Subconsultant/MW/SDV Staffing List Original …1SCSL-AE Page 1 o f 2 April 2019 Subconsultant/MW/SDV...
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1SCSL-AE Page 1 of 2 April 2019 Subconsultant/MW/SDV Staffing List A/E DESIGN Consultant / Subconsultant / Design Area Federal ID No. MBE, WBE or SDV Contract Value Dollar and/or % Partner in Charge and/or Key Staff Phase or date service begins Provide: Firm Name, Address, Contact Person, Email Address Architecture License # License # Civil Engineering Landscape Architecture License # Structural License # Plumbing & Fire Protection License # HVAC License # Electrical License # Cost Estimating License # Asbestos / HazMat License # Other (Please Specify) License # SUCF PROJECT NO. CAMPUS: TITLE: % MBE %WBE %SDV CONSULTANT NAME List your firm’s name for self-performed work and all Subconsultants. Complete page 2 for MBE, WBE or SDV firms - see instructions GOALS: Original Revised DATE (As specified in the project advertisement)
Transcript of Subconsultant/MW/SDV Staffing List Original …1SCSL-AE Page 1 o f 2 April 2019 Subconsultant/MW/SDV...
1SCSL-AE Page 1 of 2 April 2019
Subconsultant/MW/SDV Staffing ListA/E DESIGN
Consultant / Subconsultant / Design Area Federal IDNo.
MBE, WBE or SDV
Contract ValueDollar and/or % Partner in Charge and/or Key Staff Phase or date
service beginsProvide: Firm Name, Address, Contact Person, Email Address
Architecture
License #
License #
Civil Engineering
Landscape Architecture
License #
Structural
License #
Plumbing & Fire Protection
License #
HVAC
License #
Electrical
License #
Cost Estimating
License #
Asbestos / HazMat
License #
Other (Please Specify)
License #
SUCF PROJECT NO.
CAMPUS:
TITLE:
% MBE %WBE %SDV
CONSULTANT NAME List your firm’s name for self-performed work and all Subconsultants.
Complete page 2 for MBE, WBE or SDV firms - see instructions
GOALS:
Original Revised
DATE
(As specified in the project advertisement)
1SCSL-AE Page 2 of 2 April 2019
Firms must complete the following for each MW and SDV Subconsultants identified on page 1 (see instructions):
Firm Name MBE, WBE or SDV Discipline
Brief summary of services to be provided with justification of estimated participation:
Firm Name MBE, WBE or SDV Discipline
Brief summary of services to be provided with justification of estimated participation:
Firm Name MBE, WBE or SDV Discipline
Brief summary of services to be provided with justification of estimated participation:
Firm Name MBE, WBE or SDV Discipline
Brief summary of services to be provided with justification of estimated participation:
Firm Name MBE, WBE or SDV Discipline
Brief summary of services to be provided with justification of estimated participation:
Certification: I hereby certify that the information provided on this form is true, accurate and complete. I understand that the information provided is to be used to comply with the reporting requirements of Article 15-A & 17-B of the Executive Law.
Date:SUCF - Director Opportunities Program Approval:
Signature (Officer of the Company): Date:
SUCF PROJECT NO.:
