Attapulgus FY 2027 CDBG Project Engineering Services

CITY OF ATTAPULGUS

Engineering Statement of Qualifications

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NAME OF FIRM:

ADDRESS:

1. Years in Business in Present Form:

2. Firms History and Resource Capability to Perform Required Services:

3. Titles, Names, and Addresses of all Officers:

4. List categories in which firm is legally qualified to do business. Include Licenses and Registrations where applicable.

5. Does your firm carry Errors and Omissions Insurance? _____

6. If you were awarded the design, bid phase, and inspection for this project, what would your fee be?

7. Does your firm charge for the preliminary engineering report (PER)?

If yes, what would the charge be? $______________

Can your firm meet the draft PER deadline? YES____ NO______

8. List up to five (5) projects which demonstrate skills to be used on CDBG projects. Note project name, location, owner, year, contract amount, and nature of firm's responsibility.

9. List key personnel (with qualifications) likely to be involved on these projects and explain their specific role in CDBG work.

10. List three (3) references for the Firm.

11. Are you a Section 3 Business Concern? Yes No

If yes, the Attached Section 3 Business Concern Certification, Previous Certification and Action Plan must be filled out, signed, notarized, and submitted with your proposal.

Is the signed and notarized Section 3 Business Concern Certification, Previous Certification and Action Plan attached to your proposal? Yes

If no, you will only need to submit the Section 3 forms if you are the successful proposer.

12. Certifying that:

Mr./Mrs./Ms. (signature) being duly sworn deposes and states that he/she is the (title) of (name of firm) and that answers to the foregoing questions and all statements herein contained are true and correct.