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OPRPM FORM 112 (Rev. 0802)
U N I V E R S I T Y O F H A W A I ‘ I
OFFICE OF PROCUREMENT AND REAL PROPERTY MANAGEMENT
STATEMENT OF QUALIFICATIONS
QUESTIONNAIRE
FOR
ARCHITECTS AND ENGINEERS
INSTRUCTIONS
1. Responses to questionnaire shall be typewritten. Individuals or firms should submit a letter of interest and completed Statement(s) of Qualifications, OPRPM FORM 112, to:
University of Hawai‘i Office of Procurement and Real Property Management
1400 Lower Campus Road, Room 15 Honolulu, Hawaii 96822
2. In multi-discipline firms (A&E), each discipline (Architect, Structural Engineering, Mechanical Engineering, etc.) shall be provided on a separate questionnaire. It is recognized that personnel in a multi-discipline firm are often shifted where most needed. In such instances, the number of personnel should be indicated in proportion to the amount of time that such personnel normally spend within such discipline. (Example, a full-time draftsman may spend 0.3 of his time in work related to Architecture and 0.7 of his time to Civil Engineering.)
3. Personal history statements of Technical Personnel shall include only Architects, Engineers, Draftsmen, Specification Writers, Estimators, Landscape Architects, Planners, Land Surveyors, Aerial Surveyors, and Real Property Appraisers.
4. All questions pertaining to this questionnaire may be directed to the Office of Procurement and Real Property Management, telephone (808) 956-8687.
OPRPRM FORM 112 (Rev. 0802)
(LIST DISCIPLINE)
OTHER QUESTIONAIRES SUBMITTED (LIST DISCIPLINES)
UNIVERSITY OF HAWAI‘I
ESTABLISHED FIRM NAME
YEAR
STATE
TYPE OF ORGANI-ZATION
INDIVIDUAL
PARTNERSHIP
CORPORATION
JOINT VENTURE
OTHER
YEAR ESTABLISHED IN HAWAII BUSINESS ADDRESS AND TELEPHONE NO. OF HAWAII OFFICE
PRESENT BRANCH
OFFICE(S)
ADDRESS
TELEPHONE NO.
NAME OF PERSON IN CHARGE
PRINCIPALS OF
FIRM
NAMES
ASSOCIATE MEMBERS OF FIRM
NAMES
NUMBER OF PERSONNEL IN YOUR PRESENT ORGANIZATION
PRINCIPALS/KEY PERSONNEL OTHER PERSONNEL
ENGINEERS LOCATED AT ARCH
ENG OTHER ARCH
MECH. ELEC. CIVIL OTHER
DRAFTS-MEN
SPEC. WRITERS
ESTIMA-TORS
INSPEC-TORS
SURVEY-ORS BALANCE TOTALS
HOME OFFICE
BR
AN
CH
OFF
ICE
IN
TOTALS
NUMBER OF PERSONNEL IN YOUR ORGANIZATION DURING THE LAST 5 YEARS MAXIMUM NO.
YEAR
NORMAL STRENGTH
(1)
OPRPRM FORM 112 (Rev. 0802)
OUTSIDE ASSOCIATES AND CONSULTANTS USUALLY EMPLOYED BY YOUR FIRM CATEGORY NAME OF FIRM OR INDIVIDUAL CATEGORY NAME OF FIRM OR INDIVIDUAL
ARCHITECTS MECHANICAL ENGINEERS
LAND SCAPE ARCHITECTS ELECTRICAL
ENGINEERS
CIVIL ENGINEERS PLANNERS
STRUCTURAL ENGINEERS ESTIMATORS
SANITARY ENGINEERS
OTHER CONSULTANT AFFILIATIONS
INDICATE IN ORDER OF PREFERENCE THE TYPES OF PROJECTS IN WHICH YOUR FIRM SPECIALIZES
(2)
OPRPRM FORM 112 (Rev. 0802)
PERSONAL HISTORY STATEMENT OF PRINCIPALS WITHIN YOUR FIRM
NAME
NAME
RESIDENT OF HAWAII
YEARS OF EXPERIENCE
AS PRINCIPAL IN THIS FIRM
AS PRINCIPAL IN OTHER FIRMS
OTHER THAN PRINCIPAL
RESIDENT OF HAWAII YEARS OF
EXPERIENCE AS PRINCIPAL IN THIS FIRM
AS PRINCIPAL IN OTHER FIRMS
OTHER THAN PRINCIPAL
YES NO YES NO
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
REGISTRATION (TYPE, YEAR, STATE)
REGISTRATION (TYPE, YEAR, STATE)
FAMILIARITY WITH ANUNDERSTANDING OF FEDERAL REQUIRMENETS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
FAMILIARITY WITH ANUNDERSTANDING OF FEDERAL REQUIRMENETS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
NAME
NAME
RESIDENT OF HAWAII
YEARS OF EXPERIENCE
AS PRINCIPAL IN THIS FIRM
AS PRINCIPAL IN OTHER FIRMS
OTHER THAN PRINCIPAL
RESIDENT OF HAWAII YEARS OF
EXPERIENCE AS PRINCIPAL IN THIS FIRM
AS PRINCIPAL IN OTHER FIRMS
OTHER THAN PRINCIPAL
YES NO YES NO
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
REGISTRATION (TYPE, YEAR, STATE)
REGISTRATION (TYPE, YEAR, STATE)
FAMILIARITY WITH ANUNDERSTANDING OF FEDERAL REQUIRMENETS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
FAMILIARITY WITH ANUNDERSTANDING OF FEDERAL REQUIRMENETS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
(3)
OPRPRM FORM 112 (Rev. 0802)
PERSONAL HISTORY STATEMENT OF ASSOCIATES WITHIN YOUR FIRM
NAME
NAME
TITLE OR POSITION
FULL TIME
PART TIME
TITLE OR POSITION
FULL TIME
PART TIME
RESIDENT OF HAWAII YEARS OF EXPERIENCE RESIDENT OF HAWAII YEARS OF EXPERIENCE
YES NO WITH THIS FIRM
OTHER FIRMS
YES NO WITH THIS FIRM
OTHER FIRMS
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
REGISTRATION (TYPE, YEAR, STATE)
REGISTRATION (TYPE, YEAR, STATE)
FAMILIARITY WITH AND UNDERSTANDING OF FEDERAL REQUIREMENTS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
FAMILIARITY WITH AND UNDERSTANDING OF FEDERAL REQUIREMENTS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
NAME
NAME
TITLE OR POSITION
FULL TIME
PART TIME
TITLE OR POSITION
FULL TIME
PART TIME
RESIDENT OF HAWAII YEARS OF EXPERIENCE RESIDENT OF HAWAII YEARS OF EXPERIENCE
YES NO WITH THIS FIRM
OTHER FIRMS
YES NO WITH THIS FIRM
OTHER FIRMS
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
EDUCATION (COLLEGE, DEGREE, SPECIALIZATION)
REGISTRATION (TYPE, YEAR, STATE)
REGISTRATION (TYPE, YEAR, STATE)
FAMILIARITY WITH AND UNDERSTANDING OF FEDERAL REQUIREMENTS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
FAMILIARITY WITH AND UNDERSTANDING OF FEDERAL REQUIREMENTS GOVERNING PROFESSIONAL DESIGN SERVICES
YES NO
(4)
OPRPRM FORM 112 (Rev. 0802)
PRESENT ACTIVITIES ON WHICH YOUR FIRM IS DESIGNATED THE PRIME ARCHITECT OR ENGINEER
PERCENT COMPLETED NAME AND TYPE OF PROJECT LOCATION NAME OF OWNER ESTIMATED CONSTRUCTION COST
DESIGN FIELD SUP.
TOTAL NUMBER OF PRESENT PROJECTS: TOTAL ESTIMATED CONSTRUCTION COST:
(5)
OPRPRM FORM 112 (Rev. 0802)
PRESENT ACTIVITIES ON WHICH YOUR FIRM IS ASSOCIATED WITH OTHERS (INDICATE PHASE OF WORK FOR WHICH YOUR FIRM IS RESPONSIBLE)
ESTIMATED CONSTRUCTION COST OF PERCENT OF ENTIRE PROJECT COMPLETED NAME OF PROJECT
AND PHASE OF WORK
LOCATIONS
OWNERENTIRE
PROJECT
WORK FOR WHICH YOUR FIRM IS RESPONSIBLE
DESIGN FIELD SUP.
FIRM ASSOCIATED
WITH
TOTAL NUMBER OF PRESENT PROJECTS: TOTAL ESTIMATED CONSTRUCTION COST OF WORK FOR WHICH YOUR FIRM IS RESPONSIBLE:
(6)
OPRPRM FORM 112 (Rev. 0802)
COMPLETED WORK ON WHICH YOUR FIRM WAS DESIGNATED THE PRIME ARCHITECT OR ENGINEER DURING THE LAST 5 YEARS
NAME AND TYPE OF PROJECT LOCATION
YEAR YOUR WORK
COMPLETED
NAME OF OWNER ESTIMATED
CONSTRUCTION COST
CON-STRUCTED (YES OR
NO)
TOTAL NUMBER OF COMPLETED PROJECTS: TOTAL ESTIMATED CONSTRUCTION COST:
(7)
OPRPRM FORM 112 (Rev. 0802)
IN THE EVENT SPACES PROVIDED ON THE FORM ARE NOT SUFFICIENT FOR ENTRIES, OR IF YOU WISH TO FURNISH ADDITIONAL INFORMATION, IT MAY BE INSERTED HERE, AND ON THE NEXT PAGE WITH APPROPRIATE REFERENCES.
As of this date: the foregoing is a true statement of facts.
NAME OF FIRM OR INDIVIDUAL SUBMITTING QUESTIONAIRE
TYPE NAME AND TITLE OF PERSON SIGNING
SIGNATURE
NOTE: It will be to a firm's advantage to maintain its experience record on a current basis. This may be accomplished by periodically forwarding current data.
(8)
ADDITIONAL INFORMATION IF NECESSARY
OPRPRM FORM 112 SUPPLEMENT A (Rev. 0802)
ASBESTOS PROJECTS Submit only if interested in this type of project.
1. Check area(s) of interest below:
ACM-1 Inspection and management planning (planning phase)
ACM-2 Abatement design (project design phase)
ACM-3 Abatement project inspection and monitoring (project construction phase)
2. Provide information for key personnel on staff: ACCREDITATION (Y or N) DATE ACCREDITATION EXPIRES
NAME* EPA Des EPA Insp/Mgmt EPA Des EPA Insp/Mgmt
3. For ACM-1 and/or ACM-3, indicate the following:
Testing Laboratory In-House
Affiliated (provide name of laboratory and location)
4. For ACM-2, identify persons responsible for construction drawings and specifications:
NAME* Arch./Eng. Discipline License No. Date of License
* If subcontractor, add (S) after the person's name. If Name(s) not known, so state and give subcontractor's name with a statement that the person(s) to
be assigned will have the appropriate current accreditation and/or qualifications.
Name of Firm
Typed Name and Title of Person Signing
Signature
OPRPRM FORM 112 SUPPLEMENT B (Rev. 0802)
LEAD CONTAINING PAINT PROJECTS Submit only if interested in this type of project.
1. Check area(s) of interest below:
LCP-1 Lead containing paint surveys (planning phase)
LCP-2 Lead containing paint disturbance design (project design phase)
LCP-3 Lead containing paint disturbance project inspection and monitoring (project construction phase)
2. Provide names of person(s) responsible for this work. Indicate how knowledge of HUD, EPA, and OSHA regulations regarding lead containing paint was acquired. If by formal training, provide name(s) of course(s) and date(s). If by work experience state number of years in this work.
3. For LCP-1 and/or LCP-3, indicate the following:
Testing Laboratory(ies) In-House
Affiliated (provide name of laboratory(ies) and location(s))
If participating in an accreditation program, give name of program:
4. For LCP-2, and if project plans and specs are required, identify persons responsible for this work:
NAME* Arch./Eng. Discipline License No. Date of License
* If subcontractor, add (S) after the person's name. If Name(s) not known, so state and give subcontractor's name with a statement that the person(s) to
be assigned will have the appropriate current accreditation and/or qualifications.
Name of Firm
Typed Name and Title of Person Signing
Signature
OPRPRM FORM 112 ATTACHMENT 1 (Rev. 0802)
UNDERGROUND STORAGE TANK (UST) PROJECTS Submit only if interested in this type of project.
1. Check area(s) of interest below:
UST-1 New tank design, or modification of existing tank.
UST-2 Corrosion control design for a tank.
UST-3 existing tank. Release response, corrective action, removal or closure.
2. For UST-1, provide name or responsible Mechanical or Civil Engineer:
Name License No. Date of License Expertise in Federal Regulations and UG tanks acquired by/through:
3. For UST-2, provide name of responsible corrosion engineer as defined in Federal Regulation 40 CFR 280, and provide qualifications including type or certification and/or license and State:
4. For UST-3, provide name of responsible person(s) and degree of knowledge of Federal Regulation 40 CFR 280 and State Department of Health's Technical Guidance Manual for Underground Storage Tank Closure and Release Response. Also provide laboratory name and location:
5. Geotechnical engineer and/or Civil Engineer to be engaged for design, investigation or monitoring. (Engineer license as appropriate will be required):
NAME* Arch./Eng. Discipline License No. Date of License
* If subcontractor, add (S) after the person's name. If Name(s) not known, so state and give subcontractor's name with a statement that the person(s) to
be assigned will have the appropriate current accreditation and/or qualifications.
Name of Firm
Typed Name and Title of Person Signing
Signature
OPRPRM FORM 112 ATTACHMENT 1 (Rev. 0802)
MINIMUM CRITERIA FOR ASBESTOS CONTAINING MATERIALS, LEAD CONTAINING PAINT AND UNDERGROUND STORAGE TANK PROJECTS
ASBESTOS CONTAINTING MATERIALS (ACM) PROJECTS
LEAD CONTAINING PAINT (LCP) PROJECTS
UNDERGROUND STORAGE TANK (UST) PROJECTS
ACM-1 (Asbestos inspection and management planning)
Mandatory Requirements: Current EPA asbestos abatement building inspector and management planner accreditation and affiliation with a testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) for bulk asbestos fiber analysis and capable of determining air and surface fiber levels using methods mandated or recommended by EPA.
LCP-1 (lead containing paint disturbance design) and/or
UST-1 (New tank design, or modification of existing tank)
Mandatory Requirements: Hawaii Professional Engineer, mechanical or electrical engineer license, expertise in underground tanks and knowledge of Federal Regulation 40 CFR 280.
ACM-2 (Asbestos abatement project design)
Mandatory Requirement: Current EPA asbestos abatement project designer accreditation.
LCP-2 (Lead containing paint surveys) and/or
UST-2 (Corrosion control design)
Mandatory Requirements: Corrosion Engineer as defined in Federal Regulation 40 CFR 280.
ACM-3 (Asbestos abatement project inspection and air monitoring for asbestos or other asbestos related work requiring laboratory analysis)
Mandatory Requirements: Current EPA asbestos abatement project designer status and affiliation with a testing laboratory accredited by the National Institute of Standards and Technology's National Voluntary Laboratory Accreditation Program (NVLAP) for bulk asbestos fiber analysis and capable of determining air and surface fiber levels using methods mandated or recommended by EPA.
LCP-3 (Lead containing paint disturbance project inspection and ari monitoring)
Mandatory Requirements: Knowledge of HUD,EPA, and OSHA regulations regarding lead containing paint design, inspection, testing, air monitoring and analysis, controlling lead emissions and hazardous waste disposal. Affiliation with a testing laboratory regularly engaged in performance of lead containing paint analysis, air and soil monitoring for lead and other lead paint related testing including determining whether lead containing paint wastes are hazardous wastes. Laboratories accredited under EPA's National Lead Laboratory Accreditation Program (NLLAP) will be considered better qualified than a laboratory that does not have this accreditation.
UST-3 (Existing tank work. Release response, corrective action, removal and closure)
Mandatory Requirements: Knowledge of Federal Regulation 40 CFR 280 and State Department of Health's Technical Guidance Manual for Underground Storage Tank Closure and Release Response. Also affiliation with laboratory regularly engaged in the analysis of soil contaminates including Total Petroleum Hydrocarbons
If the project includes architectural or engineering design, a Hawaii Professional Architect or Engineer license as appropriate will also be required. Projects required only simple site and location plans and the related specifications are not included in these requirements. All drawings shall conform to Architectural drafting and/or CADD standards.
If the project includes architectural or engineering design, a Hawaii Professional Architect or Engineer license as appropriate will also be required. Projects required only simple site and location plans and the related specifications are not included in these requirements. All drawings shall conform to Architectural drafting and/or CADD standards.
If the project requires a geotechnical engineer or civil engineering design, a Hawaii Professional Engineer license as appropriate will also be required.