United States Department of State

Washington, D.C. 20520

July 14,2017

Subject: Request for Architect/Engineer

Qualifications - Res. roof replacement

Dear Sirs,

The U.S. Embassy in Lima, Peru is seeking for Architect/Engineer services needed to perform all worknecessary to produce complete sets of construction plans and technical specifications sufficient to replace

the residence roof at Osa Mayor 298,Camacho. This shall include, but is not limited to, any architectural,electrical, mechanical and engineering design and analyses, construction cost estimates, renderings,

photographs and scale models.

We will select an Architect/Engineer firm based on technical qualifications. Firms wishing to be

considered for this project should submit the attached Standard Form-330. A&E firms will be evaluated

based on the following:

o Relevant, professional qualifications of the firm for the type of work requiredo Specialized experience and technical competence in the type of work requiredo Demonstrated success on similar projects in terms of quality of work and compliance with

scheduleso Capacrty to accomplish work; ando Knowledge of locality of project

Please submit a completed Standard Form 330 including resumes of key individuals no later thanMonday, July 24,2017 by 10:00 hrs. :

American Embassy, LimaGSO/Procurement - Request for A&E QualificationsAv. Lima Polo cdra. 2,Monterrico

If you have any questions on this, please contact Ethel Vela at velae2@state.gov or (511) 618- 2712.

6fri DSvilantracting Officer

Enclosure: As stated.

ARCHITECT.ENGIN EER QUALIFICATIONS OMB No.: 9000-0157Expires: 1113012017

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 29 hours (25 hours for part .l and 4 hours for

U.S. General Services Administration, Regulatory secretariat (MVcBylc 9oo0-0157, office of Governmentwide Acquisition poiicy,t 800 F street, NW washington, DC 20405.

PURPOSE

Federal agencies use this form to obtain information fromarchitect-engineer (A-E) firms about their professionalqualifications. Federal agencies select firms for A-E contracts onthe basis of professional qualifications as required by 40 U.S.C.chapter 11, Selection of Architects Engineers, and Part 36 of theFederal Acquisition Regulation (FAR).

The Selection of Architects and Engineers statute requires thepublic announcement of requirements for A-E services (withsome exceptions provided by other statutes), and the selection ofat least three of the most highly qualified firms based ondemonstrated competence and professional qualificationsaccording to specific criteria published in the announcement. TheAct then requires the negotiation of a contract at a fair andreasonable price starting first with the most highly qualifled flrm.

The information used to evaluate firms is from this form and othersources, including performance evaluations, any additional datarequested by the agency, and interviews with the most highlyqualified firms and their references.

GENERAL INSTRUCTIONS

Part I presents the qualifications for a specific contract.

Part ll presents the general qualifications of a firm or a specificbranch office of a firm. Part ll has two uses:

1. An A-E flrm may submit Part ll 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, andagencies may use Part ll as a basis for selecting at least three ofthe most highly qualified firms for discussions prior to requestingsubmission of Part l. Firms are encouraged to update Part ll onfile with agency offices, as appropriate, according to FAR Part36. lf a firm has branch offices, submit a separate Part ll foreach branch office seeking work.

2. Prepare a separate Part ll for each firm that will be part ofthe team proposed for a speciflc contract and submitted with Partl. lf a firm has branch offices, submit a separate Part ll for eachbranch office that has a key role on the team.

INDIVIDUAL AGENCY INSTRUCTIONS

lndividual agencies may supplement these instructions. Forexample, they may limit the number of projects or number of

pages submitted in Part I in response to a public announcementfor a particular project. Carefully comply with any agencyinstructions when preparing and submitting this form. Be asconcise as possible and provide only the information requestedby the agency.

DEFINITIONS

Architect-Engineer Services: Defined in FAR 2.101.

Branch Office: A geographically distinct place of business orsubsidiary office of a firm that has a key role on the team.

Discipline: Primary technical capabilities of key personnel, asevidenced by academic degree, professional registration,certification, and/or extensive experience.

Firm: Defined in FAR 36.102.

Key Personne!: lndividuals who will have major contractresponsibilities and/or provide unusual or unique expertise.

SPECIFIC INSTRUCTIONS

Part I - Contract-Specific Qualifications

Section A. Contract lnformation.

1. Title and Location. Enter the tifle and location of thecontract for which this form is being submitted, exacfly as shownin the public announcement or agency request.

2. Public Notice Date. Enter the posted date of the agency'snotice on the Federal Business Opportunity website(FedBizOpps), other form of public announcement or agencyrequest for this contract.

3. Solicitation or Project Number. Enter the agency,ssolicitation number and/or project number, if applicable,exactly as shown in the public announcement or agency requestfor 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 contractoror joint venture that the agency can contact for additionalinformation.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 330 (REV.3/20i3) PAGE 1 OF INSTRUCTIONSPrescribed by GSA - FAR (48 CFR) 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 beinvolved in performance of this contract. List the primecontractor or joint venture partners first. lf a firm has branchoffices, indicate each individual branch office that will have a keyrole on the team. The named subcontractors and outsideassociates or consultants must be used, and any change mustbe approved by the contracting officer. (See FAR pafi52 Clause"Subcontractors and Outside Associates and Consultants(Architect-Engineer Services)".) Attach an additional sheet in thesame format as Section C if needed.

Section D. Organizational Chart of proposed Team.

As an attachment after Section C, present an organizationalchart of the proposed team showing the names and roles of allkey personnel listed in Section E and the firm they areassociated with as listed in Section C.

Section E. Resumes of Key Personnel proposed for ThisContract.

Complete this section for each key person who willparticipate in this contract. Group by firm, with personnel of theprime contractor or joint venture partner firms first. The followingblocks must be completed for each resume:

1 2. 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, cig and state of the firmwhere the person currently works, which must correspond withone of the firms (or branch office of a flrm, if appropriate) listedin Section C.

16. Education. Provide information on the highest relevantacademic degree(s) received. lndicate the area(s) ofspecialization for each degree.

17. Current Professional Registration. provide information oncurrent relevant professional registration(s) in a State orpossession of the United States, Puerto Rico, or the District ofColumbia according to FAR Part 36.

18. Other Professional Qualifications. provide information onany other professional qualifications relating to this contract,such as education, professional registration, publications,organizational memberships, certifications, training, awards, andforeign language capabilities.

19. Relevant Projects. provide information on up to fiveprojects in which the person had a significant role thatdemonstrates the person's capability relevant to her/his proposedrole in this contract. These projects do not necessarily have tobe any of the projects presented in Section F for the project teamif the person was not involved in any of those projects or theperson worked on other proJects that were more relevant thanthe team projects in Section F. Use the check box provided toindicate if the project was performed with any office of the currentflrm. lf any of the professional services or construction projectsare not complete, leave Year Completed blank and indicate thestatus in Brief Description and Specific Role (block (3)).

Section F. Example Projects \Mich Best lllustrate proposedTeam's Qualifications for This Contract.

Select projects where multiple team members workedtogether, if possible, that demonstrate the team,s capability toperform work similar to that required for this contract. Completeone Section F for each project. present ten projects, unlessotherwise specified by the agency. Complete the followingblocks for each project:

20. Example Prolect Key Number. Start with ',1" for the firstpro,lect and number consecutively.

21. Title and Location. Tifle and location of project orcontract. For an indefinite delivery contract, the location is thegeographic scope of the contract.

22. Year Completed. Enter the year completed of theprofessional services (such as planning, engineering study,design, or surveying), and/or the year completed ofconstruction, if applicable. lf any of the professional services orthe construction projects are not complete, leave yearCompleted blank and indicate the status in Brief Description ofProject and Relevance to This Contract (block 24).

23a. Prolect Owner. Project owner or user, such as agovernment agency or installation, an institution, a corporation orprivate individual.

23b. Point of Contact Name. provide name of a personassociated with the pro,lect owner or the organization whichcontracted for the professional services, who is very familiar withthe prolect and the firm's (or firms') performance.

23c. Point of Contact Telephone Number Self-explanatory.

24. Briet Description of project and Relevance to ThisContract. lndicate scope, size, cost, principal elements andspecial features of the project. Discuss the relevance of theexample project to this contract. Enter any other informationrequested by the agency for each example project.

STANDARD FORM 330 (REV.3/2013) pAGE 2 OF TNSTRUCTTONS

25. Firms from Section C lnvolved with This project.lndicate which firms (or branch offices, if appropriate) on theproJect team were involved in the example project, and theirroles. List in the same order as Section C.

Section G. Key Personnel participation in Example projects.

This matrix is intended to graphically depict which keypersonnel identified in Section E worked on the example projectslisted in Section F. Complete the following blocks (see examplebelow).

26. and 27. Names of Key personnel and Role in ThisContract. List the names of the key personnel and their proposedroles in this contract in the same order as they appear in SectionE.

28. Example Projects Listed in Section F. ln the columnunder each project key number (see block 29) and for each keyperson, place an "X" under the project key number forparticipation in the same or similar role.

29. Example Projects Key. List the key numbers and tifles ofthe example projects in the same order as they appear in SectionF.

Section H. Additional lnformation.

30. Use this section to provide additional informationspecifically requested by the agency or to address selectioncriteria that are not covered by the information provided inSections A-G.

Section L Authorized Representative.

31. and 32. Signature of Authorized Representative andDate. An authorized representative of a joint venture or the primecontractor must sign and date the completed form. Signingattests that the information provided is current and factual, andthat all firms on the proposed team agree to work on theproject. Joint ventures selected for negotiations must makeavailable a statement of participation by a principal of eachmember of the joint venture.

33. Name and Title. Self-explanatory.

PERSONNEL(From Section E,

Block 12)

CONTRACT(From Section E,

Block 13)

(Fill in "Example Projects Key" section below first, beforecompleting table. Place "X" under project key number for

participation in same or similar role.)

2 3 4 5 6 7 8 I 10

Jane A. Smith Chief Architect x x

.foseph B. Willi-ams Chief Mech. Engineer X x x x

Tara C. Donovan Chief El-ec. Engineer x x x

SAMPLE ENTRTES FOR SECTTON G (MATRIX)

27. ROLE IN THIS 28. EXAMPLE PROJECTS LISTED IN SECTION F26. NAMES OF KEY

Justin J. WifsonBaton Rouqe, LA

29. EXAMPLE PROJECTS KEY

TITLE OF EXAMPLE PROJECT SECTION F

XYZ Corporation Headquarters, Boston, MA

Eounder's Museum, Newport RI

TTTLE OF EXAMpLE PROJECT (FROM SECTTON F

Federal Courthouse, Denver, CO

Federal Buildlng,

STANDARD FORM 330 (REV.3/2013) PAGE 3 OF INSTRUCTTONS

Part ll - General Qualifications

See the " General lnstructions ', on page 1 for firms with branchoffices. Prepare Part ll for the specific branch office seekingwork if the firm has branch offices.

1. Solicitation Number. If part ll is submitted for a specificcontract, insert the agency's solicitation number and/or projectnumber, if applicable, exacfly as shown in the pu-blicannouncement 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. lnsert the Data Universal NumberingSystem number issued by Dun and Bradstreet lnformationServices. Firms must have a DUNS number. See FAR part 4.6.

5. Ownership.

a. Type. Enter the type of ownership or legal structure of thefirm (sole proprietor, pa(nership, corporation, joint venture, etc.).

b. Small Business Status. Refer to the North Americanlndustry Classification System (NAICS) code in the publicannouncement, and indicate if the firm is a small businessaccording to the current size standard for that NAICS code (forexample, Engineering Services (part of NAICS 541330),Architectural Services (NAICS 541310), Surveying and MappingServices (NAICS 541310)). The small business categories andthe internet website for the NAICS codes appear in FAR part 19.Contact the requesting agency for any questions. Contact yourlocal U.S. Small Business Administration office for any questionsregarding Business Status.

6a-6c. Point of Contact. provide this information for arepresentative of the flrm that the agency can contact foradditional information. The representative must be empowered tospeak on contractual and policy matters.

7. Name of Firm. Enter the name of the flrm if part ll isprepared for a branch office.

8a-8c. Former Firm Names. lndicate any other previousnames for the flrm (or branch office) during the last six years.lnsert the year that this corporate name change was

effective and the associated DUNS Number. This information isused to review past performance on Federal contracts.

9. Employees by Discipline. Use the relevant disciplines andassociated function codes shown at the end of these instructionsand list in the same numericar order. After the risted disciprines,write in any additional disciplines and leave the function codeblank. List no more than 20 disciplines. Group remainingemployees under "Other Employees,, in column b. Each p"r"oi9gl b" counted only once according to his/her primary firnction.lf Part ll is prepared for a firm (including all branch offiies), enterthe number of employees by disciplines in column c(1). lf part llis prepared for a branch office, enter the number of employeesby discipline in column c(2) and for the firm in column c(1).

10. Profile of Firm,s Experience and Annual AverageRevenue for Last 5 years. Complete this block for the firm orbranch office for which this part ll is prepared. Enter theexperience categories which most accurately reflect the firm,stechnical capabilities and project experience. Use the relevantexperience categories and associated profile codes shown at theend of these instructions, and list in the same numerical order.After the listed experience categories, write in any unlistedrelevant project experience categories and leave the profilecodes blank. For each type of experience, enter the appropriaterevenue index number to reflect the professional servicesrevenues received annually (averaged over the last 5 years) bythe firm or branch office for performing that type of work. Aparticular project may be identified with one experience categoryor it may be broken into components, as best reflects thecapabilities and types of work performed by the firm. However,do not double count the revenues received on a particularproject.

1 1. Annual Average professional Services Revenues of Firmfor Last 3 Years. Complete this block for the firm or branch officefor which this Part ll is prepared. Enter the appropriate revenueindex numbers to reflect the professional services revenuesreceived annually (averaged over the last 3 years) by the firm orbranch office. lndicate Federal work (performed direcfly for theFederal Government, either as the prime contractor orsubcontractor), non-Federal work (all other domestic and foreignwork, including Federally-assisted projects), and the total. lf thefirm has been in existence for less than 3 years, see thedefinition for "Annual Receipts,' under FAR 19. 101.

12. Authorized Representative. An authorized represent_ative of the firm or branch office must sign and date thecompleted form. Signing attests that the information provided iscurrent and factual. Provide the name and title of the authorizedrepresentative who signed the form.

STANDARD FORM 330 (REV.3/2013) PAGE 4 OF INSTRUCTIONS

List of Disciplines (Function Codes)

Code

01

0203o4050607080910

11

121314

15161718192021

22232425262728293031

Description

Acoustical EngineerAdministrativeAerial PhotographerAeronautical EngineerArcheologistArchitectBiologistCADD TechnicianCartographerChemical EngineerChemistCivil EngineerCommunications EngineerComputer ProgrammerConstruction lnspectorConstruction ManagerCorrosion EngineerCost Engineer/EstimatorEcologistEconomistElectrical EngineerElectronics EngineerEnvironmental EngineerEnvironmental ScientistFire Protection EngineerForensic EngineerFoundation/Geotechnical EngineerGeodetic SurveyorGeographic lnformation System SpecialistGeologistHealth Facility Planner

Description

Hydraulic EngineerHydrographic SurveyorHydrologistlndustrial Engineerlndustrial Hygienistlnterior DesignerLand SurveyorLandscape ArchitectMaterials EngineerMaterials Handling EngineerMechanical EngineerMining EngineerOceanographerPhoto lnterpreterPhotogrammetristPlanner: Urban/RegionalProject ManagerRemote Sensing SpecialistRisk AssessorSafety/Occupational Health EngineerSanitary EngineerSchedulerSecurity SpecialistSoils EngineerSpecifications WriterStructural EngineerTechnician/AnalystToxicologistTransportation EngineerValue EngineerWater Resources Engineer

Code

3233343536373839404142434445464748495051

52535455565758596061

62

STANDARD FORM 330 (REV.3/2013) PAGE S OF INSTRUCTIONS

List of Experience Categories (Profile Codes)

Code

401

AO2

A03

A04

A05

A06

407

A08

409

410

A1l

412

801802

c01

c02c03c04c05

c06c07

c08c09c10c11

c12c13c14c15c16c17

c18

c19

D01

D02

D03

D04

D05

D06

D07

D08

DescriptionAcoustics, NoiseAbatement

Aerial Photography; Airborne Data and lmageryCollection and Analysis

Agricultural Development; Grain Storage; Farm Mechanization

Air Pollution Control

Airports; Navaids; Airport Lighting; Aircraft Fueling

Airports; Terminals and Hangars; Freight Handling

Arctic Facilities

Animal Facilities

Anti-Terrorism/Force Protection

Asbestos Abatement

Auditoriums & Theaters

Automation; Controls; lnstrumentation

Barracks; DormitoriesBridges

Cartography

Cemeteries (Planning & Relocation)

Charting: Nautical and Aeronautical

Chemical Processing & Storage

Child Care/Development Facilities

Churches; Chapels

Coastal Engineering

Codes; Standards; Ordinances

Cold Storage; Refrigeration and Fast Freeze

Commercial Building (low ise); Shopping Centers

Community Facilities

Communications Systems; TV; Microwave

Computer Facilities, Computer Service

Conservation and Resource Management

Construction Management

Construction Surveying

Corrosion Control; Cathodic Protection; Electrolysis

Cost Estimating; Cost Engineering andAnalysis; Parametric Costing; Forecasting

Cryogenic Facilities

Dams (Concrete; Arch)

Dams (Earth; Rockl; Dikes; Levees

Desalinization (Process & Facilities)

Design-Build - Preparation of Requests for Proposals

Digital Elevation and Terrain Model Development

Digital Orthophotography

Dining Halls, Clubs; Restaurants

Dredging Studies and Design

Code DescriptionE01 Ecological&ArcheologicallnvestigationsEO2 Educational Facilities; Classrooms

E03 Electrical Studies and Design

E04 Electronics

E05 Elevators; Escalators; People-Movers

E06 Embassies and ChanceriesE07 Energy Conservation; New Energy SourcesE08 Engineering Economics

E09 Environmental lmpact Studies,Assessments or Statements

E10 Environmental and Natural ResourceMapping

E11 EnvironmentalPlanning

E12 Environmental RemediationE13 Environmental Testing and Analysis

F01F02F03F04F05F06

G01

G02

G03

G04

G05

Fallout Shelters; Blast-Resistant DesignField Houses; Gyms; StadiumsFire ProtectionFisheries; Fish laddersForensic EngineeringForestry & Forest products

Garages; Vehicle Maintenance Facilities;Parking Decks

Gas Systems (Propane; Natural, Etc.)

Geodetic Surveying: Ground and Air-borne

Geographic Information System Services:Development, Analysis, and Data Collection

Geospatial Data Conversion: Scanning,Digitizing, Compilation, Attributing, Scribing,Drafting

G06 Graphic Design

H01 Harbors; Jetties; Piers, Ship TerminalFacilities

H02 Hazardous Materials Handling and StorageH03 Hazardous, Toxic, Radioactive Waste

Remediation

H04 Heating; Ventilating; Air ConditioningH05 Health Systems Planning

H06 Highrise;Air-Rights-Type Buildings

H07 Highways; Streets; Airfield Paving; ParkingLotS

H08 Historical Preservation

H09 Hospital & Medical Facilities

H10 Hotels; Motels

H11 Housing (Residential,Multi-Family;Apartments; Condominiums)

H12 Hydraulics & Pneumatics

H13 Hydrographic Surveying

STANDARD FORM 330 (REV.3/2013) PAGE 6 OF INSTRUCTIONS

List of Experience Categories (profile Codes)

Code Description101 lndustrialBuildings;Manufacturingplants

102 lndustrial Processes; Quality Control

103 lndustrial Waste Treatment

104 lntelligentTransportationSystems

105 lnterior Design; Space Planning

106 lrrigation; Drainage

J01 Judicial and Courtroom Facilities

L01 Laboratories;MedicalResearchFacilities

L02 Land Surveying

L03 Landscape Architecture

L04 Libraries; Museums; Galleries

105 Lighting (lnterior; Display; Theater, Etc.)

L06 Lighting (Exteriors; Streets; Memorials;Athletic Fields, Etc.)

M01 Mapping Location/Addressing Systems

M02 Materials Handling Systems; Conveyors; Sorters

M03 Metallurgy

M04 Microclimatology;TropicalEngineering

M05 Mllitary Design Standards

M06 Mining & Mineralogy

M07 Missile Facilities (Silos; Fuels; Transport)

M08 Modular Systems Design; Pre-Fabricated Structures orComponents

N01 Naval Architecture; Off-Shore platforms

N02 Navigation Structures; Locks

N03 Nuclear Facilities; Nuclear Shielding

O01 Office Buildings; lndustrial ParksO02 Oceanographic EngineeringO03 Ordnance; Munitions; Special Weapons

P01 PetroleumExploration;Refining

P02 Petroleum and Fuel (Storage and Distribution)

P03 Photogrammetry

P04 Pipelines (Cross-Country - Liquid & Gas)

P05 Planning (Community, Regional, Areawide and State)

P06 Planning (Site, lnstallation, and Project)

P07 Plumbing & Piping Design

P08 Prisons & Correctional Facilities

Code DescriptionP09 Product, Machine Equipment Design

P10 PneumaticStructures,Air-SupportBuildings

P11 Postal Facilities

P12 PowerGeneration,Transmission,Distribution

P13 Public Safety Facilities

R01 Radar; Sonar; Radio & RadarTelescopes

R02 Radio Frequency Systems & Shieldings

R03 Railroad; Rapid Transit

R04 Recreation Facilities (Parks, Marinas, Etc.)

R05 Refrigeration Plants/Systems

R06 Rehabilitation(Buildings;Structures;Facilities)

R07 Remote Sensing

R08 Research Facilities

R09 Resources Recovery; Recycling

R10 Risk Analysis

R11 Rivers; Canals; Waterways; Flood Control

R12 Roofing

S01 Safety Engineering; Accident Studies; OSHAStudies

S02 Security Systems; lntruder & Smoke Detection

S03 Seismic Designs & Studies

S04 Sewage Collection, Treatment and Disposal

S05 Soils & Geologic Studies; Foundations

506 Solar Energy Utilization

S07 Solid Wastes; lncineration; Landfill

S08 Special Environments; Clean Rooms, Etc.

S09 Structural Design; Special Structures

510 Surveying; Platting; Mapping; FloodPlain Studies

511 Sustainable Design

S12 Swimming Pools

513 Storm Water Handling & Facilities

T01 Telephone Systems (Rural; Mobite; lntercom,Etc.)

T02 Testing & lnspection ServicesT03 Traffic & Transportation Engineering

T04 Topographic Surveying and MappingT05 Towers (Self-Suppofting & Guyed Sysfems)T06 Tunnels & Subways

STANDARD FORM 330 (REV.3/2013) PAGE 7 OF INSTRUCTIONS

List of Experience Categories (profile Codes)

Code DescriptionU01 UnexplodedOrdnanceRemediation

U02 Urban Renewals; Community Development

U03 Utilities (Gas and Steam)

V01 Value Analysis; Life-Cycle Costing

\ /01 Warehouses & Depots

\ /02 Water Resources; Hydrology; Ground Water

l /03 Water Supply; Treatnent and Distribution

\ O4 \A/ind Tunnels; Research/Testing Facilities Design

ZO1 Zoning; Land Use Studies

STANDARD FORil330 (REV.3/2013) PAGE 8 OF TNSTRUCTTONS

ARGHITECT . ENGINEER QUALIFIGATIONS

PART I - CONTRACT.SPEGIFIC QUALIFICATIONS

A. CONTRACT INFORMATION1. TITLE AND LOCA (CiU and State)

B. ARCHITECT.ENGINEER POINT OF CONTACT

this section for the pime contractor and all subcontractors

11. ROLE IN THIS CONTRACT

CHECK IF BRANCH OFFICE

D. ORGANIZATIONAL CHART OF PROPOSED TEAM | 4ttachea)AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 330 (REV.3/2013) PAGE 1

(Complete one Section E for each key person.)

15. FIRM NAME AND LOCATION (City and State)

E. RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT

16. EDUCATION (DEGREE AND SPECIALIZATION)

18. OTHER PROFESSIONAL QUALIFICATIONS (Publications,

14- YEARS EXPERIENCE

b. WTH CURRENT FIRM

17. CURRENT PROFESSIONAL REGISTRATION (STATE AND DISCIPLINE)

Awards, etc.)

(1) TITLE AND LOCATION (City and State)

(1) TITLE AND LOCATION (City and State)

1) TITLE AND LOCATION (City and State)

(1) TITLE AND LOCATION (City and State)

(1) TITLE AND LOCATION (CW and State)

19. RELEVANT PROJECTS

BRIEF DESCRIPTION (B/.,ef scope, slze, cosf, efc.) AND SPECIFIC ROLE

BRIEF DESCRIPTION (B/ref scope, size, cost, etc.)

BRIEF DESCRIPTION (Bn-ef scope, size, cost etc.) AND SPECIFIC ROLE

DESCRIPTION (Bief scope, sze, cosf, elc.) AND SPECIFIC ROLE

(2) YEAR COMPLETED

CONSTRUCTION (lf applicable)

! Cnecf if project performed with current firm

(2) YEAR COMPLETED

CONSTRUCTION (ff applicable)

I Cnect if project performed with current firm

(2) YEAR COMPLETED

TION (ff applicable)

Check if project performed with current firm

(2) YEAR COMPLETED

CONSTRUCTION (ff applicabte)

! Cnect if project performed with current firm

(2) YEAR COMPLETED

TRUCTION (lf applicable)

Check if project performed with current firm(3) BRIEF DE cost etc.) AND SPECIFIC ROLE

(REV 3t2013)

QUALIFICATIONS FOR THIS CONTRACT(Present as many projects-??

l?Suestgd g.y thg ggency., or 10 piojects, if not specified.Complete one Section F tor ea6i oroiedt I

EXAMPLE PROJECT KEYNUMBER

D

CONSTRUCTION (lf appticabte)

21. T|TLEAND LOCATTON (City and

23. PROJECT OWNER'S INFORMATION

OF CONTAC

24.BRlEFDESCRlPTloNoFPRoJEcTANoRelevRlcerorrrls@

25. FIRMS FROM SECTION C INVOLVED WTH THIS PROJECT(1) FIRM NAME (2) FIRM LOCATION (City and State) (3)

1) FIRM NAME (2) FIRM LOCATION (City and StaE)

(1) FIRM NAME ,2) FIRM LOCATION (City and State) (3) ROLE

1) FIRM NAME (2) FIRM LOCATION (City and State) ROLE

(1) FIRM NAME (2) FIRM LOCATION (City and State) ROLE

f.1) FIRM NAME (2) FIRM LOCATTON (City and State) ROLE

STANDARD FORM 330 (REV.3/2013) PAGE 3

26. NAMES OF KEYPERSONNEL

(From Section E, Block 12)

G. KEY PERSONNEL PARTICIPATION IN EXAMPLE PROJECTS

28. EXAMPLE PROJECTS LISTED IN SECTION F(Fillin "Example.Projects Key" section below before completing table.Place 'X" under project key number for participation i, ."rJ"i'rii.,irli'irr".l

27. ROLE IN THISCONTRACT

(From Section E, Block 13)

29. EXAMPLE PROJECTS KEY

STANDARD FORM 330 Gev. grzorotFAGEZ

H. ADDITIONAL TNFORMATION

30. PROVIDE ANY ADDITIONAL INFORMAT

I. AUTHORIZED REPRESENTATIVE

33. NAME AND TITLE

The foregoing is a statement of facts.

STANDARD FORil 330 (REV.3/2013) PAGE s

2a. FIRM (OR BRANCH

2c. CITY

6a. POINT CONTACT NAME AND TITLE

8a. FORMER FIRM

9. EMPLOYEES BY DISCIPLINE

11. ANNUAL AVERAGE PROFESSIONALSERVICES REVENUES OF FIRM

FOR LAST 3 YEARS(lnseft revenue index number shown at right)

1. SOLICITAT|ON ruUUaeR llrany,)

4. DUNS NUMBER

5. O!\NERSHIP

block 2a is a branch office)

8c. DUNS NUMBER

10. PROFTLE OF FtRM,S EXPERTENCEAND INNUAL AVERAGE REVENUE FOR LAST 5 YEARS

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

ARC HITECT-ENGINEER QUALIFICATIONS

a firm has branchP-4RT il - GENERAL OUAL|F|CAT|OTS

for each branch office

1. Less than $1OO,OOO2. $100,00 to less than $2SO,OO03. $250,000 to tess than $500,0004. $500,000 to less than $1 million5. $1 million to less than $2 million

6. $2 million to less than $5 million7. $5 million to less than $10 million8. $10 million to less than $25 million9. $25 million to less than $50 million10. $50 million or greater

b

AUTHORIZED FOR LOCAL NTPROOUCTloiSTANDARD FORM 330 fnEv.3t2o13)pAGE 6