STANDARD
 FORM (SF)
 255
 Architect-Engineer
 and Related Services
 Questionnaire for
 Specific Project	 1.	Project Name/Location for which Firm Is Filing:

	 2a.	Commerce Business
Daily  Announcement
Date, if any:

	 2b.	Agency Identification
Number, If any:

	
 3.	Firm (or Joint-Venture) Name & Address

	 3a.	Name, Title & Telephone Number of Principal to Contact

	 3b.	Address of office to perform work, if different from item 3
	
4.	Personnel by Discipline: (List each person only once, by primary function.)  Enter proposed consultant personnel to be utilized on this project on line (A)
and In-house personnel on line (B).  	
(A)	0	(B)	0	Administrative	(A)	0	(B)	0	Electrical Engineers	(A)	0	(B)	0	Oceanographers	(A)	0	(B)	0	CADD Technician	
(A)	0	(B)	0	Architects	(A)	0	(B)	0	Estimators	(A)	0	(B)	0	Planners: Urban/Regional	(A)	0	(B)	0	Licensed Land Surveyor	
(A)	0	(B)	0	Chemical Engineers	(A)	0	(B)	0	Geologists	(A)	0	(B)	0	Sanitary Engineers	(A)	0	(B)	0	Surveyor Coordinator	
(A)	0	(B)	0	Civil Engineers	(A)	0	(B)	0	Hydrologists	(A)	0	(B)	0	Soils Engineers	(A)	0	(B)	0	Designers	
(A)	0	(B)	0	Construction Engineers	(A)	0	(B)	0	Interior Designers	(A)	0	(B)	0	Specification Writers	(A)	0	(B)	0	Survey Technician	
(A)	0	(B)	0	Draftsmen	(A)	0	(B)	0	Landscape Architects	(A)	0	(B)	0	Structural Engineers	(A)	0	(B)	0	Project Manager	
(A)	0	(B)	0	Ecologists	(A)	0	(B)	0	Mechanical Engineers	(A)	0	(B)	0	Surveyors	(A)		(B)			
(A)	0	(B)	0	Economists	(A)	0	(B)	0	Mining Engineers	(A)	0	(B)	0	Transportation Engineers	(A)	0	(B)	0	Total Personnel	
	
 5.	If submittal is by JOINT-VENTURE list participating firms and outline specific areas of responsibility (including administrative, technical and financial) for each
firm:  Attach SF 254 for each if not on file with Procuring Office.)
	
5a.	Has this Joint-Venture previously worked together?  [  ] Yes [X] No	
	STANDARD FORM 255 PAGE 3  (REV. 11-92)	

6.	If respondent is not a joint-venture, list outside key Consultants/Associates anticipated for this project (Attach SF 254 for Consultants/Associates listed, if not already on file with the Contracting Office).	

Name & Address	

Specialty 	Worked With
Prime before
(Yes or No)	
1)				
2)				
3)				
4)				
5)				
6)				
7)				
8)				
	STANDARD FORM 255 PAGE 3  (REV. 11-92)	

	a.	Name & Title:

	b.	Project Assignment:

	c.	Name of Firm with which associated:

	d.	Years experience: With This Firm           With Other Firms        

	e.	Education:  Degree(s)/Year/Specialization

	f.	Active Registration: Year first Registered/Discipline

	g.	Other Experience and Qualifications relevant to the proposed project:

	

Name
	Owner information	date	$	$	

Long Description

Name
	Owner information	date	$	$	

Long Description

Name
	Owner information	date	$	$	

Long Description

Name	Responsibility	Agency	%	$	$	

Information here

  11.  The foregoing is a statement of facts.
	
  Signature:                                                                                         Typed Name and Title:		  Date: