Professional Services Roster Questionnaire Roster effective dates: January 1 - December 31, 2018. Company Contact Name Mailing Address Street Address (if different)City State Zip Telephone Number Fax Number E-mail Address Website Address Business License # Fed I.D. # Type of Ownership Corporation Sole Proprietorship Partnership LLCHow long has the firm been in present business? (in years)Does the company maintain?General liability insurance of at least $1,000,000 per occurrence; $1,000,000 aggregate, Combined Single Limit (CSL); and Automobile liability of at least $1,000,000 per accident CSL. Yes NoIf no, describe any differences to the specified coverage amounts. Authorized Company Signature Date Print/Type Name of Signer Title Professional Services Please check the following types of work for which you wish to be registered for submitting proposals to do work for the Port of Walla Walla.Engineering Bridges (Inspection, Design) Sewer Utility Construction Management, Administration, Inspection Signals Storm Water Management Development Site Design Streets & Roads Electrical Engineering Structural Hydraulic/Hydrology Traffic Engineering Mechanical Engineering Wastewater Collections Municipal Solid Waste Engineering Wastewater Treatment Project Management Water Distribution Retaining Wall Design Water Treatment SCADA ProgrammingEnvironment Biological Assessments Environmental Assessments Environmental Mitigation Industrial Pretreatment SEPA/NEPA Surface Water Management Wastewater EngineeringGeotechnical Groundwater Evaluation Hydrogeology Pavement Design and Evaluation Soils Testing Site EvaluationSurveying Services Aerial Construction Surveying Right-of-Way/Monuments/Boundary Topographic Survey for DesignArchitectural Services Commercial Landscape/Irrigation Municipal/IndustrialPersonal ServicesReal Property Services Administrative Offer Summary Appraisal (State Certified) Appraisal Review Negotiation Relocation/AcquisitionTesting Services Bacterial Testing Chemical Testing Material Testing Paint Application, Inspecting Water Meter TestingMiscellaneous Services Cultural/Historic Resources (Section 106) Public Involvement Master Plans / Comprehensive Plans RadioOther Services Please submit a Statement of Qualifications (limited to 25 pages, not including cover letter or tabs) to perform the work(s) indicated above; to include qualifications, experience, and office locations. Also include five references with names, addresses, and telephone numbers that may be contacted to determine prior satisfactory performance for each of the items indicated. One PDF and one hard copy are required to be submitted; submit the hard copy to: Port of Walla Walla Attn: Noel Sanders 310 A Street Walla Walla, Washington, 99362-2269 Fax: (509) 525-3101 E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. PDF Maximum file size allowed is: 20MBVerify Powered by ChronoForms - ChronoEngine.com
Follow the Port on Facebook
