parks Oceanographic Engineering Ordnance; Munitions; Special Weapons Petroleum Exploration; Refining Petroleum and Fuel (Storage and Distribution) Pipelines (Cross-Country - Liquid & Gas) Planning (Community, Regional Areawide and State) Planning (Site, Installation, and Project) Plumbing & Piping Design Pneumatic Structures, Air-Support Buildings Postal Facilities Power Generation, Transmission. Distribution Prisons & Correctional Facilities
085 086 087 088 089 090 091 092 093 094 095 096 097 098 099 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 201 202 203 204 205
Product, Machine & Equipment Design Radar; Sonar; Radio & Radar Telescopes Railroad; Rapid Transit Recreation Facilities (Parks, Marinas, Etc.) Rehabilitation (Buildings; Structures; Facilities) Resource Recover; Recycling Radio Frequency Systems &Shieldings Rivers; Canals; Waterways; Flood Control 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; Land Fill Special Environments; Clean Rooms, Etc. Structural Design; Special Structures Surveying:; Platting; Mapping; Flood Plain Studies Swimming Pools Storm Water Handling & Facilities Telephone Systems (Rural; Mobile: Intercom, Etc.) Testing Inspection Services Traffic & Transportation Engineering Towers (Self-Supporting & Guyed Systems) Tunnels & Subways Urban Renewals; Community Development Utilities (Gas & Steam) Value Analysis; Life-Cycle Costing Warehouses & Deports Water Resources; Hydrology; Ground Water Water Supply; Treatment and Distribution Wind Tunnels; Research/Testing Facilities Design Zoning; Land Use Studies ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________
STANDARD FORM 254
PAGE 3
(REV. 11-92)
STANDARD FORM (SF)
1. Firm Name/Business Address:
2. Year Present Firm Established
3. Date Prepared:
254
Architect-Engineer and Related Services Questionnaire 1a. Submittal is for Parent Company Branch or Subsidiary Office 5. Name of Parent Company, if any:
.
4. Specify type of ownership and check below, if applicable.
A. Small Business B. Small Disadvantaged Business C. Woman-owned Business
5a. Former Parent Company Name(s), if any, and Year(s) Established:
6. Names of not more than Two Principals to Contact: Title/Telephone
1) 2)
7. Present Offices:
City / State / Telephone / No. Personnel Each Office
7a. Total Personnel
8. Personnel by Discipline: (List each person only once, by primary function.) Administrative Electrical Engineers Architects Estimators Chemical Engineers Geologist Civil Engineers Hydrologists Construction Inspectors Interior Designers Draftsmen Landscape Architects Ecologists Mechanical Engineers Economists Mining Engineers 9. Summary of Professional Services Fees Received: (Insert index number)
Direct Federal contract work, including overseas
Oceanographers Planners: Urban/Regional Sanitary Engineers Soils Engineers Specification Writers Structural Engineers Surveyors Transportation Engineers 19 19
Ranges of Professional Services Fees INDEX 1. Less than $100,000 2. $100,000 to $250.000 3. $250,000 to 500,000 4. $500,000 to $1 million 5. $1 million to $2 million 6. $2 million to $5 million 7. $5 million to $10 million 8. $10 million or greater
Last 5 Years (most recent year first) 19 19 19
All other domestic work All other foreign work*
*Firms interested in foreign work, but without such experience, check here:
STANDARD FORM 254
PAGE 4
(REV. 11-92)
Profile of Firm's Project Experience, Last 5 Years Profile
1) 2) 3) 4) 5) 6) 7) 8) 9) 10)
Number of
Total Gross Fees (in thousands)
11) 12) 13) 14) 15) 16) 17) 18) 19) 20)
Profile Code
Number of Projects
Total Gross Fees (in thousands)
21) 22) 23) 24) 25) 26) 27) 28) 29) 30)
Profile Code
Number of Projects
Total Gross Fees (in thousands)
11. Project examples, Last 5 Years Profile Code "P," "C," "JV," or "IE" Project Name and Location 1. Owner Name and Address Cost of Work (in thousands) Completion Date (Actual
.
2
3
4
5
6
7
STANDARD FORM 254
PAGE 5
(REV. 11-92)
8
9
10
11
12
13
14
15
16
17
18
19
STANDARD FORM 254
PAGE 6
(REV. 11-92)
20
21
22
23
24
25
26
27
28
29
30
12. The foregoing is a statement of facts Typed Name and Title:
Date:
STANDARD FORM 254
PAGE 7
(REV. 11-92)
STANDARD FORM (SF)
255
Architect-Engineer and Related Services Questioinnaire for Specific Project
Form Approved OMB No. 9000-0005
Public reporting burden for this collection of information is estimated to average 1.2 hours per response, 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 infomation, including suggestions for reducing this burden, to the FAR Secretarial (VRS), Office of Federal Acquisition and Regulatory Policy, GSA,Washington, D.C. 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0005), Washington, D.C. 20503. Purpose: This form is a supplement to the "Architect-Engineer and Related Services Questtionnaire" (SF254). Its purpose is to provide additional information regarding the qualifications of interested firms to undertake a specific Federal A-E project. Firms, or branch offices of firms, submitting this form should enclose (or already have on file with the appropriate office of the agency) a current (within the past year) and accurate copy of the SF254 for that office. The procurement official responsible for each proposed project may request submission of the SF255 "Architiect-Engineer and Related Services Questionnaire for Specific Project" in accord with applicable civilian and military procurement regulations and shall evaluate such submissions, as well as related information contained on the Standard Form 254, and any other performance data on file with the agency, and shall select firms for subsequent discussions leading to contract award in conformance with Public Law 92-582. This form should only be filed by an architect-engineer or related services firm when requested to do so by the agency or by a public announcements. Responses should be as complete and accurate as possible, contain data relative to the specific project for which you wish to be considered, and should be provided, by the required due date, to the office specified in the request or public announcement. This form will be used only for the specified project. Do not refer to this submittal in response to other requests or public announcements. Definitions: "Architect-Engineer Services" are defined in Part 36 of the Federal Acquisition Regulation. "Principals" are those individuals in a firm who possess legal responsibility for its management. They may be owners, partners, corporate officers, associates, administrators, etc. "Discipline," as used in this questionnaire, refers to the primary technological capability of individuals in the responding firm. Possession of an academic degree, professional registration, certification, or extensive experience in a particular field of practice normally reflects an individual's primary technical discipline. "Joint Venture" is a collaborative undertaking by two or more firms or individuals for which the participants are both jointly and individully responsible. "Key Persons, Specialists, and Individual Consultants, " as used in thi squestionnnaire, refer to individuals who will have major project responsibility or will provide unusual or unique capabilities for the project under consideration. Instructions for Filing (Numbers below correspond to numbers contained in form): 1. Give name and location of the project for which this form is being submitted. 2. Provide appropriated data from the Commerce Business Daily (CBD) identifying the particular project for which this form is being filed. 2a. Give the date of the Commerce Business Daily in which the project announcement appeared, or indicate "not applicable" (N/A) if the source of the announcement is other than the CBD. 2b. Indicate Agency identification or contract number as provided in the CBD announcement. 3. Show name and address of the individual or firm (or joint venture) which is submitting this form for the project. 3a. List the name, title, and telephone number of that principal who will serve as the point of contact. Such an individual must be empowered to speak for the firm on policy and contractual matters and should be familiar with the programs and procedures of the agency to which this form is directed. 3b. Give the address of the specific office which will have responsibility for performing the announced work. 4. Insert the number of consultant personnel by discipline proposed for subject project on line (A). Insert the number of in-house personnel by discipline proposed for subject project on line (B). While some personnel may be qualified in several disciplines, each person should be counted only once in accord with his or her primary function. Include clerical personnel as "administrative." Write in any additional disciplines-- sociologists, biologists, etc.--and number of people in each, in blank spaces. 5. Answer only if this form is being submitted by a joint venture of two or more collaborating firms. Show the names and addresses of all individuals or organizations excepted to be included as part of the joint venture and describe their particular areas of anticipated responsibility (ie., technical disciplines, administration, financial, sociological, environment, etc.). 5a. Indicate, by checking the appropriate box, whether this particular joint venture has worked together on other projects. Each firm participating in the joint venture should have a Standard Form 254 on file with the contracting office receiving this form. Firms which do not have such forms on file should provide same immediately along with a notation at the top of page 1 of the form regarding their association with this joint venture submittal.
NSN 7540-01-152-8074 Previous edition not usable.
255-104
STANDARD FORM 255 (REV. 11-92) Prescibibed by GSA - FAR (48 CFR) 53.236-2(2)
STANDARD FORM (SF)
255
Architect-Engineer and Related Services Questioinnaire for Specific Project
Standard Form 255 General Services Administration Washington, D.C. 20405
9. List only those projects which the A-E firm or joint ventrue, or members of the joint venture, are currently performing under direct contract with an agency or department of the Federal Government. Exclude any grant or loan projects being financed by the Federal Government but being performed under contract to other non-Federal Government entities. Information provided under each heading is similar to that requested in the preceding Item 8, except for (d) "Percent Complete." Indicate in this item the percentage of A-E work completed upon filing this form. 10. Through narrative discussion, show reason why the firm or joint venture submitting this questionnaire believes it is especially qualified to undertake the project. Information provided should include, but not be limited to, such data as: specialized equipment available for this work, any awards or recognition received by a firm or individuals for similar work, required security clearances, special approaches or concepts developed by the firm relevant to this project, etc. Respondents may say anything they wish in support of their qualifications. When appropriate, respondents may supplement this proposal with graphic material and photographs which best demonstrate design capabilities of the team proposed for this project. 11. Completed forms should be signed by the chief executive officer of the joint venture (thereby attesting to the concurrence and commitment of all members of the joint venture), or by the architect-engineer principal responsible for the conduct of the work in the event it is awarded to the organization submitting this form. Joint ventures selected for subsequent discussions regarding this project must make available a statement of participation signed by a principal of each member of the joint venture. ALL INFORMATION CONTAINED IN THE FORM SHOULD BE CURRENT AND FACTUAL.
6. If respondent is not a joint venture, but intends to use outside (as opposed to in-house or permanently and formally affiliated) consultants or associates, he should provide names and addresses of all such individuals or firms, as well as their particular areas of technical/professional expertise, as it relates to this project. Existence of previous working relationships should be noted. If more eight outside consultants or associates are anticipated, attach an additional sheet containing requested information. 7. Regardless of whether respondent is a joint venture or an independent firm, provide brief resumes of key personnel expected to participate on this project. Care should be taken to limit resumes to only those personnel and specialists who will have major project responsibilities. Each resume must include: (a) name of each key person and specialist and his or her title, (b) the project assignment or role which that person will be expected to fulfill in connection with this project, (c) the name of the firm or organization, if any, with whom that individual is presently associated, (d) years of relevant experience with present firm and other firms, (e) the highest academic degree achieved and the discipline covered (if more than one highest degree, such as two Ph.D.'s, list both), the year received and the particular technical/professional discipline which that individual will bring to the project, (f) if registered as an architect, engineer, surveyor, etc., show only the field of registration and the year that such registration was first acquired. If registrered in several states, do not list states, and (g) a synopsis of experience, training, or other qualities which reflect individual's potential contribution to this project. Include such data as: familiarity with Government or agency procedures, similar type of work performed in the past, management abilities, familiarity with the geographic area, relevant foreign language capabilities, etc. Please limit synopsis of experience to directly relevant information. 8. List up to ten projects which demonstrate the firm's or joint venture's competence to perform work similar to that likely to be required on this project. The more recent such projects, the better. Prime consideration will be given to projects which illustrate respondent's capability for performing work similar to that being sought. Required information must include: (a) name and location of project, (b) brief description of type and extent of services provided for each project (submissions by joint ventures should indicate which member of the joint venture was the prime on that particular project and what role it played), (c) name and address of the owner of that project (if Government agency, indicate responsible office), and name and phoone number of individual to contact for reference (preferably the project manager), (d) completion date (actual when available, otherwise estimated), (e) total construction cost of completed project (or where no construction was involved, the approximate cost of your work) and that portion of the cost of the project for which the named firm was/is responsible.
STANDARD FORM 255 PAGE 2 (REV.11-92)
STANDARD FORM (SF)
1. Project Name/Location for which Firm is Filing:
255
Architect-Engineer and Related Services Questionnaire for
2a. Commerce Business Daily Announcement Date, if any:
2b. Agency Identification Number, if any:
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 utillized on this project on line (A) and in-house personnel on line (B).
(A) (A) (A) (A) (A) (A) (A) (A) (B) (B) (B) (B) (B) (B) (B) (B)
Administrative Architects Chemical Engineers Civil Engineers
(A) (A)
(B) (B) (B) (B) (B) (B) (B) (B)
Electrical Engineers Estimaotors Geologists Hydrologists Interior Designers Landscape Architects Mechanical Engineers Mining Engineers
(A) (A) Construction Inspectorrs (A) Draftsmen (A) Ecologists (A) Economists (A)
(A) (A) (A) (A) (A) (A) (A) (A)
(B) (B) (B) (B) (B) (B) (B) (B)
Oceanographers Sanitary Engineers Soils Engineers Specifications Writers Structural Engineers Surveyors
(A) (A) (A) (A)
(B) (B) (B) (B) (B) (B) (B) (B)
Planners: Urban/Regional (A)
(A) (A) Transportation Engineers (A)
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). Worked with Prime before (Yes or No)
Name & Address 1.
Specialty
2.
3.
4.
5.
6.
7.
8.
STANDARD FORM 255 PAGE 4 (REV.11-92)
7. Brief resume of key persons, specialist, and individual consultants anticipated for this project. a. Name & Title: a. Name & Title:
b. Project Assignment:
b. Project Assignment:
c. Name of Firm with which associated:
c. Name of Firm with which associated:
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
f. Active Registration: Year First Registered/Discipline
f. Active Registration: Year First Registered/Discipline
g. Other Experience and Qualifications relevant to the proposed project:
g. Other Experience and Qualifications relevant to the proposed project:
STANDARD FORM 255 PAGE 5 (REV.11-92)
7. Brief resume of key persons, specialist, and individual consultants anticipated for this project. a. Name & Title: a. Name & Title:
b. Project Assignment:
b. Project Assignment:
c. Name of Firm with which associated:
c. Name of Firm with which associated:
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
f. Active Registration: Year First Registered/Discipline
f. Active Registration: Year First Registered/Discipline
g. Other Experience and Qualifications relevant to the proposed project:
g. Other Experience and Qualifications relevant to the proposed project:
STANDARD FORM 255 PAGE 6 (REV.11-92)
7. Brief resume of key persons, specialist, and individual consultants anticipated for this project. a. Name & Title: a. Name & Title:
b. Project Assignment:
b. Project Assignment:
c. Name of Firm with which associated:
c. Name of Firm with which associated:
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
f. Active Registration: Year First Registered/Discipline
f. Active Registration: Year First Registered/Discipline
g. Other Experience and Qualifications relevant to the proposed project:
g. Other Experience and Qualifications relevant to the proposed project:
STANDARD FORM 255 PAGE 7 (REV.11-92)
7. Brief resume of key persons, specialist, and individual consultants anticipated for this project. a. Name & Title: a. Name & Title:
b. Project Assignment:
b. Project Assignment:
c. Name of Firm with which associated:
c. Name of Firm with which associated:
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
d. Years experience: With this Firm e. Education: Degree(s)/Year/Specialization
With Other Firms
f. Active Registration: Year First Registered/Discipline
f. Active Registration: Year First Registered/Discipline
g. Other Experience and Qualifications relevant to the proposed project:
g. Other Experience and Qualifications relevant to the proposed project:
STANDARD FORM 255 PAGE 8 (REV.11-92)
8. Work by firms or joint-venture members which best illustrates current qualifications relevant to this project (list not more than 10 projects). 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
a. Project Name & Location (1)
b. Nature of Firm's Responsibility
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
STANDARD FORM 255 PAGE 9 (REV. 11-92)
9. All work by firms or joint-venture members currently being perfomed directly for Federal agencies. c. Agency (Responsible Office) Name and Address and Project Manager's Name & Phone Number
e. Estimated Cost (in Thousands) Entire Project Work for Which Firm Is Responsible
a. Project Name & Location
b. Nature of Firm's Responsibility
d. Percent Complete
STANDARD FORM 255 PAGE 10 (REV11-92)
10. Use this space to provide any additional information or desciption of resources (including any computer design capabilities) supporting your firm's qualificaitons for the proposed project
11. The foregoing is a statement of facts. Signature: Typed Name and Title:
Date:
STANDARD FORM 255 PAGE 10 (REV11-92)
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
Instructions for Filing (Numbers below correspond to numbers contained in form):
1. 2.
Give name and location of the project or a description of the request for qualifications for which this form is being submitted. Show name and address of the individual or firm (or joint venture) which is submitting this form. 2a. List the name, title, and telephone number of that principal who will serve as the point of contact. Such an individual must be empowered to speak for the firm on policy and contractual matters and should be familiar with the programs and procedures of the agency to which this form is directed. Give the address of the specific office which will have responsibility for performing the announced work.
6.
2b. 3.
List up to ten projects which demonstrate the firm's or joint venture's competence to perform work similar to that likely to be required. The more recent such projects, the better. Prime consideration will be given to projects which illustrate respondent's capability for performing work similar to that being sought. Required information must include: (a) name and location of project, (b) brief description of type and extent of services provided for each project (submissions by joint ventures should indicate which member of the joint venture was the prime on that particular project and what role it played), (c) name and address of the owner of that project (if Government agency, indicate responsible office), and name and phone number of individual to contact for reference (preferably the project manager), (d) completion date (actual when available, otherwise estimated), (e) total construction cost of completed project (or where no construction was involved, the approximate cost of work) and that portion of the cost of the project for which the named firm was/is responsible. Through narrative discussion, show reason why the firm or joint venture submitting this questionnaire believes it is - especially qualified to undertake the proposed work, Information provided should include, but not be limited to, such data as: specialized equipment available for this work, any awards or recognition received by a firm or individuals for similar work, required security clearances, special approaches or concepts developed by the firm relevant to similar work, etc, Respondents may say anything they wish in support of their qualifications. When appropriate, respondents may supplement this proposal with graphic material and photographs which best demonstrate design capabilities of the team proposed. Completed forms should be signed by the chief executive officer of the joint venture (thereby attesting to the concurrence and commitment of all members of the joint venture), or by the engineer principal responsible for the conduct of the work in the event it is awarded to the organization submitting this form. Joint ventures selected for subsequent discussions regarding this project must make available a statement of participation signed by a principal of each member of the joint venture, ALL INFORMATION CONTAINED IN THE FORM SHOULD BE CURRENT AND FACTUAL.
Answer only if this form is being submitted by a joint venture of two or more collaborating firms. Show the names and addresses of all individuals or organizations excepted to be included as part of the joint venture and describe their particular areas of anticipated responsibility (ie., technical disciplines, administration, financial, sociological, environment, etc.). 3a. indicate, by checking the appropriate box, whether this particular joint venture has worked together on other projects.
7.
4.
If respondent is not a joint venture, but intends to use outside (as opposed to in-house or permanently and formally affiliated) consultants or associates, he should provide names and addresses of all such individuals or firms, as well as their particular areas of technical/professional expertise, as it relates to this project. Existence of previous working relationships should be noted. If more than eight outside consultants or associates are anticipated, attach an additional sheet containing requested information. Regardless of whether respondent is a joint venture or an independent firm, provide brief resumes of key personnel expected to participate on this project. Care should be taken to limit resumes to only those personnel and specialists who will have major project responsibilities. Each resume must include: (a) name of each key person and specialist and his or her title, (b) the project assignment or role which that person will be expected to fulfill in connection with this project, (c) the name of the firm or organization, if any, with whom that individual is presently associated, (d) years of relevant experience with present firm and other firms, (e) the highest academic degree achieved and the discipline covered (if more than one highest degree, such as two Ph.D.'s, list both), the year received and the particular technical/professional discipline which that individual will bring to the project, (f) if registered as an architect, engineer, surveyor, etc., show only the field of registration and the year that such registration was first acquired. If registered in several states, do not list states, and (g) a synopsis of experience, training, or other qualities which reflect individual's potential contribution to this project. Include such data as: familiarity with Government or agency procedures, similar type of work performed in the past, management abilities, familiarity with the geographic area, relevant foreign language capabilities, etc. Please limit synopsis of experience to directly relevant information.
8.
5.
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
1. NAME OF PROJECT OR DESCRIPTION OF RFQ:
2. FIRM (OR JOINT-VENTURE) NAME & ADDRESS:
2a. NAME, TITLE & TELEPHONE NUMBER OF PRINCIPAL TO CONTACT:
2b. ADDRESS OF OFFICE TO PERFORM WORK, IF DIFFERENT FROM ITEM 2:
3. IF SUBMITTAL IS BY JOINT-VENTURE LIST PARTICIPATING FIRMS AND OUTLINE SPECIFIC AREAS OF RESPONSIBILITY FOR EACH FIRM:
3a. HAS THIS JOINT-VENTURE PREVIOUSLY WORKED TOGETHER:
YES
NO
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
4. IF RESPONDENT IS NOT A JOINT-VENTURE, LIST OUTSIDE KEY CONSULTANTS/ASSOCIATES ANTICIPATED FOR THIS PROJECT: WORKED WITH PRIME BEFORE (YES or NO)
NAME & ADDRESS:
SPECIALTY:
1.
2.
3.
4.
5.
6.
7.
8.
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
5. BRIEF RESUME OF KEY PERSONS, SPECIALIST, AND INDIVIDUAL CONSULTANTS PROPOSED IN THIS RESPONSE: a. NAME & TITLE: a. NAME & TITLE:
b. PROJECT ASSIGNMENT:
b. PROJECT ASSIGNMENT:
c. NAME OF FIRM WITH WHICH ASSOCIATED:
c. NAME OF FIRM WITH WHICH ASSOCIATED:
d. YEARS OF EXPERIENCE:
WITH THIS FIRM
WITH OTHER FIRMS
d. YEARS OF EXPERIENCE:
WITH THIS FIRM
WITH OTHER FIRMS
e. EDUCATION: DEGREE(S) / YEAR / SPECIALIZATION
e. EDUCATION: DEGREE(S) / YEAR / SPECIALIZATION
f. ACTIVE REGISTRATION: YEAR FIRST REGISTERED / DISCIPLINE
f. ACTIVE REGISTRATION: YEAR FIRST REGISTERED / DISCIPLINE
g. OTHER EXPERIENCE AND QUALIFICATIONS RELEVANT TO THE PROJECT:
g. OTHER EXPERIENCE AND QUALIFICATIONS RELEVANT TO THE PROJECT:
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
6. WORK BY FIRMS OR JOINT-VENTURE MEMBERS WHICH BEST ILLUSTRATES CURRENT QUALIFICATION RELEVANT TO THIS RFQ/RFP (list no more than 10 projects): ESTIMATED COST PROJECT NAME & LOCATION NATURE OF FIRM'S RESPONSIBILITY PROJECT OWNER'S NAME & ADDRESS & PROJECT MANAGER'S NAME & PHONE NUMBER COMPLETION DATE ENTIRE PROJECT WORK FOR WHICH FIRM WAS/IS RESPONSIBLE
1.
2.
3.
4.
5.
6.
7.
8.
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT
Engineering Services Questionnaire form
Riverside County Transportation Department RFQ/RFP process
7. USE THIS SPACE TO PROVIDE ANY ADDITIONAL INFORMATION OR DESCRIPTION OF RESOURCES (INCLUDING ANY COMPUTER DESIGN CAPABILITIES) SUPPORTING YOUR FIRM'S QUALIFICATIONS:
RIVERSIDE COUNTY TRANSPORTATION DEPARTMENT