ࡱ>   bjbj jN N UUUUq4Uz...../ / /HzJzJzJzJzJzJz|CdJz/////Jz.._z0H0H0H/..Hz0H/Hz0H0Hl Dr. |1UN0:(n:4zuz0zbn0 tDrDr0H///JzJz\< ///z/////////////N W: ARCHITECT-ENGINEER QUALIFICATIONSOMB No.: 9000-0157Public reporting burden for this collection of information is estimated to average a total of 29 hours per response (25 hours for Part 1 and 4 hours for Part 2), 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 (MVA), Regulatory and Federal Assistance Publications Division, GSA, Washington, DC 20405. PURPOSE Federal agencies use this form to obtain information from architect-engineer (A-E) firms about their professional qualifications. Federal agencies select firms for A-E contracts on the basis of professional qualifications as required by the Brooks A-E Act (40 U.S.C. 1101 - 1104) and Part 36 of the Federal Acquisition Regulation (FAR). The Brooks A-E Act requires the public announcement of requirements for A-E services (with some exceptions provided by other statutes), and the selection of at least three of the most highly qualified firms based on demonstrated competence and professional qualifications according to specific criteria published in the announcement. The Act then requires the negotiation of a contract at a fair and reasonable price starting first with the most highly qualified firm. The information used to evaluate firms is from this form and other sources, including performance evaluations, any additional data requested by the agency, and interviews with the most highly qualified firms and their references. GENERAL INSTRUCTIONS Part I presents the qualifications for a specific contract. Part II presents the general qualifications of a firm or a specific branch office of a firm. Part II has two uses: An A-E firm may submit Part II to the appropriate central, regional or local office of each Federal agency to be kept on file. A public announcement is not required for certain contracts, and agencies may use Part II as a basis for selecting at least three of the most highly qualified firms for discussions prior to requesting submission of Part I. Firms are encouraged to update Part II on file with agency offices, as appropriate, according to FAR Part 36. If a firm has branch offices, submit a separate Part II for each branch office seeking work. Prepare a separate Part II for each firm that will be part of the team proposed for a specific contract and submitted with Part I. If a firm has branch offices, submit a separate Part II for each branch office that has a key role on the team. INDIVIDUAL AGENCY INSTRUCTIONS Individual agencies may supplement these instructions. For example, they may limit the number of projects or number ofpages submitted in Part I in response to a public announcement for a particular project. Carefully comply with any agency instructions when preparing and submitting this form. Be as concise as possible and provide only the information requested by the agency. DEFINITIONS Architect-Engineer Services: Defined in FAR 2.101. Branch Office: A geographically distinct place of business or subsidiary office of a firm that has a key role on the team. Discipline: Primary technical capabilities of key personnel, as evidenced by academic degree, professional registration, certification, and/or extensive experience. Firm: Defined in FAR 36.102. Key Personnel: Individuals who will have major contract responsibilities and/or provide unusual or unique expertise. Part I - Contract-Specific Qualifications Section A. Contract Information. Title and Location. Enter the title and location of the contract for which this form is being submitted, exactly as shown in the public announcement or agency request. Public Notice Date. Enter the posted date of the agency's notice on the Federal Business Opportunity website (FedBizOpps), other form of public announcement or agency request for this contract. Solicitation or Project Number. Enter the agency's solicitation number and/or project number, if applicable, exactly as shown in the public announcement or agency request for this contract. Section B. Architect-Engineer Point of Contact. 4-8. Name, Title, Name of Firm, Telephone Number, Fax (Facsimile) Number and E-mail (Electronic Mail) Address. Provide information for a representative of the prime contractor or joint venture that the agency can contact for additional information. AUTHORIZED FOR LOCAL REPRODUCTION MANDATORY USE DATE OF FORM 6/2004 STANDARD FORM 330 (1/2004) PAGE 1 OF INSTRUCTIONS Prescribed by GSA FAR (48 VFR)53.236.2(b) Section C. Proposed Team. 9-11. Firm Name, Address, and Role in This Contract. Provide the contractual relationship, name, full mailing address, and a brief description of the role of each firm that will be involved in performance of this contract. List the prime contractor or joint venture partners first. If a firm has branch offices, indicate each individual branch office that will have a key role on the team. The named subcontractors and outside associates or consultants must be used, and any change must be approved by the contracting officer. (See FAR Part 52 Clause "Subcontractors and Outside Associates and Consultants (Architect-Engineer Services)".) Attach an additional sheet in the same format as Section C if needed. Section D. Organizational Chart of Proposed Team. As an attachment after Section C, present an organizational chart of the proposed team showing the names and roles of all key personnel listed in Section E and the firm they are associated with as listed in Section C. Section E. Resumes of Key Personnel Proposed for This Contract. Complete this section for each key person who will participate in this contract. Group by firm, with personnel of the prime contractor or joint venture partner firms first. The following blocks must be completed for each resume: 12. Name. Self-explanatory. 13. Role in This Contract. Self-explanatory. 14. Years Experience. Total years of relevant experience (block 14a), and years of relevant experience with current firm, but not necessarily the same branch office (block 14b). 15. Firm Name and Location. Name, city and state of the firm where the person currently works, which must correspond with one of the firms (or branch office of a firm, if appropriate) listed in Section C. 16. Education. Provide information on the highest relevant academic degree(s) received. Indicate the area(s) of specialization for each degree. 17. Current Professional Registration. Provide information on current relevant professional registration(s) in a State or possession of the United States, Puerto Rico, or the District of Columbia according to FAR Part 36. 18. Other Professional Qualifications. Provide information on any other professional qualifications relating to this contract, such as education, professional registration, publications, organizational memberships, certifications, training, awards, and foreign language capabilities.19. Relevant Projects. Provide information on up to five projects in which the person had a significant role that demonstrates the person's capability relevant to her/his proposed role in this contract. These projects do not necessarily have to be any of the projects presented in Section F for the project team if the person was not involved in any of those projects or the person worked on other projects that were more relevant than the team projects in Section F. Use the check box provided to indicate if the project was performed with any office of the current firm. If any of the professional services or construction projects are not complete, leave Year Completed blank and indicate the status in Brief Description and Specific Role (block (3)). Section F. Example Projects Which Best Illustrate Proposed Team's Qualifications for This Contract. Select projects where multiple team members worked together, if possible, that demonstrate the team's capability to perform work similar to that required for this contract. Complete one Section F for each project. Present ten projects, unless otherwise specified by the agency. Complete the following blocks for each project: 20. Example Project Key Number. Start with "1" for the first project and number consecutively. 21. Title and Location. Title and location of project or contract. For an indefinite delivery contract, the location is the geographic scope of the contract. 22. Year Completed. Enter the year completed of the professional services (such as planning, engineering study, design, or surveying), and/or the year completed of construction, if applicable. If any of the professional services or the construction projects are not complete, leave Year Completed blank and indicate the status in Brief Description of Project and Relevance to This Contract (block 24). 23a. Project Owner. Project owner or user, such as a government agency or installation, an institution, a corporation or private individual. 23b. Point of Contact Name. Provide name of a person associated with the project owner or the organization which contracted for the professional services, who is very familiar with the project and the firm's (or firms') performance. 23c. Point of Contract Telephone Number. Self-explanatory. 24. Brief Description of Project and Relevance to This Contract. Indicate scope, size, cost, principal elements and special features of the project. Discuss the relevance of the example project to this contract. Enter any other information requested by the agency for each example project. STANDARD FORM 330 (1/2004) PAGE 2 OF INSTRUCTIONS  SPECIFIC INSTRUCTIONS 25. Firms from Section C Involved with This Project. Indicate which firms (or branch offices, if appropriate) on the project team were involved in the example project, and their roles. List in the same order as Section C. Section G. Key Personnel Participation in Example Projects. This matrix is intended to graphically depict which key personnel identified in Section E worked on the example projects listed in Section F. Complete the following blocks (see example below). 26. and 27. Names of Key Personnel and Role in This Contract. List the names of the key personnel and their proposed roles in this contract in the same order as they appear in Section E. 28. Example Projects Listed in Section F. In the column under each project key number (see block 29) and for each key person, place an "X" under the project key number for participation in the same or similar role. Example Projects Key. List the key numbers and titles of the example projects in the same order as they appear in Section F. Section H. Additional Information. Use this section to provide additional information specifically requested by the agency or to address selection criteria that are not covered by the information provided in Sections A-G. Section I. Authorized Representative. 31. and 32. Signature of Authorized Representative and Date. An authorized representative of a joint venture or the prime contractor must sign and date the completed form. Signing attests that the information provided is current and factual, and that all firms on the proposed team agree to work on the project. Joint ventures selected for negotiations must make available a statement of participation by a principal of each member of the joint venture. 33. Name and Title. Self-explanatory. SAMPLE ENTRIES FOR SECTION G (MATRIX) 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 first, 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 Jane A. Smith Chief Architect X X Joseph B. Williams Chief Mech. Engineer X X X X Tara C. Donovan Chief Elec. Engineer X X X   29. EXAMPLE PROJECTS KEY NO. TITLE OF EXAMPLE PROJECT (FROM SECTION F) NO. TITLE OF EXAMPLE PROJECT (FROM SECTION F) 1 Federal Courthouse, Denver, CO 6 XYZ Corporation Headquarters, Boston, MA 2 Justin J. Wilson Federal Building, Baton Rouge, LA 7 Founder's Museum, Newport RI STANDARD FORM 330 (1/2004) PAGE 3 OF INSTRUCTIONS Part II - General Qualifications See the "General Instructions" on page 1 for firms with branch offices. Prepare Part II for the specific branch office seeking work if the firm has branch offices. 1. Solicitation Number. If Part II is submitted for a specific contract, insert the agency's solicitation number and/or project number, if applicable, exactly as shown in the public announcement or agency request. 2a-2e. Firm (or Branch Office) Name and Address. Self-explanatory. 3. Year Established. Enter the year the firm (or branch office, if appropriate) was established under the current name. 4. DUNS Number. Insert the Data Universal Numbering System number issued by Dun and Bradstreet Information Services. Firms must have a DUNS number. See FAR Part 4.6. 5. Ownership. a. Type. Enter the type of ownership or legal structure of the firm (sole proprietor, partnership, corporation, joint venture, etc.). b. Small Business Status. Refer to the North American Industry Classification System (NAICS) code in the public announcement, and indicate if the firm is a small business according to the current size standard for that NAICS code (for example, Engineering Services (part of NAICS 541330), Architectural Services (NAICS 541310), Surveying and Mapping Services (NAICS 541370)). The small business categories and the internet website for the NAICS codes appear in FAR Part 19. Contact the requesting agency for any questions. Contact your local U.S. Small Business Administration office for any questions regarding Business Status. 6a-6c. Point of Contact. Provide this information for a representative of the firm that the agency can contact for additional information. The representative must be empowered to speak on contractual and policy matters. 7. Name of Firm. Enter the name of the firm if Part II is prepared for a branch office. 8a-8c. Former Firm Names. Indicate any other previous names for the firm (or branch office) during the last six years. Insert the year that this corporate name change was effective and the associated DUNS Number. This information is used to review past performance on Federal contracts. 9. Employees by Discipline. Use the relevant disciplines and associated function codes shown at the end of these instructions and list in the same numerical order. After the listed disciplines, write in any additional disciplines and leave the function code blank. List no more than 20 disciplines. Group remaining employees under "Other Employees" in column b. Each person can be counted only once according to his/her primary function. If Part II is prepared for a firm (including all branch offices), enter the number of employees by disciplines in column c(1). If Part II is prepared for a branch office, enter the number of employees by discipline in column c(2) and for the firm in column c(1). 10. Profile of Firm's Experience and Annual Average Revenue for Last 5 Years. Complete this block for the firm or branch office for which this Part II is prepared. Enter the experience categories which most accurately reflect the firm's technical capabilities and project experience. Use the relevant experience categories and associated profile codes shown at the end of these instructions, and list in the same numerical order. After the listed experience categories, write in any unlisted relevant project experience categories and leave the profile codes blank. For each type of experience, enter the appropriate revenue index number to reflect the professional services revenues received annually (averaged over the last 5 years) by the firm or branch office for performing that type of work. A particular project may be identified with one experience category or it may be broken into components, as best reflects the capabilities and types of work performed by the firm. However, do not double count the revenues received on a particular project. 11. Annual Average Professional Services Revenues of Firm for Last 3 Years. Complete this block for the firm or branch office for which this Part II is prepared. Enter the appropriate revenue index numbers to reflect the professional services revenues received annually (averaged over the last 3 years) by the firm or branch office. Indicate Federal work (performed directly for the Federal Government, either as the prime contractor or subcontractor), non-Federal work (all other domestic and foreign work, including Federally-assisted projects), and the total. If the firm has been in existence for less than 3 years, see the definition for "Annual Receipts" under FAR 19.101. 12. Authorized Representative. An authorized representative of the firm or branch office must sign and date the completed form. Signing attests that the information provided is current and factual. Provide the name and title of the authorized representative who signed the form. STANDARD FORM 330 (1/2004) PAGE 4 OF INSTRUCTIONS  CodeDescriptionCodeDescriptionFederalE&ASFederalE&AS27Acoustical/Sound System Engineer10Ground Water Geologist01Acoustical Engineer 38Hazardous Materials Specialist02Administrative 39Hazardous Materials Planner03Aerial Photographer 31Health Facility Planner04Aeronautical Engineer 3259Hydraulic Engineer 0513Archeologist 33Hydrographic Surveyor0601Architect15Hydrologic Engineer07Biologist 34Hydrologist 44Building Controls Consultant35Industrial Engineer 43Building Code/Code Plan Review Specialist3636Industrial Hygienist 47CADD Drafting/Scanning/Photography37Interior Designer08CADD Technician 3808Land Surveyor09Cartographer 3907Landscape Architect 10Chemical Engineer 40Materials Engineer 11Chemist 41Materials Handling Engineer 1202Civil Engineer 4204Mechanical Engineer 45Commissioning Engineer43Mining Engineer 13Communications Engineer 44Oceanographer 14Computer Programmer 45Photo Interpreter 46Constructability Review Consultant46Photogrammetrist 15Construction Inspector 4734Planner: Urban/Regional 1621Construction Project Management16Programming17Corrosion Engineer Cost 48Project Manager 30Cost Estimator49Remote Sensing Specialist 18Cost Engineer/Estimator 50Risk Assessor 19Ecologist14Roofing/Envelope Consultant20Economist 93Safety Engineer2103Electrical Engineer 51Safety/Occupational Health Engineer22Electronics Engineer 5241Sanitary Engineer 31Elevator/Escalator Consultant53Scheduler 33Energy Management5494Security Specialist 25Engineering Geologist42Signage Consultant23Environmental Engineer 09Soil/Geo-Tech Engineer24Environmental Scientist 55Soils Engineer37Environmental Services28Solar Energy Consultant06ESCO Consultant17Space Planning/Interior Design Services2511Fire Protection Engineer56Specifications Writer 26Forensic Engineer 5705Structural Engineer 35Forest Engineer58Technician/Analyst27Foundation/Geotechnical Engineer 19Telecommunications Engineer/Designer28Geodetic Surveyor18Testing Laboratory29 Geographic Information System Specialist59Toxicologist30 Geologist 60 Transportation Engineer 12Geothermal Consultant61 29Value Engineer 62Water Resources Engineer  Bolded Codes are used by the Division of Engineering and Architectural Services (E&AS) for the A/E Reference File and must be used when submitting your statement of qualifications to the Division of Engineering and Architectural Services. Only E&AS codes will be accepted. STANDARD FORM 330 (1/2004) PAGE 5 OF INSTRUCTIONS  List of Experience Categories (Profile Codes)CodeDescriptionCodeDescriptionFederalE&ASFederalE&ASA01001Acoustics/Sound SystemD01Dams (Concrete; Arch)202ADA ConsultingD02Dams (Earth; Rock); Dikes; LeveesA02Aerial Photography; Airborne Data and Imagery015Daycare Facilities Collection and AnalysisD03Desalinization (Process & Facilities)A03Agricultural Development; Grain Storage; FarmD04Design-Build -Preparation of Requests for  Mechanization ProposalsA04004Air Pollution ControlD05Digital Elevation and Terrain Model A05Airports; Navaids; Airport Lighting; Aircraft Development FuelingD06Digital OrthophotographyA06Airports; Terminals and Hangars; Freight027Dinning halls/Kitchens/Food service HandlingD07Dining Halls; Clubs; Restaurants094Alarm & Security SystemsD08Dredging Studies and DesignA07Arctic Facilities003Archeological InvestigationE01028Ecological InvestigationsA08Animal FacilitiesE02029Educational Facilities; ClassroomsA09Anti-Terrorism/Force ProtectionE03214Electrical Studies and DesignA10Asbestos AbatementE04ElectronicsA11008Auditoriums & TheatersE05031Elevators; Escalators; People-MoversA12Automation; Controls; InstrumentationE06Embassies and ChanceriesB01Barracks; Dormitories207Energy AuditsE07035Energy Conservation; New Energy Sources033Boilers034Energy Infrastructure102Boundry/Plats/Topgraphic Surveys032Energy ManagementB02011BridgesE08Engineering Economics212Building Condition Assessment217Envelope Waterproofing (Above Ground)218Envelope Waterproofing (Below Ground)C01CartographyE09208Environmental AuditsC02Cemeteries (Planning & Relocation)220Environmental Impact Studies, C03Charting: Nautical and Aeronautical Assessments or StatementsC04Chemical Processing & StorageE10Environmental and Natural Resource MappingC05Child Care/Development FacilitiesE11Environmental PlanningC06Churches; ChapelsE12Environmental RemediationC07Coastal EngineeringE13Environmental Testing and AnalysisC08Codes; Standards; Ordinances012Emergency Services/Training FacilitiesC09Cold Storage; Refrigeration and Fast Freeze203ESCO Projects227Combustion EngineeringC10017Commercial Building (low rise); Shopping209Facilities Management CentersF01Fallout Shelters; Blast-Resistant DesignC11Community FacilitiesF02Field Houses; Gyms; Stadiums 018Communication Voice data, Audio/Video024Fire Alarms108Communication TowersF03Fire ProtectionC12Communications Systems; TV; MicrowaveF04037Fisheries; Fish laddersC13019Computer Facilities; Computer ServiceF05Forensic Engineering C14020Conservation and Resource ManagementF06Forestry & Forest productsC15Construction ManagementC16Construction SurveyingG01039Garages; Vehicle Maintenance 113Construction Testing & Inspection Facilities; Parking DecksC17Corrosion Control; Cathodic Protection ElectrolysisG02Gas Systems (Propane; Natural, Etc.)C18Cost Estimating; Cost Engineering and Analysis;G03103Geodetic Surveying: Ground & Air borne Parametric Costing; ForecastingG04Geographic Information System Services: C19Cryogenic Facilities Development, Analysis, and Data Collection Bolded Codes are used by the Division of Engineering and Architectural Services (E&AS) for the A/E Reference File and must be used when submitting your statement of qualifications to the Division of Engineering and Architectural Services. Only E&AS codes will be accepted  STANDARD FORM 330 (1/2004) PAGE 6 OF INSTRUCTIONS  List of Experience Categories (Profile Codes)CodeDescriptionCodeDescriptionFederalE&ASFederalE&ASG05Geospatial Data Conversion: Scanning,M01Mapping Location/Addressing Systems  Digitizing, Compilation, Attributing,079Master/Site Planning Scribing, Drafting M02Materials Handling Systems; Conveyors; SortersG06Graphic DesignM03Metallurgy 040Groundwater heat pump systemsM04Microclimatology; Tropical Engineering030Gyms, Stadiums, Field HousesM05Military Design Standards M06Mining & Mineralogy H01Harbors; Jetties; Piers, Ship Terminal M07Missile Facilities (Silos; Fuels; Transport) Facilities069Modular/Pre-Fab Design, Temporary 210Hazardous Materials, Asbestos StructuresH02Hazardous Materials Handling and Storage M08Modular Systems Design; Pre-Fabricated H03Hazardous, Toxic, Radioactive Waste 215Mold and Fungus Inspection, Testing, and  Remediation AbatementH04043Heating; Ventilating; Air ConditioningH05Health Systems PlanningN01Naval Architecture; Off-Shore PlatformsH06Highrise; Air-Rights-Type BuildingsN02Navigation Structures; Locks H07Highways; Streets; Airfield Paving Parking Lots005Noise Pollution Control/StudiesH08047Historical PreservationN03Nuclear Facilities; Nuclear Shielding H09048Hospital & Medical FacilitiesH10Hotels; MotelsO01072Office Buildings H11050Housing/Group Homes O02Oceanographic Engineering H12Hydraulics & PneumaticsO03Ordnance; Munitions; Special WeaponsH13Hydrographic Surveying046Parking Lots, Streets213Indoor Air Quality216PCB Mitigation, Inspection, Testing and I01Industrial Buildings; Manufacturing Plants AbatementI02Industrial Processes; Quality ControlP01Petroleum Exploration; Refining I03Industrial Waste Treatment P02Petroleum and Fuel (Storage and Distribution)I04Intelligent Transportation Systems P03Photogrammetry I05Interior Design; Space PlanningP04Pipelines (Cross-Country - Liquid & Gas)I06Irrigation; Drainage P05078Planning (Community, Regional,  Areawide and State) J01Judicial and Courtroom Facilities P06Planning (Site, Installation, and Project) P07Plumbing & Piping Design L01058Laboratories; Medical Research FacilitiesP08084Prisons & Correctional Facilities L02Land Surveying P09Product, Machine Equipment Design L03Landscape Architecture P10Pneumatic Structures, Air-Support Buildings211Lead-based paintP11Postal Facilities 204LEED/LEED EBP12Power Generation, Transmission, DistributionL04060LibrariesP13Public Safety Facilities 061Lighting-Interior & ExteriorL05Lighting (Interior; Display; Theater, Etc.)R01Radar; Sonar; Radio & Radar TelescopesL06Lighting (Exteriors; Streets; Memorials; R02Radio Frequency Systems & Shieldings Athletic Fields, Etc.)R03Railroad; Rapid Transit 206Load StudiesR04Recreation Facilities (Parks, Marinas, Etc.)049Log Home Restoration088Recreation Specialist Bolded Codes are used by the Division of Engineering and Architectural Services (E&AS) for the A/E Reference File and must be used when submitting your statement of qualifications to the Division of Engineering and Architectural Services. Only E&AS codes will be accepted. STANDARD FORM 330 (1/2004) PAGE 7 OF INSTRUCTIONS List of Experience Categories (Profile Codes)CodeDescriptionCodeDescriptionFederalE&ASFederalE&ASR05Refrigeration Plants/Systems V01112Value Analysis; Life-Cycle CostingR06089Rehabilitation (Buildings; Structures;  Facilities)W01Warehouses & DepotsR07Remote Sensing 106Wastewater Treatment Design & ManagementR08Research Facilities W02Water Resources; Hydrology; Ground WaterR09Resources Recovery; Recycling W03Water Supply; Treatment and DistributionR10Risk Analysis 107Watershed ManagementR11092Rivers; Canals; Waterways; Flood ControlW04Wind Tunnels; Research/Testing Facilities R12Roofing  Design201Roofing, design and inspectionZ01117Zoning; Land Use StudiesS01Safety Engineering; Accident Studies; OSHA  StudiesS02Security Systems; Intruder & Smoke Detection096Security Systems IntegrationS03095Seismic Designs & Studies S04Sewage Collection, Treatment and DisposalS05Soils & Geologic Studies; FoundationsS07Solid Wastes; Incineration; Landfill S08Special Environments; Clean Rooms, Etc.097Septic/Sewer Design025Sprinkler SystemsS13104Storm Water Handling & Facilities 105Storm Water ManagementS09101Structural Design; Special Structures,  Steel StructuresS10Surveying; Platting; Mapping; Flood Plain StudiesS11100Sustainable Design S12087Swimming Pools T01Telephone Systems (Rural; Mobile; Intercom, Etc.)T02Testing & Inspection Services T03Traffic & Transportation Engineering T04Topographic Surveying and Mapping T05Towers (Self-Supporting & Guyed Systems)T06Tunnels & Subways U01Unexploded Ordnance RemediationU02Urban Renewals; Community DevelopmentU03Utilities (Gas and Steam)111Underground Utilities/Subsurface  Investigation STANDARD FORM 330 (1/2004) PAGE 8 OF INSTRUCTIONSBolded Codes are used by the Division of Engineering and Architectural Services (E&AS) for the A/E Reference File and must be used when submitting your statement of qualifications to the Division of Engineering and Architectural Services. Only E&AS codes will be accepted. ARCHITECT - ENGINEER QUALIFICATIONSPART I - CONTRACT-SPECIFIC QUALIFICATIONSA. CONTRACT INFORMATION1. TITLE AND LOCATION (City and State) 2. PUBLIC NOTICE DATE3. SOLICITATION OR PROJECT NUMBER B. ARCHITECT-ENGINEER POINT OF CONTACT4. NAME AND TITLE5. NAME OF FIRM6. TELEPHONE NUMBER7. FAX NUMBER8. E-MAIL ADDRESSC. PROPOSED TEAM (Complete this section for the prime contractor and all key subcontractors.)(Check)9. FIRM NAME10. ADDRESS11. ROLE IN THIS CONTRACTPRIMEJ-V PARTNERSUBCON-TRACTOR 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 OFFICED. ORGANIZATIONAL CHART OF PROPOSED TEAM ( (Attached)AUTHORIZED FOR LOCAL REPRODUCTION MANDATORY USE DATE OF FORM 6/2004 STANDARD FORM 330 (1/2004) PAGE 1  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 a( 1) TITLE AND LOCATION (City and State)(2) YEAR COMPLETED PROFESSIONAL SERVICESCONSTRUCTION (If Applicable)(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE ( Check if project performed with current firm  b( 1) TITLE AND LOCATION (City and State)(2) YEAR COMPLETED PROFESSIONAL SERVICESCONSTRUCTION (If Applicable)(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE ( Check if project performed with current firm  c( 1) TITLE AND LOCATION (City and State)(2) YEAR COMPLETEDPROFESSIONAL SERVICESCONSTRUCTION (If Applicable)(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE ( Check if project performed with current firm  d( 1) TITLE AND LOCATION (City and State)(2) YEAR COMPLETEDPROFESSIONAL SERVICESCONSTRUCTION (If Applicable)(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE ( Check if project performed with current firm  e( 1) TITLE AND LOCATION (City and State)(2) YEAR COMPLETEDPROFESSIONAL SERVICESCONSTRUCTION (If Applicable)(3) BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE ( Check if project performed with current firm STANDARD FORM 330 (1/2004) PAGE 2  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 COMPLETEDPROFESSIONAL SERVICES CONSTRUCTION (If applicable) 23. PROJECT OWNER'S INFORMATIONa. PROJECT OWNERb. POINT OF CONTACTc. POINT OF CONTACT TELEPHONE NUMBER24. 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  STANDARD FORM 330 (1/2004) PAGE 3 26. NAMES OF KEY PERSONNEL (From Section E, Block 12) 27. ROLE IN THIS CONTRACT (From Section E, Block 13) 28. EXAMPLE PROJECTS (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 G. KEY PERSONNEL PARTICIPATION IN EXAMPLE PROJECTS29. 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 STANDARD FORM 330 (1/2004) PAGE 4  I. AUTHORIZED REPRESENTATIVE The foregoing is a statement of facts.31. SIGNATURE32. DATE33. NAME AND TITLESTANDARD FORM 330 (1/2004) PAGE 5 H. ADDITIONAL INFORMATION30. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS NEEDED. 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 STATUS6a. POINT OF CONTACT NAME AND TITLE7. NAME OF FIRM (If block 2a. is a branch office)6b. TELEPHONE NUMBER6c. E-MAIL ADDRESS8a. FORMER FIRM NAME(S) (If any)8b. YR ESTABLISHED8c. DUNS NUMBER9. EMPLOYEES BY DISCIPLINE10. PROFILE OF FIRM'S EXPERIENCE AND ANNUAL AVERAGE REVENUE FOR LAST 5 YEARSa. Function Code b. Disciplinec. No. of Employees a. Profile Codeb. Experiencec. Revenue Index Number (see below)(1) FIRM(2) BRANCHOther EmployeesTotal11. ANNUAL AVERAGE PROFESSIONAL SERVICES REVENUES OF FIRM FOR LAST 3 YEARS (Insert revenue index number shown at right) PROFESSIONAL SERVICES REVENUE INDEX NUMBER1. Less than $100,000 2. $100,00 to less than $250,000 3. $250,000 to less than $500,000 4. $500,000 to less than $1 million 5. $1 million to less than $2 million 6. $2 million to less than $5 million 7. $5 million to less than $10 million 8. $10 million to less than $25 million 9. $25 million to less than $50 million 10. $50 million or greatera. Federal Work b. Non-Federal Work c. Total Work 12. AUTHORIZED REPRESENTATIVE The foregoing is a statement of facts.a. SIGNATURE b. DATE c. NAME AND TITLE AUTHORIZED FOR LOCAL REPRODUCTION MANDATORY USE DATE OF FORM 5/1/2004 STANDARD FORM 330 (1/2004) PAGE 6 ARCHITECT-ENGINEER QUALIFICATIONS1. 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