DPW FORM 120 (Rev. 5/96) STATE OF HAWAII QUESTIONNAIRE ...

DPW FORM 120 (Rev. 5/96)
1. Please fill out questionnaire with typewriter.
STATE OF HAWAII
QUESTIONNAIRE
FOR
ARCHITECTS, ENGINEERS AND OTHER PROFESSIONAL SERVICES
INSTRUCTIONS
2. In multi-discipline firms such as Architectural and Engineering (A&E), each discipline (architect, Structural Engineering,
Mechanical Engineering, etc.) shall be covered in separate questionnaire. It is recognized that personnel in a multi-discipline
firm is often shifted where most needed. In such instance, the number of personnel should be indicated in proportion to the
amount of time that such personnel normally spend within such discipline. (Example, a full-time draftsman may spend 0.3 of
his time in work related to Architecture and 0.7 of his time to Civil Engineering.
3. Personal History statements of Technical personnel shall include only those employees whose work is directly related to the
particular discipline, such as, Architects, Engineers, Draftsmen, Specification Writers, and Estimators for A&E firms.
4. The names and phone numbers of up to five clients who may be contacted, including at least two for whom services were
rendered during the preceding year.
5. Any promotional or descriptive literature, which the firm desires to submit.
6. Provide a brief narrative qualification summary outlining firm’s strengths and attributes to substantiate firms’ qualification to
do typical project. Include relevant education and experience summaries of principals and associates.

DPW FORM 120 (Rev. 5/96)
Questionnaire for: (list discipline) Other questionnaires submitted (list disciplines) Date
STATE OF HAWAII
Firm name Established Type of organization
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
Present branch Address Telephone no. Name of person in charge
office(s)
Principals of firm
Names Names
Associate members
of firm
Number of personnel in your present organization
Principals & key personnel Other personnel
Located at
Engi-
Engineers
Drafts- Spec. Esti- Inspec- Sur-
Totals
Arch. Others Arch. Balance
neer
Mech. Elec. Civil Other
men writer mator tor veyor
Home office
Branch in
Totals
Number of personnel in your organization Average no. Maximum no. Year Normal strength
during last 5 years

DPW FORM 120 (Rev. 5/96)
OUTSIDE ASSOCIATES AND CONSULTANTS USUALLY EMPLOYED
Discipline Name of firm or individual Discipline Name of firm or individual
Indicate in descending order your firm’s class of work and project type specialization (e.g., new hospital design, cafeteria renovation or
maintenance/repair design, etc.)

DPW FORM 120 (Rev. 5/96)
PERSONAL HISTORY STATEMENT OF PRINCIPALS AND ASSOCIATES WITHIN YOUR FIRM
Name Name
Resident of Years of As principal As principal Other than Resident of Years of As principal As principal Other than
(state/country) experience in this firm in other principal (state/country) experience in this firm in other principal
firms firms
Education (college, degree, year, specialization) Education (college, degree, year, specialization)
Membership in professional organizations Membership in professional organizations
Registration (type, year, state) Registration (type, year, state)
Name Name
Resident of Years of As principal As principal Other than Resident of Years of As principal As principal Other than
(state/country) experience in this firm in other principal (state/country) experience in this firm in other principal
firms firms
Education (college, degree, year, specialization) Education (college, degree, year, specialization)
Membership in professional organizations Membership in professional organizations
Registration (type, year, state) Registration (type, year, state)
Name Name
Resident of Years of As principal As principal Other than Resident of Years of As principal As principal Other than
(state/country) experience in this firm in other principal (state/country) experience in this firm in other principal
firms firms
Education (college, degree, year, specialization) Education (college, degree, year, specialization)
Membership in professional organizations Membership in professional organizations
Registration (type, year, state) Registration (type, year, state)

DPW FORM 120 (Rev. 5/96)
PERSONAL HISTORY STATEMENT OF TECHNICAL PERSONNEL WITHIN YOUR FIRM
Name Title or position Full time Name Title or position Full time
Part time Part time
Years of experience Years of experience
With this firm With last firm (name and no. of years) Other firms With this firm With last firm (name and no. of years) Other firms
Education Education
Registration (type, year, state) Registration (type, year, state)
Name Title or position Full time Name Title or position Full time
Part time Part time
Years of experience Years of experience
With this firm With last firm (name and no. of years) Other firms With this firm With last firm (name and no. of years) Other firms
Education Education
Registration (type, year, state) Registration (type, year, state)
Name Title or position Full time Name Title or position Full time
Part time Part time
Years of experience Years of experience
With this firm With last firm (name and no. of years) Other firms With this firm With last firm (name and no. of years) Other firms
Education Education
Registration (type, year, state) Registration (type, year, state)

DPW FORM 120 (Rev. 5/96)
PRESENT ACTIVITIES IN WHICH YOUR FIRM IS DESIGNATED THE PRIME CONSULTANT IN DISCIPLINE APPLIED FOR
Name and location of project and Percent complete
Description of project & Name, address & Estimated
name of firm’s principal design
your scope of work phone number of owner construction cost
architect/engineer Design Field Spt.
Total number of present projects: Total estimated construction cost:

DPW FORM 120 (Rev. 5/96)
PRESENT ACTIVITIES IN WHICH YOUR FIRM IS ASSOCIATED WITH OTHERS
(LIST ONLY THOSE IN DISCIPLINE OF WORK BEING APPLIED FOR)
Estimated construction
Percentage of
your portion of
cost of entire project
Name & location
of project and
phase of work
Description of project
& your scope
Owner name, address and
phone number
Work for
completed Prime firm
associated
with
Entire
project
which your
firm is
responsible
Design
Field
spt.
Total number of Total estimated construction cost of
present projects work for which your firm is responsible

DPW FORM 120 (Rev. 5/96)
COMPLETED WORK IN WHICH YOUR FIRM WAS DESIGNATED THE PRIME ARCHITECT OR ENGINEER
DURING THE LAST 10 YEARS (IN DISCIPLINE BEING APPLIED FOR)
Year Con-
Name, scope, type and Name of principal design your wk Name of owner, address Estimated structed
location of project architect/engineer com- & phone no. construction cost (yes or
pleted no)
Total number of completed projects: Total estimated construction cost:

DPW FORM 120 (Rev. 5/96)
In the event spaces provided on the form are not sufficient for entries, or if you wish to furnish additional information, it may be inserted
here, on the reverse of this page, or on separate sheets, with appropriate references. Explain firm’s individual project assignment and
project management structure, and firm’s execution (work flow and responsibilities) and quality control process.
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 will be to a firm’s advantage to maintain its experience record on a current basis. This may be accomplished by periodically
forwarding current data.

DPW FORM 120 (Rev. 5/96) 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 change 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: