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| Question | Answer |
|---|---|
| Form Name | Standard Form Dotd 23 116 |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | DOTD 23 116 Comite River Diversion Canal dotd 23 116 form |
REVISED: SEPTEMBER 13, 2011
STANDARD FORM: DOTD
Professional Right of Way and Related Services
1. Project Title:
2a. Announcement Date:
2b. Project Number:
3. Name & Mailing address of firm:
3a. Name, title, and telephone number of the contact principal:
3b. Mailing address of office to perform work:
4.
a.Right of Way Professionals (Agents & Certified Appraisers)
b.Land Surveying Personnel
c.Other Personnel not included in above categories
Total personnel domiciled in Louisiana (a+b+c)
5.
a.Real Estate Professionals (Agents & Certified Appraisers)
b.Land Surveying Personnel
c.Other Personnel not included in above categories
Total personnel not domiciled in Louisiana (sum of a, b, c) |
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6. Do you presently have sufficient staff to perform these services in the designated time frame?
YesNo
7. Do you intend to use a |
No |
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Identify the element of work (as |
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defined in the advertisement), |
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and the % of the element to be |
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performed by the Sub- |
Has |
Name and Address: |
Consultant. |
with prime before (yes/no)? |
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8. Brief resume of key persons anticipated to work on this project.
a) Name, title, and domicile: |
b) |
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Project Assignment: |
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c) |
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Percent of time available on this |
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project |
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d) |
Name of firm by which employed |
e) |
Years of experience: |
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With this firm: |
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With other firms: |
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f) |
Education: Degree(s)/Years Specialization: |
g) |
Active registration: |
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Year first registered: |
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Branch: |
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LA License No.: |
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h) Other experience and qualifications relevant to the proposed project:
9. Work by firm (or
Project Name & Location
Project Description
Nature of firm's responsibility
Owner's name, address, Owner’s contact name,
Completion Date and cost in thousands
Project Name & Location
Project Description
Nature of firm's responsibility
Owner's name, address, Owner’s contact name,
Completion Date and cost in thousands
1st Project |
2nd Project |
3rd Project |
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4th Project |
5th Project |
6th Project |
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10. All ownerships currently being negotiated directly for LA DOTD Real Estate.
1st Project |
2nd Project |
3rd Project |
Project Number, Name
and Location*
Nature of your firm's responsibility ( also identify if prime or sub)
Percent complete (by phase/type work)
Ownerships
Total:
4th Project |
5th Project |
6th Project |
Project Number, Name
and Location*
Nature of your firm's responsibility ( also identify if prime or sub)
Percent complete (by phase/type work)
Ownerships
Total:
*For retainer contracts, list open task orders individually
**Do not include
11.Use this space to identify other staff members anticipated to work on this project. Also, to provide any additional information or description of resources supporting your firm's qualifications for the proposed project.