Dpw Form 120 PDF Details

The Department of Public Works has a form called Dpw Form 120. This form is used to request service or information from the department. The form can be used for a variety of purposes, such as requesting a pothole to be filled, getting information about garbage collection schedules, or asking for clarification about a parking ticket. The Dpw Form 120 is available on the Department of Public Works website. It can be downloaded and printed out, or filled out online. Instructions for how to fill out the form are also included on the website. If you need service or information from the Department of Public Works, be sure to use Dpw Form 120. The form is easy to fill out, and it will help ensure that you get the service or information you need as quickly as possible.

QuestionAnswer
Form NameDpw Form 120
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other nameshawaii state dpw 120 form, form dpw 120, state form dpw 120, dpw120 form hawaii

Form Preview Example

DPW FORM 120 (Rev. 6/99)

STATE OF HAWAII

DEPARTMENT OF ACCOUNTING AND GENERAL SERVICES

QUESTIONNAIRE FOR ARCHITECTS, ENGINEERS AND OTHER PROFESSIONAL SERVICES

QUESTIONNAIRE FOR: (LIST DISCIPLINE)

OTHER QUESTIONNAIRES SUBMITTED: (LIST DISCIPLINES)

DATE

 

 

 

FIRM NAME

ESTABLISHED

TYPE OF ORGANIZATION (Underline)

 

 

 

 

YEAR STATE

 

 

 

 

 

 

 

 

 

INDIVIDUAL

PARTNERSHIP

CORPORATION

JOINT VENTURE

OTHER

 

 

 

 

 

 

 

 

BUSINESS ADDRESS, TELEPHONE & FAX NO. OF HAWAII OFFICE

 

AGE OF FIRM

 

FEDERAL ID NO.

 

YEARS

 

 

 

 

 

 

 

 

ESTABLISHED IN

 

 

 

 

 

 

 

HAWAII

 

 

 

 

 

 

 

 

PRINCIPALS OF FIRM: (NAMES)

 

ASSOCIATE MEMBERS OF FIRM: (NAMES)

 

 

 

PRESENT BRANCH OFFICE(s): (ADDRESS, TELEPHONE & FAX NO.)

PERSON IN CHARGE: (NAMES)

NUMBER OF PERSONNEL IN YOUR PRESENT ORGANIZATION

LOCATED

PRINCIPALS & KEY

 

 

 

OTHER PERSONNEL

 

 

 

TOTAL

PERSONNEL

 

 

 

 

 

 

 

 

 

AT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Architect

Engineer

Others

Architect

Engineers

Draftsmen

Spec.

Estimator

Inspector

Surveyor

Balance

 

 

 

 

 

 

 

 

 

 

 

Mech.

Electri

Civil

Others

Writer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME OFFICE

BRANCH IN

TOTAL

TECHNICAL PERSONNEL:

NUMBER OF PERSONNEL WITH HAWAII LICENSES

NUMBER OF PERSONNEL WITHOUT HAWAII LICENSES

Page 1 of 9

DPW FORM 120 (Rev. 6/99)

PERSONAL HISTORY STATEMENT OF PRINCIPALS AND ASSOCIATES WITHIN YOUR FIRM

NAME

 

 

RESIDENT OF

 

 

 

 

 

TITLE

 

 

 

 

 

 

 

 

YEARS OF

AS PRINCIPAL

AS PRINCIPAL

OTHER THAN

EXPERIENCE

IN THIS FIRM

IN OTHER FIRMS

PRINCIPAL

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

 

 

 

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

 

 

 

 

 

REGISTRATION (TYPE, YEAR, STATE)

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

RESIDENT OF

 

 

 

 

 

TITLE

 

 

 

 

 

 

 

 

YEARS OF

AS PRINCIPAL

AS PRINCIPAL IN

OTHER THAN

EXPERIENCE

IN THIS FIRM

OTHER FIRMS

PRINCIPAL

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

REGISTRATION (TYPE, YEAR, STATE)

NAME

RESIDENT

 

 

TITLE

YEARS OF

AS

PRINCIPAL

AS PRINCIPAL IN

OTHER THAN

EXPERIENCE

IN

THIS FIRM

OTHER FIRMS

PRINCIPAL

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

REGISTRATION (TYPE, YEAR, STATE)

NAME

RESIDENT OF

 

 

TITLE

YEARS OF

AS

PRINCIPAL

AS PRINCIPAL IN

OTHER THAN

EXPERIENCE

IN

THIS FIRM

OTHER FIRMS

PRINCIPAL

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

REGISTRATION (TYPE, YEAR, STATE)

Page 2 of 9

DPW Form 120 (Rev. 6/99)

PERSONAL HISTORY STATEMENT OF TECHNICAL PERSONNEL WITHIN YOUR FIRM

NAME

STATUS (Underline)

NAME

STATUS (Underline)

 

 

 

 

Full-Time Part-Time

 

 

 

 

Full-Time Part-Time

 

 

TITLE OR POSITION

 

YEARS OF EXPERIENCE

TITLE OR POSITION

 

 

YEARS OF EXPERIENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

 

 

 

 

(NAME & NO. OF YEARS)

 

 

 

(NAME & NO. OF YEARS)

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

 

 

 

 

 

 

 

 

 

REGISTRATION (TYPE, YEAR, STATE)

 

REGISTRATION (TYPE, YEAR, STATE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

STATUS (Underline)

NAME

 

 

STATUS (Underline)

 

 

 

 

 

Full-Time Part-Time

 

 

 

 

Full-Time Part-Time

 

 

 

 

 

 

 

 

 

 

 

TITLE OR POSITION

 

YEARS OF EXPERIENCE

TITLE OR POSITION

 

 

YEARS OF EXPERIENCE

 

 

 

 

 

 

 

 

 

 

 

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

 

 

 

 

(NAME & NO. OF YEARS)

 

 

 

(NAME & NO. OF YEARS)

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

 

 

 

 

 

 

 

 

 

REGISTRATION (TYPE, YEAR, STATE)

 

REGISTRATION (TYPE, YEAR, STATE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

STATUS (Underline)

NAME

 

 

STATUS (Underline)

 

 

 

 

 

Full-Time Part-Time

 

 

 

 

Full-Time Part-Time

 

 

 

 

 

 

 

 

 

 

 

TITLE OR POSITION

 

YEARS OF EXPERIENCE

TITLE OR POSITION

 

 

YEARS OF EXPERIENCE

 

 

 

 

 

 

 

 

 

 

 

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

WITH THIS FIRM

 

WITH LAST FIRM

WITH OTHER FIRMS

 

 

 

 

(NAME & NO. OF YEARS)

 

 

 

 

(NAME & NO. OF YEARS)

 

 

 

 

 

 

 

 

 

 

 

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)

 

 

 

 

 

 

 

 

REGISTRATION (TYPE, YEAR, STATE)

 

REGISTRATION (TYPE, YEAR, STATE)

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3 of 9

DPW FORM 120 (Rev. 6/99)

OUTSIDE ASSOCIATES AND CONSULTANTS USUALLY EMPLOYED

DISCIPLINE

NAME OF FIRM OR INDIVIDUAL

DISCIPLINE

NAME OF FIRM OR INDIVIDUAL

ERRORS AND OMISSIONS INSURANCE

DOES YOUR FIRM HAVE ERRORS & OMISSION (E&O) INSURANCE? (Underline)

AMOUNT OF COVERAGE

PER CLAIM

AMOUNT OF DEDUCTIBLE

YES

NO

PROJECT INSURANCE

$

$

Submit proof of insurance or insurability from your insurance carrier with this form.

Page 4 of 9

DPW FORM 120 Rev. 6/99)

SUMMARY OF YOUR FIRM’S COMPLETED AND PRESENT PROJECTS DURING THE LAST TEN YEARS

AS A PRIME A/E CONSULTANT

TOTAL NUMBER OF COMPLETED PROJECTS

TOTAL ESTIMATED CONSTRUCTION COST OF COMPLETED PROJECTS

TOTAL NUMBER OF PRESENT PROJECTS

TOTAL ESTIMATED CONSTRUCTION COST OF PRESENT PROJECTS

$

$

AS AN ASSOCIATE WITH OTHER A/E CONSULTANTS

 

TOTAL NUMBER OF COMPLETED PROJECTS

 

 

 

 

 

 

 

TOTAL ESTIMATED CONSTRUCTION COST OF COMPLETED PROJECTS (ONLY THE PORTION OF WORK FOR WHICH YOUR FIRM WAS

 

$

 

RESPONSIBLE)

 

 

 

 

 

 

 

 

 

TOTAL NUMBER OF PRESENT PROJECTS

 

 

 

 

 

 

 

TOTAL ESTIMATED CONSTRUCTION COST OF PRESENT PROJECTS (ONLY THE PORTION OF WORK FOR WHICH YOUR FIRM IS

 

$

 

RESPONSIBLE)

 

 

 

 

 

 

 

 

 

CLASS OF WORK AND PROJECT TYPE SPECIALIZATION

 

 

TYPE OF PROJECT

TOTAL NO. OF COMPLETED

PROJECTS

TOTAL ESTIMATED CONSTRUCTION COST

TOTAL ESTIMATED PROJECT

SIZE (G.S.F.)

Categorize your firm’s class for work during the last ten years by project type. Examples of project types include Educational, Commercial, Industrial, Residential, Health Care, Correctional and Judicial Facilities. Work may also be categorized as planning, civil sitework, renovation/alteration, architectural barrier removal, fire alarm system, etc.

Page 5 of 9

DPW FORM 120 (Rev. 6/99)

PRESENT/COMPLETED PROJECTS IN WHICH YOUR FIRM IS/WAS DESIGNATED THE PRIME CONSULTANT (BY TYPE)

(LIST A MAXIMUM OF 10 PROJECTS FOR EACH DISCIPLINE/TYPE OF WORK BEING APPLIED FOR. LIST PROJECTS THAT REFLECT YOUR ABILITY TO PROVIDE QUALITY

WORK FOR YOUR REQUESTED PROJECTS.)

TYPE:

YEAR

NAME AND LOCATION

OF THE PROJECT

NAME OF LEAD

DESIGNER

NAME, ADDRESS, PHONE & FAX NO.

OF THE OWNER

ESTIMATED

CONST. COST

($)

DURATION FOR

DESIGN

(MONTHS)

%COMPLETED

DESIGN CONST.

Page 6 of 9

DPW FORM 120 (Rev. 6/99)

PRESENT/COMPLETED PROJECTS THAT YOUR FIRM IS/WAS ASSOCIATED WITH OTHERS (BY TYPE)

(LIST A MAXIMUM OF 10 PROJECTS FOR EACH DISCIPLINE/TYPE OF WORK BEING APPLIED FOR. LIST PROJECTS THAT REFLECT YOUR ABILITY TO PROVIDE QUALITY

WORK FOR YOUR REQUESTED PROJECTS.)

TYPE:

 

 

 

 

 

 

NAME AND LOCATION

 

ESTIMATED CONSTRUCTION COST

DURATION FOR

% COMPLETED

NAME, ADDRESS, PHONE &

 

 

YEAR

 

 

DESIGN

PRIME FIRM ASSOCIATED

 

 

ENTIRE

YOUR FIRM’S

WITH

 

OF THE PROJECT

FAX NO. OF THE OWNER

(MONTHS)

 

DESIGN

CONST.

 

 

PROJECT

WORK

 

 

 

 

 

 

Page 7 of 9

DPW FORM 120 (Rev. 6/99)

Explain firm’s individual project assignment, project management structure, project execution (work flow and

responsibilities) and quality control process. In the event the spaces provided on this form are not sufficient for

entries, or if you wish to furnish additional information, it may be inserted here or on separate sheets, with appropriate references.

As of this date ____________________________ the foregoing is a true statement of facts.

NAME OF FIRM OR INDIVIDUAL SUBMITTING QUESTIONNAIRE

TYPE NAME AND TITLE OF PERSON SIGNING

SIGNATURE

NOTE: It is to a firm’s advantage to maintain its experience record on a current basis. This may be accomplished by periodically forwarding current data to DAGS.

 

Page 8 of 9

DPW FORM 120 SUPPLEMENT 1

(Rev. 6/99)

PRINCIPALS ONLY - ADDITIONAL INFORMATION

NAME

TITLE AND POSITION

YEARS WITH FIRM

 

 

 

MAJOR RESPONSIBILITIES WITH THIS FIRM

 

 

 

 

 

PRIOR EMPLOYMENT

(START WITH LATEST EMPLOYMENT PRIOR TO JOINING THIS FIRM AND PROVIDE SIMILAR INFORMATION FOR EACH SEPARATE

EMPLOYMENT OR MAJOR CHANGES IN DUTIES WITH THE SAME EMPLOYER.)

 

 

 

 

 

 

 

 

 

FIRM:

 

DATE

 

FIRM:

 

DATE

 

FROM:

 

 

TO:

 

FROM:

 

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

JOB TITLE:

 

 

 

JOB TITLE:

 

 

 

 

 

 

 

 

 

 

 

SUPERVISOR’S NAME AND TITLE:

 

 

 

SUPERVISOR’S NAME AND TITLE:

 

 

 

 

 

 

 

 

 

 

 

MAJOR DUTIES:

 

 

 

MAJOR DUTIES:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRM:

 

DATE

 

FIRM:

 

DATE

 

FROM:

 

 

TO:

 

FROM:

 

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

JOB TITLE:

 

 

 

JOB TITLE:

 

 

 

 

 

 

 

 

 

 

 

SUPERVISOR’S NAME AND TITLE:

 

 

 

SUPERVISOR’S NAME AND TITLE:

 

 

 

 

 

 

 

 

 

 

 

MAJOR DUTIES:

 

 

 

MAJOR DUTIES:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 9 of 9

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