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requirements contracts for engineering design and related services ...

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PROJECT: HWDRMX02L, HWDRKR02L, HWDRQ02L<br />

PIN: 8502013VP0008P-10P<br />

ATTACHMENT 5<br />

CURRENT AND ANTICIPATED WORKLOAD DISCLOSURE<br />

The proposer <strong>and</strong> his/her Sub-consultant(s) providing <strong>services</strong> on this project must complete a separate<br />

Current <strong>and</strong> Anticipated Work Load Disclosure <strong>for</strong>m. The values shown shall not include: (1) amount<br />

owed to Sub-consultants <strong>and</strong> Sub-contractors, or, (2) amount owed <strong>for</strong> rental/purchase of equipment.<br />

PROJECT ID: _____________________<br />

FIRM NAME ______________________________<br />

______________________________<br />

PROJECT DESCRIPTION<br />

CONTACT<br />

_________________________________ PERSON ______________________________<br />

_________________________________ PHONE ( )__________________________<br />

_________________________________ FIRM ADDRESS:<br />

_________________________________ ____________________________________<br />

_________________________________ ____________________________________<br />

_________________________________ ____________________________________<br />

NUMBER OF FIRM‘S DESIGN PERSONNEL IN THE OFFICE WHERE THIS PROJECT WILL BE<br />

ASSIGNED:<br />

Project Mgr. _______ Sr. Civil Engr (HWY) _______ Civil Engr (HWY) _______<br />

Firm’s Total uncompleted Workload with NYCDDC/NYCDOT<br />

(From next page)<br />

$______________<br />

Firm’s Total Uncompleted Workload with other City <strong>and</strong> State agencies<br />

$______________<br />

CERTIFICATION<br />

By signing in the space provided below, the proposer certifies that the dollar amounts set <strong>for</strong>th on this<br />

Attachment are true <strong>and</strong> accurate in all respects.<br />

_________________________________________________<br />

Name of Firm<br />

____________________________________<br />

Signature of Partner or Corporate Officer<br />

____________________________________<br />

Print Name<br />

_________________________________<br />

Title<br />

_________________________________<br />

Date<br />

RFP-23

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