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General Company Information
Company Name
Company Address
City
State (ex-Az)
Zip
Phone (enter digits only. ex - 5201234567)
Fax (enter digits only. ex - 5201234567)
Company Email Address
Name(s) of Principal(s) and/or Partner(s) in the Firm
Contact Person(s)
Small Business?
Yes
No
(For purposes of this document and as stated in A.R.S. § 41-1001 (19), a small business is defined as a concern, including its affiliates, which is independently owned and operated, which is not dominant in its field and which employs fewer than one hundred full-time employees or which had gross annual receipts of less than four million dollars in its last fiscal year. For purposes of a specific rule, an agency may define small business to include more persons if it finds that such a definition is necessary to adapt the rule to the needs and problems of small businesses and organizations
I. Disciplines
Please check only those that your firm is interested in providing as an independent, in-house service.
Acoustical Engineering (AE)
Materials Engineering (Mat)
Architecture (A)
Mechanical Engineering (ME)
Civil Engineering (CE)
Parking Consulting (PC)
Commissioning Svcs. (CS)
Partnering Facilitation (PF)
Construcaibility Review (CR)
Photogrammetry (Ph)
Const.
Administration (CA)
Programming/Space Planning (Prg)
Const.
Inspection (CI)
Project Estimating (PE)
Const
.
Management (CM)
Project Scheduling (PS
)
Electrical Engineering (EE)
Specifications (Sp)
Geotechnical Enginr
.
(Geo)
Structural Engineering (SE)
Hazardous Waste
(HW)
Telecommunications (Tel)
Interior Design (Int)
Value Engineering (VE)
Land Surveying (LS)
Others (Oth)
Landscape Architecture (LA)
II. Experience Emphasis
ADA Compliance (ADA)
Museums (Mus)
Agricultual Facilities (Ag)
Music Facilities (MF)
Athletic Facilities (Ath)
Observatories
(
Obs
)
Auditorium/Theater (Aud)
Office Facilities (OF)
Clean Rooms (CR)
Outdoor Recreation (OR)
Construction Inspection (CI)
Parking Structures (PS)
Elevators (Elev)
Partnering Workshops (PW)
Facilities Programming (FP)
Photo Surveying (Ph)
Feasibility Studies (Fe)
Recreation Activities/Centers (Rec)
Food Services (FS)
Renovation/Remodeling (RR)
General Classroom (GC)
Reroofing (Rfg)
Hazardous Waste Facilities
(
HW
)
Research Labs (RL)
Heating & Refrigeration (HR)
Residence Halls (RH)
Historic Conservation (HC)
Signage/Graphics (SG)
Hydrology Studies (HS)
Site Planning/Design (SP)
Landscape Design (LD)
Soils Investigation (Soil)
Libraries (Lib)
Special Inspection (SI)
Maitenance Facilities (Mnt)
Teaching Labs (TL)
Master Planning (MP)
Traffic Enginnering (TE)
Materials Testing (Mat)
Utilities (Util)
Medical Facilities (Med)
III. Arizona Professional Licenses
Please select those that apply to your firm and indicate how many individuals in each
Y/N
number of individuals
Architecture
Civil
Electrical
Landscape
Mechanical
Structural
Surveying
Other
IV. Insurance
Please indicate the current dollar amount and provider for the following
Automobile
Name
$
Comprehensive
Name
$
Professional Liability
Name
$
Workman's Compensation
Name
$
Can these be increased?
Yes
No
*You can print a copy of the completed form after you hit the submit button
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