ARCHITECT - ENGINEER QUALIFICATIONS
PART I - CONTRACT-SPECIFIC QUALIFICATIONS
A. CONTRACT INFORMATION
1. TITLE AND LOCATION (City and State)

2. PUBLIC NOTICE DATE

3. SOLICITATION OR PROJECT NUMBER
B. ARCHITECT-ENGINEER POINT OF CONTACT
4. NAME AND TITLE

5. NAME OF FIRM

6. TELEPHONE NUMBER

7. FAX NUMBER	8. EMAIL ADDRESS
C. PROPOSED TEAM

(Complete this section for the prime contractor and all key subcontractors.)
9. FIRM NAME	10. ADDRESS	11. ROLE IN THIS CONTRACT
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 OFFICE
D. 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
(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

(3) BRIEF DESCRIPTION (Brief scope size, cost, etc.) AND SPECIFIC ROLE	Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

(3) BRIEF DESCRIPTION (Brief scope size, cost, etc.) AND SPECIFIC ROLE	Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

(3) BRIEF DESCRIPTION (Brief scope size, cost, etc.) AND SPECIFIC ROLE	Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)

(3) BRIEF DESCRIPTION (Brief scope size, cost, etc.) AND SPECIFIC ROLE	Check if project performed with current firm

(1) TITLE AND LOCATION (City and State)

(2) YEAR COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (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 COMPLETED
PROFESSIONAL SERVICES

CONSTRUCTION (If applicable)
23. PROJECT OWNER'S INFORMATION
a. PROJECT OWNER

b. POINT OF CONTACT NAME	c. POINT OF CONTACT TELEPHONE NUMBER
24. 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	(3) ROLE

b.	(1) FIRM NAME	(2) FIRM LOCATION	(3) ROLE

c.	(1) FIRM NAME	(2) FIRM LOCATION	(3) ROLE

d.	(1) FIRM NAME	(2) FIRM LOCATION	(3) ROLE

e.	(1) FIRM NAME	(2) FIRM LOCATION	(3) ROLE

f.	(1) FIRM NAME	(2) FIRM LOCATION	(3) ROLE

STANDARD FORM 330 (1/2004) PAGE 3

G. KEY PERSONNEL PARTICIPATION IN EXAMPLE PROJECTS
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 "Examples 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
29. 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

H. ADDITIONAL INFORMATION
30. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS NEEDED.

I. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.
31. SIGNATURE

32. DATE
33. NAME AND TITLE

STANDARD FORM 330 (1/2004) PAGE 5

ARCHITECT-ENGINEER QUALIFICATIONS	1. SOLICITATION NUMBER (If any)
PART II - GENERAL QUALIFICATIONS

(If a firm has branch offices, complete for each specific branch office seeking work.)
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 STATUS
6a. POINT OF CONTACT NAME AND TITLE

7. NAME OF FIRM (If block 2a is a branch office)
6b. TELEPHONE NUMBER

6c. E-MAIL ADDRESS
8a. FORMER FIRM NAME(S) (If any)	8b. YR. ESTABLISHED	8c. DUNS NUMBER

9. EMPLOYEES BY DISCIPLINE	10. PROFILE OF FIRM'S EXPERIENCE AND

ANNUAL AVERAGE REVENUE FOR LAST 5 YEARS
a. Function

Code	b. Discipline	c. No. of Employees	a. Profile

Code	b. Experience	c. Revenue Index

Number

(see below)
(1) FIRM	(2) BRANCH
Other Employees
Total
11. ANNUAL AVERAGE PROFESSIONAL

SERVICES REVENUES OF FIRM

FOR LAST 3 YEARS

(Insert revenue index number shown at right)	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
a. Federal Work	3.	$250,000 to less than $500,000	8.	$10 million to less than $25 million
b. Non-Federal Work	4.	$500,000 to less than $1 million	9.	$25 million to less than $50 million
c. Total Work	5.	$1 million to less than $2 million	10.	$50 million or greater
12. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.
a. SIGNATURE	b. DATE
c. NAME AND TITLE
AUTHORIZED FOR LOCAL REPRODUCTION	STANDARD FORM 330 (1/2004) PAGE 6

MANDATORY USE DATE OF FORM 5/1/2004