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MIAMI DADE COUNTY OCI

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					                     MIAMI-DADE COUNTY – OFFICE OF CAPITAL IMPROVEMENTS (OCI)
                  STEP 1 - EVALUATION OF QUALIFICATIONS – OCI FORM 1
                  ALL TEAM MEMBERS MUST BE DENOTED ON THIS FORM
                               Section A – Project Information
OCI Project No.:                          Project Name: Design Build Services for the Palmetto Station Traction
DB09-MDT-01 ARRA, R 2                     Power Sub-Station
Measures: 20%   Goal                            DBE


                                    Section B – Design-Builder’s Information
Firm No.




               Complete this section for the design-builder only; pursuant to Division 1, Section 1.8 of the RDBS “Teaming
                 Restrictions”, design-builder may only participate on one (1) team when responding to this solicitation.
           Design-Builder’s Name:                                                       FEIN:
           Business Address:
1          Contact Person’s Name & Title:                                            Addenda Received (Indicate number)
           Telephone Number: ( )      -            Fax Number: (      )    -        E-mail:
           General Contractor’s / Building Contractor’s License No.

                     Section C (1) – Proposed Architecture & Engineering (A &E)
Firm No.




                                     Subconsultants (DESIGN TEAM)
               Complete this section for all proposed A & E subconsultants; pursuant to Division 1, Section 1.8 of the RDBS
                                                          “Teaming Restrictions”.
                                     A & E Subconsultant’s Name                                                FEIN:
2

3

4

5

6

7

8

9

10

11

12

13

14

15




                                                                                                        OCI FORM 1 / DB – Rev 09/22/10
       Section C (2) - A&E Technical Certification Requirements (DESIGN TEAM)
Fill in this section by indicating which firm on the team, using the numbers shown in Sections C(1), will provide services in
          the technical categories required in the RDBS; you may list more than one firm per category, if applicable.
                                                                                  Lead A & E                 A&E
                      A&E Technical Category
                                                                                  Consultant              Subconsultant
           Mass Transit Systems - Mass Transit Program
2.01       (Systems) Management
           (LEAD A/E CONSULTANT FOR DESIGN TEAM)
           Engineering Construction Management
17.00
           (LEAD A/E CONSULTANT FOR DESIGN TEAM)
           Mass Transit Systems - Mass Transit Controls,
2.04
           Communications & Information Systems

2.05       Mass Transit Systems - General Quality Engineering

           Mass Transit Systems - Mass Transit Safety Certification
2.06
           for System Element
           Soils, Foundations and Materials Testing - Roof Testing
9.05
           and Consulting
           Soils, Foundations and Materials Testing - Materials
9.06
           Testing / Consulting / Training
           Environmental Engineering - Contamination Assessment
10.05
           and Monitoring

11.00      General Structural Engineering

12.00      General Mechanical Engineering


13.00      General Electrical Engineering


14.00      Architecture

15.01      Surveying and Mapping - Land Surveying


16.00      General Civil Engineering




                                                                                                     OCI FORM 1 / DB – Rev 09/22/10
           Section D – Proposed Non-A & E Subconsultants and/or Subcontractors
            Complete this section for all proposed non-A & E subconsultants and/or subcontractors who will perform Work with
Firm No.

                readily identifiable scopes of services and subcontractors as referenced in Section 2.1 – Experience and
            Qualifications of the RDBS. The following must be provided below: firm name, address, phone number (including
                                          area code), contact person, assigned services and FEIN.
                         Non A & E Subconsultant’s/Subcontractor’s Name                                      FEIN:
           Firm Name:
           Address:
a          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
b          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
c          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
d          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
e          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
 f         Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
g          Phone Number: (      )   -
           Contact Person:
           Assigned Services:
           Firm Name:
           Address:
h          Phone Number: (      )   -
           Contact Person:
           Assigned Services:




                                                                                                      OCI FORM 1 / DB – Rev 09/22/10
                           Section E – Table of Organization
                             Please attach the following documents:
                                    1) Table of Organization
2) RESUMES SOLELY FOR KEY PERSONNEL. Resumes are limited to a maximum of two (2) pages per resume.
             3) General Contractors or Building Contractors License for Design-Builder




                                                                               OCI FORM 1 / DB – Rev 09/22/10
               Section F – Design-Builder’s Experience and Qualifications
Pursuant to Division 2 of the RDBS, Step 1 Evaluation of Qualifications, Section 2.1 - Experience and Qualifications, please
complete the information requested below to indicate the Design-Builder’s experience and qualifications. Respondents will
                          adhere to the timeframe and reference quantity as denoted in the RDBS.
Reference Project Name/Address:
Name(s) and role(s) of key personnel working on this reference project:
Reference Project Description:
Scope of Services Provided:
Professional Fees $         Project Start Date: :   /      Project Completion Date:     /
Construction Start Date:   /         Construction Completion Date:
A: Project Construction Cost: $               B: Professional Fees: $                   Total Project Cost (A+B): $
Reference Company Name:              Reference Name:
Reference Phone Number (         )    -     Fax Number (     )    -       E-mail:
Please denote which Experience/Qualification(s) is/are being met with this reference:
Supplemental information and/or graphics provided YES            NO


Design-Builder may use the space below to expand on the scope of services provided for this project:




                                                                                                             OCI FORM 1 / DB – Rev 09/22/10
                      Section G – A & E Subconsultants/Subcontractors
                               Experience and Qualifications
  Pursuant to Division 2 of the RDBS, Step 1 – Evaluation of Qualifications, Section 2.1 - Experience and Qualifications,
 please complete the information requested below to indicate the A & E Subconsultants / Subcontractors experience and
        qualifications. Respondents will adhere to the timeframe and reference quantity as denoted in the RDBS.

A & E Subconsultant’s / Subcontractor’s Name:
Reference Project Name/Address:
Name(s) and role(s) of key personnel working on this reference project:
Reference Project Description:
Scope of Services Provided:
Professional Fees $        Project Start Date: :   /       Project Completion Date:     /
Construction Start Date:   /         Construction Completion Date:
A: Project Construction Cost: $           B: Professional Fees: $              Total Project Cost (A+B): $
Reference Company Name:              Reference Name:
Reference Phone Number (         )    -     Fax Number (     )      -     E-mail:
Please denote which Experience/Qualification(s) is/are being met with this reference:
Supplemental information and/or graphics provided YES            NO


A & E Subconsultant / Subcontractor may use the space below to expand on the scope of services provided for this project:




                                                                                                             OCI FORM 1 / DB – Rev 09/22/10
Section H – NOT APPLICABLE - Local Certified Service-Disabled Veteran
Business Enterprise
A Local Certified Service-Disabled Veteran Business Enterprise is a firm that is a) a local business pursuant to Section 2-
8.5 of the Code of Miami-Dade County and b) Prior to Proposal submittal is certified by the State of Florida Department of
Management Services as a service-disabled veteran business enterprise pursuant to Section 295.187 of the Florida
Statutes. At the time of proposal submission, the Local Certified Service-Disabled Veteran Business Enterprise must
affirm in writing its compliance with the certification requirements of Section 295.187 of the Florida Statues and submit
said affirmation and a copy of the actual certification along with the proposal submission.
    Place a checkmark here only if affirming Proposer is a certified Local Certified Service-Disabled Veteran Business
Enterprise. A copy of the required certification must be submitted with the proposal.

Section I - Compliance with Insurance Requirements
The Design Builder acknowledges that if selected, the Design Build firm will comply with the insurance requirements as
denoted in Division 1, Section 1.6 of the RDBS - Insurance Requirements.



THE EXECUTION OF OCI FORM 1 CONSTITUTES THE EXPRESS REPRESENTATION BY THE
DESIGN-BUILDER THAT IT HAS THE AUTHORITY AND ABILITY TO PERFORM THE
SERVICES REQUESTED UNDER THIS RDBS AND IF AWARDED A CONTRACT, HAS THE
AUTHORITY AND ABILITY TO ENTER INTO, AND PERFORM THE CONTRACT ACCORDING
TO THE TERMS.

I hereby certify that to the best of my knowledge and belief all the foregoing information is true and correct.


Authorized Design-Builder’s Representative                                                     Title
                                                                 (Print Name)


Signature of Authorized Representative ______________________________________________ Date




                                                                                                                  OCI FORM 1 / DB – Rev 09/22/10

				
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