**ARCHITECT-ENGINEER QUALIFICATIONS** OMB No.: **9000-0157**

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Public 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.

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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:

1\. 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.

2\. 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 of pages 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.

**SPECIFIC INSTRUCTIONS**

**Part I - Contract-Specific Qualifications**

Section A. Contract Information.

1\. 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.

2\. 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.

3\. 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

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.

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.

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.

29\. 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.

30\. 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 27. ROLE IN THIS 28. EXAMPLE PROJECTS LISTED IN
SECTION F

PERSONNEL CONTRACT Fill in \"Example Projects Key\" section below

(From Section E, (From Section E, before completing table. Place \"X\"
under project

Block 12) Block 13) key number for participation in same or similar
role.

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1 2 3 4 5 6 7 8 9 10

  ------------------ ------------------ --- --- --- --- -- --- --- --- ---- ---
  Jane A. Smith      Chief Architect    X       X                           

  Joseph B. Williams Chief Mech.        X   X   X   X                       
                     Engineer                                               

  Tara C. Donovan    Chief Elec.        X   X       X                       
                     Engineer                                               
  ------------------ ------------------ --- --- --- --- -- --- --- --- ---- ---

29. **EXAMPLE PROJECTS KEY**

+---+-----------------------------+---+---------------------------------+
| N | TITLE OF EXAMPLE PROJECT    | N | TITLE OF EXAMPLE PROJECT        |
| O |                             | O |                                 |
| . | (FROM SECTION F)            | . | (FROM SECTION F)                |
+---+-----------------------------+---+---------------------------------+
| 1 | Federal Courthouse, Denver, | 6 | XYZ Corporation Headquarters,   |
|   | CO                          |   | Boston, MA                      |
+---+-----------------------------+---+---------------------------------+
| 2 | Justin J. Wilson Federal    | 7 | Founder\'s Museum, Newport, RI  |
|   | Building, Baton Rouge, LA   |   |                                 |
+---+-----------------------------+---+---------------------------------+

**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.

List of Disciplines (Function Codes)

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**Code Description Code Description**

01 Acoustical Engineer 32 Hydraulic Engineer

02 Administrative 33 Hydrographic Surveyor

03 Aerial Photographer 34 Hydrologist

04 Aeronautical Engineer 35 Industrial Engineer

05 Archeologist 36 Industrial Hygienist

06 Architect 37 Interior Designer

07 Biologist 38 Land Surveyor

08 CADD Technician 39 Landscape Architect

09 Cartographer 40 Materials Engineer

10 Chemical Engineer 41 Materials Handling Engineer

11 Chemist 42 Mechanical Engineer

12 Civil Engineer 43 Mining Engineer

13 Communications Engineer 44 Oceanographer

14 Computer Programmer 45 Photo Interpreter

15 Construction Inspector 46 Photogrammetrist

16 Construction Manager 47 Planner: Urban/Regional

17 Corrosion Engineer 48 Project Manager

18 Cost Engineer/Estimator 49 Remote Sensing Specialist

19 Ecologist 50 Risk Assessor

20 Economist 51 Safety/Occupational Health Engineer

21 Electrical Engineer 52 Sanitary Engineer

22 Electronics Engineer 53 Scheduler

23 Environmental Engineer 54 Security Specialist

24 Environmental Scientist 55 Soils Engineer

25 Fire Protection Engineer 56 Specifications Writer

26 Forensic Engineer 57 Structural Engineer

27 Foundation/Geotechnical Engineer 58 Technician/Analyst

28 Geodetic Surveyor 59 Toxicologist

29 Geographic Information System Specialist 60 Transportation Engineer

30 Geologist 61 Value Engineer

31 Health Facility Planner 62 Water Resources Engineer

List of Experience Categories (Profile Codes)

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**Code Description Code Description**

A01 Acoustics, Noise Abatement D01 Dams *(Concrete; Arch)*

A02 Aerial Photography; Airborne Data and Imagery D02 Dams *(Earth;
Rock)*; Dikes; Levees

Collection and Analysis D03 Desalinization *(Process and Facilities)*

A03 Agricultural Development; Grain Storage; D04 Design-Build -
Preparation of Requests for

Farm Mechanization Proposals

A04 Air Pollution Control D05 Digital Elevation and Terrain Model
Develop-

A05 Airports; Navaids; Airport Lighting; ment

Aircraft Fueling D06 Digital Orthophotography

A06 Airports; Terminals and Hangars; Freight D07 Dining Halls; Clubs;
Restaurants

Handling D08 Dredging Studies and Design

A07 Arctic Facilities

A08 Animal Facilities E01 Ecological and Archeological

A09 Anti-Terrorism/Force Protection Investigations

A10 Asbestos Abatement E02 Educational Facilities; Classrooms

A11 Auditoriums and Theaters E03 Electrical Studies and Design

A12 Automation; Controls; Instrumentation E04 Electronics

E05 Elevators; Escalators; People-Movers

B01 Barracks; Dormitories E06 Embassies and Chanceries

B02 Bridges E07 Energy Conservation; New Energy

Sources

C01 Cartography E08 Engineering Economics

C02 Cemeteries *(Planning and Relocation)* E09 Environmental Impact
Studies,

C03 Charting; Nautical and Aeronautical Assessments or Statements

C04 Chemical Processing and Storage E10 Environmental and natural
Resource

C05 Child Care/Development Facilities Mapping

C06 Churches; Chapels E11 Environmental Planning

C07 Coastal Engineering E12 Environmental Remediation

C08 Codes; Standards; Ordinances E13 Environmental Testing and Analysis

C09 Cold Storage; Refrigeration and

Fast Freeze F01 Fallout Shelters; Blast-Resistant Design

C10 Commercial Building *(Low Rise)*; F02 Field Houses; Gyms; Stadiums

Shopping Centers F03 Fire Protection

C11 Community Facilities F04 Fisheries; Fish Ladders

C12 Communications Systems; TV; Microwave F05 Forensic Engineering

C13 Computer Facilities; Computer Service F06 Forestry and Forest
Products

C14 Conservation and Resource

Management G01 Garages; Vehicles Maintenance Facilities;

C15 Construction Management Parking Decks

C16 Construction Surveying G02 Gas Systems *(Propane; Natural, Etc.)*

C17 Corrosion Control; Cathodic Protection G03 Geodetic Surveying:
Ground and Air-

Electrolysis borne

C18 Cost Estimating; Cost Engineering and G04 Geographic Information
System

Analysis; Parametric Costing; Services: Development,

Forecasting Analysis, and Data Collection

C19 Cryogenic Facilities

**Code Description Code Description**

G05 Geospatial Data Conversion: Scanning, M08 Modular systems Design;

Digitizing, Compilation, Pre-Fabricated Structures or

Attributing, Scribing, Drafting Components

G06 Graphic Design

N01 Naval Architecture; Off-Shore

H01 Harbors; Jetties; Piers, Ship Platforms

Terminal Facilities N02 Navigation Structures; Locks

H02 Hazardous Materials Handling and N03 Nuclear Facilities; Nuclear
Shielding

Storage

H03 Hazardous, Toxic, Radioactive O01 Office Buildings; Industrial Parks

Waste Remediation O02 Oceanographic Engineering

H04 Heating; Ventilating; Air O03 Ordnance; Munitions; Special

Conditioning Weapons

H05 Health Systems Planning

H06 High-rise; Air-Rights-Type Buildings P01 Petroleum Exploration;
Refining

H07 Highways; Streets; Airfield Paving; P02 Petroleum and Fuel *(Storage
and*

Parking Lots *Distribution)*

H08 Historical Preservation P03 Photogrammetry

H09 Hospital and Medical Facilities P04 Pipelines *(Cross-Country -
Liquid and*

H10 Hotels; Motels *Gas)*

H11 Housing *(Residential, Multi-Family;* P05 Planning *(Community,
Regional,*

*Apartments; Condominiums) Areawide and State)*

H12 Hydraulics and Pneumatics P06 Planning *(Site, Installation and
Project)*

H13 Hydrographic Surveying P07 Plumbing and Piping Design

P08 Prisons and Correctional Facilities

I01 Industrial Buildings; Manufacturing P09 Product, Machine Equipment
Design

Plants P10 Pneumatic Structures, Air-Support

I02 Industrial Processes; Quality Buildings

Control P11 Postal Facilities

I03 Industrial Waste Treatment P12 Power Generation, Transmission,

I04 Intelligent Transportation Systems Distribution

I05 Interior Design; Space Planning P13 Public Safety Facilities

I06 Irrigation; Drainage

R01 Radar; Sonar; Radio and Radar

J01 Judicial and Courtroom Facilities Telescopes

R02 Radio Frequency Systems and

L01 Laboratories; Medical Research Shieldings

Facilities R03 Railroad; Rapid Transit

L02 Land Surveying R04 Recreation Facilities *(Parks,*

L03 Landscape Architecture *Marinas, Etc.)*

L04 Libraries; Museums; Galleries R05 Refrigeration Plants/Systems

L05 Lighting *(Interior; Display; Theater,* R06 Rehabilitation
*(Buildings; Structures;*

*Etc.) Facilities*

L06 Lighting *(Exteriors; Streets;* R07 Remote Sensing

*Memorials; Athletic Fields, Etc.)* R08 Research Facilities

R09 Resources Recovery; Recycling

M01 Mapping Location/Addressing Systems R10 Risk Analysis

M02 Materials Handling Systems; R11 Rivers; Canals; Waterways; Flood

Conveyors; Sorters Control

M03 Metallurgy R12 Roofing

M04 Microclimatology; Tropical

Engineering S01 Safety Engineering; Accident

M05 Military Design Standards Studies; OSHA Studies

M06 Mining and Mineralogy S02 Security Systems; Intruder and Smoke

M07 Missile Facilities *(Silos; Fuels;* Detection

*Transport)* S03 Seismic Designs and Studies

**Code Description**

S04 Sewage Collection, Treatment and

Disposal

S05 Soils and Geologic Studies;

Foundations

S06 Solar Energy Utilization

S07 Solid Wastes; Incineration; Landfill

S08 Special Environments; Clean Rooms,

Etc.

S09 Structural Design; Special

Structures

S10 Surveying; Platting; Mapping; Flood

Plain Studies

S11 Sustainable Design

S12 Swimming Pools

S13 Storm Water Handling and Facilities

T01 Telephone Systems *(Rural; Mobile;*

*Intercom, Etc.)*

T02 Testing and Inspection Services

T03 Traffic and Transportation Engineering

T04 Topographic Surveying and Mapping

T05 Towers *(Self-Supporting and Guyed*

*Systems)*

T06 Tunnels and Subways

U01 Unexploded Ordnance Remediation

U02 Urban renewals; Community

Development

U03 Utilities *(Gas and Steam)*

V01 Value Analysis; Life-Cycle Costing

W01 Warehouse and Depots

W02 Water Resources; Hydrology;

Ground Water

W03 Water Supply; Treatment and

Distribution

W04 Wind Tunnels; Research/Testing

Facilities Design

Z01 Zoning; Land Use Studies

**ARCHITECT - ENGINEER QUALIFICATIONS**

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**PART I - CONTRACT-SPECIFIC QUALIFICATIONS**

A.  **CONTRACT INFORMATION**

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1.  TITLE AND LOCATION *(City and State):*

2.  PUBLIC NOTICE DATE:

3.  SOLICITATION OR PROJECT NUMBER:

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B.  **ARCHITECT-ENGINEER POINT OF CONTACT**

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4.  NAME AND TITLE:

5.  NAME OF FIRM:

6.  TLEPHONE NUMBER:

7.  FAX NUMBER:

8.  E-MAIL ADDRESS:

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C.  **PROPOSED TEAM**

***(Complete this section for the prime contractor and all key
subcontractors.)***

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9a. PRIME (CHECK HERE):

9a. JOINT-VENTURE PARTNER (CHECK HERE):

9a. SUBCONTRACTOR (CHECK HERE):

9a. FIRM NAME:

9a. IF BRANCH OFFICE CHECK HERE:

10a. ADDRESS

11a. ROLE IN THIS CONTRACT

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9b. PRIME (CHECK HERE):

9b. JOINT-VENTURE PARTNER (CHECK HERE):

9b. SUBCONTRACTOR (CHECK HERE):

9b. FIRM NAME:

9b. IF BRANCH OFFICE CHECK HERE:

10b. ADDRESS

11b. ROLE IN THIS CONTRACT

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9c. PRIME (CHECK HERE):

9c. JOINT-VENTURE PARTNER (CHECK HERE):

9c. SUBCONTRACTOR (CHECK HERE):

9c. FIRM NAME:

9c. IF BRANCH OFFICE CHECK HERE:

10c. ADDRESS

11c. ROLE IN THIS CONTRACT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9d. PRIME (CHECK HERE):

9d. JOINT-VENTURE PARTNER (CHECK HERE):

9d. SUBCONTRACTOR (CHECK HERE):

9d. FIRM NAME:

9d. IF BRANCH OFFICE CHECK HERE:

10d. ADDRESS

11d. ROLE IN THIS CONTRACT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9e. PRIME (CHECK HERE):

9e. JOINT-VENTURE PARTNER (CHECK HERE):

9e. SUBCONTRACTOR (CHECK HERE):

9e. FIRM NAME:

9e. IF BRANCH OFFICE CHECK HERE:

10e. ADDRESS

11e. ROLE IN THIS CONTRACT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9f. PRIME (CHECK HERE):

9f. JOINT-VENTURE PARTNER (CHECK HERE):

9f. SUBCONTRACTOR (CHECK HERE):

9f. FIRM NAME:

9f. IF BRANCH OFFICE CHECK HERE:

10f. ADDRESS

11f. ROLE IN THIS CONTRACT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**D. ORGANIZATIONAL CHART OF PROPOSED TEAM** *(Attached; check here)*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**E. RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT**

*(Complete one Section E for each key person.)*

12. NAME:

13. ROLE IN THIS CONTRACT:

14a. YEARS EXPERIENCE - TOTAL:

14b. YEARS EXPERIENCE - 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.)*:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

19a(1) RELEVANT PROJECT - TITLE AND LOCATION *(City and State):*

19a(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19a(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION *(If
applicable):*

19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION *(Brief scope, size, cost
etc.)* AND SPECIFIC ROLE:

19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project
performed with current firm:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

19b(1) RELEVANT PROJECT - TITLE AND LOCATION *(City and State):*

19b(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19b(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION *(If
applicable):*

19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION *(Brief scope, size, cost
etc.)* AND SPECIFIC ROLE:

19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project
performed with current firm:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

19c(1) RELEVANT PROJECT - TITLE AND LOCATION *(City and State):*

19c(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19c(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION *(If
applicable):*

19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION *(Brief scope, size, cost
etc.)* AND SPECIFIC ROLE:

19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project
performed with current firm:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

19d(1) RELEVANT PROJECT - TITLE AND LOCATION *(City and State):*

19d(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19d(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION *(If
applicable):*

19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION *(Brief scope, size, cost
etc.)* AND SPECIFIC ROLE:

19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project
performed with current firm:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

19e(1) RELEVANT PROJECT - TITLE AND LOCATION *(City and State):*

19e(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES:

19e(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION *(If
applicable):*

19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION *(Brief scope, size, cost
etc.)* AND SPECIFIC ROLE:

19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project
performed with current firm:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**F. EXAMPLE PROJECTS WHICH BEST ILLUSTRATE PROPOSED TEAM\'S**

**QUALIFICATIONS FOR THIS CONTRACT**

*(Present as many projects as requested by the agency, or 10 projects,
if not specified.*

*Complete one Section F for each project.)*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

D.  EXAMPLE PROJECT KEY NUMBER:

E.  TITLE AND LOCATION (*City and State):*

F.  YEAR COMPLETED - PROFESSIONAL SERVICES:

G.  YEAR COMPLETED - CONSTRUCTION *(If applicable):*

23a. PROJECT OWNER\'S INFORMATION - PROJECT OWNER:

23b. PROJECT OWNER\'S INFORMATION - POINT OF CONTACT NAME:

23c. PROJECT OWNER\'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER:

24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT
    *(Include scope, size, and cost):*

25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT

  ----------------------- ----------------------- -----------------------
  \(1\) FIRM NAME         \(2\) FIRM LOCATION     \(3\) ROLE
                          *(City and State)*      

                                                  

                                                  

                                                  

                                                  

                                                  

                                                  
  ----------------------- ----------------------- -----------------------

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 16%" />
<col style="width: 27%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="15"><h1 id="section"></h1>
<h1 id="g.-key-personnel-participation-in-example-projects">G. KEY
PERSONNEL PARTICIPATION IN EXAMPLE PROJECTS</h1></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"><ol start="26" type="1">
<li><p>NAMES OF KEY PERSONNEL</p></li>
</ol>
<p>(From Section E, Block 12)</p></td>
<td colspan="2" rowspan="2"><ol start="27" type="1">
<li><p>ROLE IN THIS CONTRACT</p></li>
</ol>
<blockquote>
<p>(From Section E, Block 13)</p>
</blockquote></td>
<td colspan="11"><ol start="28" type="1">
<li><p>EXAMPLE PROJECTS LISTED IN SECTION F</p></li>
</ol>
<blockquote>
<p>(Fill in “Example Projects Key” section below before completing
table. Place “X” under project key number for participation in same or
similar role.)</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2">1</td>
<td>2</td>
<td>3</td>
<td>4</td>
<td>5</td>
<td>6</td>
<td>7</td>
<td>8</td>
<td>9</td>
<td>10</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="29" type="1">
<li><p><strong>EXAMPLE PROJECTS KEY</strong></p></li>
</ol></td>
</tr>
<tr class="odd">
<td>NO.</td>
<td colspan="2">TITLE OF EXAMPLE PROJECT (FROM SECTION F)</td>
<td colspan="2">NO.</td>
<td colspan="10">TITLE OF EXAMPLE PROJECT (FROM SECTION F)</td>
</tr>
<tr class="even">
<td>1</td>
<td colspan="2"></td>
<td colspan="2">6</td>
<td colspan="10"></td>
</tr>
<tr class="odd">
<td>2</td>
<td colspan="2"></td>
<td colspan="2">7</td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td>3</td>
<td colspan="2"></td>
<td colspan="2">8</td>
<td colspan="10"></td>
</tr>
<tr class="odd">
<td>4</td>
<td colspan="2"></td>
<td colspan="2">9</td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td>5</td>
<td colspan="2"></td>
<td colspan="2">10</td>
<td colspan="10"></td>
</tr>
</tbody>
</table>

**H. ADDITIONAL INFORMATION**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

29. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH
    ADDITIONAL SHEETS AS\
    NEEDED:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9.  **AUTHORIZED REPRESENTATIVE\
    The foregoing is a statement of facts.**

```{=html}
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```
30. SIGNATURE OF AUTHORIZED REPRESENTATIVE:

31. DATE SIGNED:

32. NAME AND TITLE OF SIGNER:

**ARCHITECT-ENGINEER QUALIFICATIONS**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**PART II - GENERAL QUALIFICATIONS**

*(If a firm has branch offices, complete for each specific branch office
seeking work.)*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1.  SOLICITATION NUMBER *(If any):*

2a. FIRM (OR BRANCH OFFICE) NAME:

2b. FIRM (OR BRANCH OFFICE) STREET:

2c. FIRM (OR BRANCH OFFICE) CITY:

2d. FIRM (OR BRANCH OFFICE) STATE:

2e. FIRM (OR BRANCH OFFICE) ZIP CODE:

3.  YEAR ESTABLISHED:

4.  DUNS NUMBER:

5a. OWNERSHIP - TYPE:

5b. OWNERSHIP - SMALL BUSINESS STATUS:

6a. POINT OF CONTACT NAME AND TITLE:

6b. POINT OF CONTACT TELEPHONE NUMBER:

6c. POINT OF CONTACT E-MAIL ADDRESS:

7.  NAME OF FIRM *(If block 2a is a branch office):*

  ----------------------------------------- -------------- --------------
  8a. FORMER FIRM NAME(S) *(If any)*        8b. YR.        8c. DUNS
                                            ESTABLISHED    NUMBER

                                                           

                                                           

                                                           
  ----------------------------------------- -------------- --------------

**9. EMPLOYEES BY DISCIPLINE**

+---------+---------------------------------+------------+------------+
| a\.     | b\. Discipline                  | c(1). No.  | c(2). No.  |
| F       |                                 | of         | of         |
| unction |                                 | Employees  |            |
| Code    |                                 |            | E          |
|         |                                 | \- Firm    | mployees - |
|         |                                 |            | Branch     |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         |                                 |            |            |
+---------+---------------------------------+------------+------------+
|         | Other Employee                  |            |            |
+---------+---------------------------------+------------+------------+
|         | **Total**                       |            |            |
+---------+---------------------------------+------------+------------+

10. **PROFILE OF FIRM\'S EXPERIENCE AND ANNUAL AVERAGE REVENUE FOR LAST
    5 YEARS**

  ---------- ------------------------------------------------ -----------
  a\.        b\. Experience                                   c\. Revenue
  Profile                                                     Index
  Code                                                        Number
                                                              *(see
                                                              below)*

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------- ------------------------------------------------ -----------

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

1.  Less than \$100,000 6. \$2 million to less than \$5 million

2.  \$100,000 to less than \$250,000 7. \$5 million to less than \$10
    million

3.  \$250,000 to less than \$500,00 8. \$10 million to less than \$25
    million

4.  \$500,000 to less than \$1 million 9. \$25 million to less than \$50
    million

5.  \$1 million to less than \$2 million 10. \$50 million or greater

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11. ANNUAL AVERAGE PROFESSIONAL SERVICES REVENUES OF FIRM FOR LAST 3
    YEARS

> (Insert revenue index number shown above)

11a. Federal Work:

11b. Non-Federal Work:

11c. Total Work:

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12. **AUTHORIZED REPRESENTATIVE. The foregoing is a statement of
    facts.**

12a. SIGNATURE:

12b. DATE SIGNED: