DPW MASTER PLAN AND DESIGN, BIDDING, AND … · 2) Meet with the Town and DPW staff to review program requirements and update the master plan. 3) Develop building and site concepts

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DPW MASTER PLAN AND DESIGN, BIDDING, AND CONSTRUCTION ADMINISTRATION SERVICES FOR NEW DEPARTMENT OF PUBLIC WORKS SALT STORAGE FACILITIES

& SUPPORT STRUCTURE

Contract # 16C-491-0020 The Town of Burlington is requesting qualifications package from Engineering Firms as they relate to providing consulting and engineering services for a DPW Master Plan and new Department of Public Works (DPW) Salt Storage Facilities and Support Structure I. GENERAL INFORMATION AND SUBMISSION REQUIREMENTS. The original RFQ and three copies must be submitted by 12:00 PM, May 13, 2016 at the DPW/Engineering Division, 25 Center Street, 2

nd floor Burlington MA 01803. The RFQ shall be clearly marked as follows:

Project Name DPW MASTER PLAN AND DESIGN, BIDDING, AND CONSTRUCTION ADMINISTRATION SERVICES FOR NEW DEPARTMENT OF PUBLIC WORKS SALT STORAGE FACILITIES & SUPPORT

STRUCTURE

Contract # 16C-491-0020

1) This Request for Qualifications is made in accordance with MGL c.7 §§38A ½ -O.

2) Provide a “Firm Profile” that includes:

a. Full name, tax identification number, main office address and officers of the Firm that would ultimately enter into a Contract with the Town of Burlington.

b. History and background including when the Firm was organized and if a corporation, where incorporated, and how many years engaged in providing the stated services. Provide a complete list of officers and/or associates who will be directly involved with the stated project including name, title, address, telephone number, and e-mail address.

3) Complete,sign, and submit the Commonwealth of Massachusetts, Standard Designer Application Form

for Municipalities and Public Agencies not within DSB Jurisdiction (attached).

4) The Tax Compliance Certification and the Certificate of Non-Collusion must be included with the bid response. The bid must be signed by the authorized individual(s).

5) Questions concerning this RFQ must be submitted in writing to John Sanchez, DPW Director via email

at JSanchez@ Burlington.org.

6) The Town of Burlington will not be responsible for any expenses incurred in preparing and submitting RFQ’s. All RFQ’s shall become the property of the Town of Burlington.

7) Responders must be willing to enter into the Town of Burlington’s standard form of contract that will

include the scope of services description of this RFQ.

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8) The bid, and any subsequent contract for the services, is hereby issued in accordance with applicable Massachusetts General Laws. The selected bidder shall be expected to comply with all applicable state and federal laws in performance of service.

9) Any RFQ’s received after the advertised date and time for opening will be returned to the responder

unopened.

10) Purchases by the Town of Burlington are exempt from federal, state and municipal sales and/or excise taxes.

11) Designer will be required to provide the following certifications:

a. certification that the designer or construction manager has not given, offered, or agreed to give

any person, corporation, or other entity any gift, contribution, or offer of employment as an

inducement for, or in connection with, the award of the contract for design services;

b. certification that no consultant to, or subcontractor for, the designer or construction manager

has given, offered, or agreed to give any gift, contribution, or offer of employment to the

designer or construction manager, or to any other person, corporation, or entity as an

inducement for, or in connection with, the award to the consultant or subcontractor of a contract

by the designer or construction manager;

c. certification that no person, corporation, or other entity, other than a bona fide full-time

employee of the designer or construction manager, has been retained or hired by the designer

or construction manager to solicit for or in any way assist the designer or construction manager

in obtaining the contract for design services upon an agreement or understanding that such

person, corporation, or other entity be paid a fee or other consideration contingent upon the

award of the contract to the designer; and

d. certification that the designer has internal accounting controls as required by M.G.L. c. 30, §

39R(c), and that the designer has filed and will continue to file an audited financial statement as

required by M.G.L. c. 30, § 39R(d).

12) Unexpected closures. If, at the time of the scheduled bid opening, Town Hall is closed due to uncontrolled events such as fire, snow, ice, wind or building evacuation, the bid opening will be postponed until 2:00 PM on the next normal business day. RFQ’s will be accepted until that date and time.

13) The Town of Burlington is an AfFirmative Action/Equal Opportunity Employer. The Town encourages

RFQ’s from qualified MBE/DBE/WBE Firms.

14) Responses to the RFQ must be prepared according to the guidelines set forth herein. Selection of the successful responder will be based upon an evaluation and analysis of the information and materials required under the RFQ.

II. SCOPE OF SERVICES. The Town of Burlington DPW is soliciting RFQ from qualified Firms to develop a master plan for a new DPW Facility to replace the aging public works facilities. Work will include reviewing and updating the previously completed DPW Facility master plan. In addition to the development of a master plan, the DPW intends to initially construct two (2) new salt storage facilities and an associated support structure to replace the Town’s antiquated salt storage facility. This work will include providing design, bidding, and construction administration

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services for a new +/- 4,800 SF storage structure at the location of the existing facility located off of Grant Avenue. Work will also include the design of a second smaller salt storage structure and a support structure at a Town owned satellite site located off of Adams Street. The satellite site will include a +/- 2,500 SF salt storage structure as well as a separate +/- 1,000 SF pre-engineered metal building support structure to house DPW equipment, employee facilities, and future Town functions (to be determined). Each of the facilities will include the design of associated site improvements to support the structures. The following is a summary of the anticipated services associated with this project:

1) The Firm shall familiarize themselves with the current operations and the proposed program developed in the initial DPW master plan.

2) Meet with the Town and DPW staff to review program requirements and update the master plan. 3) Develop building and site concepts for the preferred sites. 4) Based on the results of the updated master plan, provide subsurface exploratory soil borings at the sites

of the salt storage structures and support structure to conFirm subsurface conditions and provide design data for foundations.

5) Provide survey of existing sites for use in developing site development plans for the salt storage structures and support structure.

6) Develop and periodically update construction cost estimates throughout the design phase. The cost estimates shall include all estimated soft costs associated with a project of this type.

7) Prepare design documents for the salt storage structures and support structure to include: a. Utilizing approved conceptual site and building plans, prepare schematic design for the new

structures and site including all required professional design services: civil/site design, geotechnical/foundation design, structural design, architectural design, mechanical systems (HVAC and plumbing) design, electrical design, and fire protection (if required).

b. Bid Documents shall be prepared in accordance with Massachusetts General Laws (M.G.L.) Chapter 149 and shall include drawings and specifications.

8) Meet with various Town boards and community groups as necessary to assist in obtaining project approval.

9) Meet with the DPW on a regular basis to discuss project approach, designs, and costs. 10) Provide permitting services necessary to assist in obtaining project approval. 11) Assist in the preparation of presentation materials. 12) Provide design development services, construction document services, bidding services, and

construction administration services for the salt storage structures and support structure as approved by the Town.

Additional services by the Firm for the full build-out of the DPW Facility including full Design Services, Construction Documents, Bidding and Construction Administration Services may be continued under the same contract, subject to approval by the Town and further appropriation by the Town. III. PROPOSAL EVALUATION PROCEDURE The Town will evaluate qualifications on the basis of criteria contained herein. Submittals failing to comply with one or more of the minimum criteria stated below shall be disqualified from further consideration. Submittals that comply with the minimum criteria will be further evaluated on the basis of the comparative Criteria detailed below. Each proposal meeting the minimum criteria will be assigned a rating for each comparative criterion, as well as a composite rating. Selection of the three finalists will be based on meeting all minimum criteria, and the evaluation of qualifications with regard to the comparative criteria. The Town will rank the three finalists.

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A. Minimum Evaluation Criteria The Town shall reject Proposals which do not meet the following certain minimum requirements:

1) Submitting Firm must have a minimum of five (5) projects during the past five years involving similar

Municipal Design services in Massachusetts.

2) The Firm must be an individual or established business, corporation, partnership, sole proprietorship, joint stock company, joint venture, Firm, or other entity engaged in the practice of providing such services as the principal business for which the entity was formed.

3) The Firm must possess all necessary current licenses and registrations, as applicable, either within the

Firm or through independent consultants, to qualify under Massachusetts law to perform the stated services. All consultants carried by the Firm are to be licensed to provide professional services in the Commonwealth of Massachusetts.

B. Staffing Requirements

1. The Firm must set forth the staffing to be utilized for this service, including the estimated

percentage of time to be dedicated to this project.

2. Submitting Firm must be prepared to contractually commit all individuals as submitted in their Proposal to this service. Any deviation from the proposed will constitute a breach of Contract to any agreement which may result from this Request for Qualifications.

3. Include resumes, experience, and qualifications of any proposed consultants that would be

utilized by the Firm in the performance of this contract. Any deviation from the Firm’s listed

consultants or their team will constitute a breach of Contract to any agreement which may result

from this Request for Proposals. Any change in consultants listed in the Proposal must obtain

approval from the Town.

4. Should it become impossible for a contractually committed individual to complete his duties, for

a reason such as termination of employment, any change in the Firm’s staffing as outlined in the

Proposal will be subject to the approval of the Town of Burlington. The Town shall notify the

Firm within fifteen (15) business days of the acceptance or rejection of any such staff

substitutions. Any substituted person must be of an experience level equal to or greater than

the person being replaced unless approved by the Town.

C. Additional Narrative Information

1. List the anticipated amount of support services and/or documents the Town would be expected to provide to you.

2. Define what is not included within your fee proposal.

D. Miscellaneous Requirements

Public Relations: The Town of Burlington and the Firm shall cooperate in maintaining good public relations throughout the period of this project. Any announcements including, but not limited to, press releases, bill stuffers, flyers, web site information, and so forth, shall be submitted to the Project Manager, or designee, for review and approval before distribution to the public.

The Engineer, or a representative of the Firm given the Contract may be required to meet privately or publicly with various representatives, committees, boards, or commissions of the Town of Burlington, or other public forums, to discuss this project, gather information, and address any concerns or to provide timely updates.

COMPARATIVE EVALUATION CRITERIA

The Town reserves the right to award the contract to the Firm which best meets the Town’s needs, taking into account Firm qualifications, submittal quality, and evaluation criteria. The awarding authority’s decision

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or judgment on these matters shall be final; the committee will use the comparative criterion for each separate rating area, and based upon these criteria, will assign an overall rating to each proposal. Each of the criteria may contain ratings of:

Unacceptable Not Advantageous Acceptable Advantageous Highly Advantageous An “Unacceptable” rating in any one of the criteria will eliminate the proposal from further consideration. Firms must meet the minimum requirements as specified in Section III A. Failure to meet the minimum evaluation criteria will result in immediate rejection of the qualification submittal and will not be subject to further review. The following criteria will be used in the evaluation of the Firm regarding the Technical or Non-Price Proposal in order to be placed on the short list for an interview with the Selection Committee. Responding Firms are to address each of the following criteria( items 1 - 7) in a clearly labeled section of their response and in the same order.

1) The Firm Background and Capability: Capacity to perform all of the aspects of the project, such as programming, building permitting, cost estimating and value engineering, architectural, mechanical, fire protection and electrical engineering.

a. Unacceptable: Less than three (3) years of experience in providing Design services in Massachusetts with documented examples of such services.

b. Acceptable: Three (3) to five (5) years of experience in providing Design services in Massachusetts with documented examples of such services.

c. Advantageous: More than five (5) years of experience in providing Design services in Massachusetts with documented examples of such services.

d. Highly Advantageous: More than seven (7) years of experience in providing Design services in Massachusetts with documented examples of such services.

2) Recent Relevant Experience: Firm to describe relevant Massachusetts, permitting and design with projects comparable to the proposed facility.

a. Unacceptable: Firm has no permitting or design background in providing this type of facility

project. No projects of similar type have been successfully completed. b. Acceptable: Firm has prior experience in permitting and design in providing this type of facility

project that is current (within the past 5 years). One (1) to Three (3) projects of similar type have been successfully completed.

c. Highly Advantageous: Firm has prior experience with permitting and design background in this type of facility project within that is current (within past 5 years). Additional similar work is underway currently within the Firm. Three (3) or more projects of similar type have been successfully completed.

3) Current Firm Capacity: List significant current work and work completed in the last five (5) years, as

well as projects in-house but not yet begun; quantify. a. Unacceptable: No or limited current work listed. b. Not Advantageous: Firm capacity may be challenged by current work load when taking on this

new assignment. c. Advantageous: Firm capacity appears to be able to handle this assignment with the given

work load. d. Highly Advantageous: Firm capacity can easily handle this assignment with their given work

load.

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4) References: Provide references with contact names and valid phone numbers of other clients whereby similar work has been performed.

a. Unacceptable: References are not provided. b. Not Advantageous: References provided are not related to similar project type c. Acceptable: At least two (2) references are from similar project experience. d. Advantageous: More than three (3) references are provided from similar project types. e. Highly Advantageous: Five or more references are provided for similar project types.

5) Project Discussion & Scope of Work: Explain Firms Understanding, Approach, & Challenges to project implementation.

a. Unacceptable - Proposal did not adequately convey the Firms understanding of the project and the Firm’s approach to completing the project successfully.

b. Not Advantageous - The response indicates the Firm may understand the Owner’s needs, but the plan provided is not clear enough to make a determination. The Firms approach does not instill confidence in a plan to complete the project in a well thought out manner.

c. Advantageous - The Scope of Services response provided indicates the Firm will meet the needs of the Owner; and shows the Firms demonstrated understanding of the project and their approach to the work required to complete a successful project.

d. Highly Advantageous - The Scope of Services response provided clearly indicates the understanding and ability to successfully meet the needs of the Owner; shows the Firms demonstrated understanding of the project; their ability to bring leadership to the project and that their approach to the project demonstrates a creative and thorough process

6) Proposed Schedule

a. Unacceptable: A proposed schedule was not offered. b. Not Advantageous: The proposed project schedule does not instill confidence by the Owner in

the Firm to complete the project in a well thought out manner. c. Acceptable: The proposed project schedule provided indicates the Firm understands the

project, its scope and its timeframes for completing the work adequately. d. Advantageous: The proposed schedule provided indicates the Firm has more than adequately

demonstrated their understanding of the project and the work required to complete a successful project and to meet the requirement of the Owner’s review and approval cycles.

e. Highly Advantageous: The proposed schedule provided indicates the Firm has demonstrated their complete understanding of the project and will monitor and keep the project on schedule. The Firm understands the time required to complete a successful project and has clearly demonstrated their process which will meet the requirements of the Owner for timely reviews and approvals.

7) Response to Additional Narrative Information: List support services and/or required documents

required by your Firm of the Town and define services not included within your fee proposal. a. Unacceptable – Firm did not address Additional Narrative Information section. b. Not Advantageous – Proposal did not adequately respond to all additional Narrative

Information as requested. c. Advantageous – Proposal was responsive, adequately responded to additional Narrative

Information requested, appeared consistent with project intent, and responded to needs expressed by the documents in all areas

d. Highly Advantageous - Proposal was very responsive, thoroughly responded to additional Narrative Information requested, appeared consistent with project intent, and responded to needs expressed by the documents in all areas.

8) General Impression of Proposal: FOR DESIGNER SELECTION COMMITTEE

a. Unacceptable - The proposal was not responsive to the Comparative Evaluation Criteria in an acceptable manner.

b. Not Advantageous - Response is informative, meets the criteria for responsiveness. Reviewer feels proposal reflects that Firm is able to perform in a manner acceptable to the Town but was not overly impressed by Firms expression of ability.

c. Advantageous - Response is informative, meets criteria for responsiveness and communicates well. Reviewer feels proposal reflects that Firm is able to perform in a manner acceptable to the

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Town, and shows the Firms commitment to the Town and the project. d. Highly Advantageous - Response is concise, informative, and highly detailed. Proposal

reflects that provider is able to perform in a manner acceptable to the Town, communicates well and shows the Firms commitment to the Town and the project.

VI RULE FOR AWARD The contract shall be awarded to the responsive and responsible Firm with the highest evaluation criteria rating. VII BASIS OF COMPENSATION Fee to be negotiated but not to exceed $400,000.

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CERTIFICATION

NON-COLLUSION I certify under penalties of perjury that this bid or proposal has been made and submitted under good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals. TAX COMPLIANCE Pursuant to Massachusetts General Law Chapter 62C, Section 49A, I certify under the penalties of perjury that, to the best of my knowledge and belief, I am in compliance with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support. Signature: __________________________________________________________ (Person Signing Bid) ___________________________________________________________________ (Name of Business)

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Standard Designer Application Form for Municipalities and Public Agencies not within DSB Jurisdiction

Updated May 2014 Municipalities & Other Public Agencies Form Page 1

Commonwealth of Massachusetts Standard Designer Application Form for Municipalities and Public Agencies not within DSB Jurisdiction (Updated May 2014)

1. Project Name/Location For Which Firm Is Filing: 2. Project #

This space for use by Awarding Authority only.

3a. Firm (Or Joint-Venture) - Name and Address Of Primary Office To Perform The Work:

3e. Name Of Proposed Project Manager:

For Study: (if applicable)

For Design: (if applicable)

3b.

Date Present and Predecessor Firms Were Established:

3f. Name and Address Of Other Participating Offices Of The Prime Applicant, If Different From Item 3a Above:

3c.

Federal ID #:

3g. Name and Address Of Parent Company, If Any:

3d. Name and Title Of Principal-In-Charge Of The Project (MA Registration Required):

3h. Check Below If Your Firm Is Either: (1) SDO Certified Minority Business Enterprise (MBE)

Email Address: (2) SDO Certified Woman Business Enterprise (WBE)

Telephone No:

Fax No.:

(3) SDO Certified Minority Woman Business Enterprise (M/WBE)

4. Personnel From Prime Firm Included In Question #3a Above By Discipline (List Each Person Only Once, By Primary Function -- Average Number Employed Throughout The Preceding 6 Month Period. Indicate Both The Total Number In Each Discipline And, Within Brackets, The Total Number Holding Massachusetts Registrations):

Admin. Personnel ( ) Ecologists ( ) Licensed Site Profs. ( ) Other ( )

Architects ( ) Electrical Engrs. ( ) Mechanical Engrs. ( ) ( )

Acoustical Engrs. ( ) Environmental Engrs. Engrs. Engrs. Engrs.

( ) Planners: Urban./Reg. ( ) ( )

Civil Engrs. ( ) Fire Protection Engrs. Engrs.

( ) Specification Writers ( ) ( )

Code Specialists ( ) Geotech. Engrs. ( ) Structural Engrs. ( ) ( )

Construction Inspectors ( ) Industrial Hygienists ( ) Surveyors ( ) ( )

Cost Estimators ( ) Interior Designers ( ) ( ) ( )

Drafters ( ) Landscape Architects ( ) ( ) Total Personnel

( )

5. Has this Joint-Venture previously worked together? Yes No


6. List ONLY Those Prime And Sub-Consultant Personnel Specifically Requested In The Advertisement. This Information Should Be Presented Below In The Form Of An Organizational Chart. Include Name Of Firm And Name Of The One Person In Charge Of The Discipline, With Mass. Registration Number, As Well As MBE/WBE Status, If Applicable:

CITY/TOWN

/ AGENCY

Prime Consultant Principal-In-Charge

Discipline (from advertisement)

Name Of Firm

Person In Charge Of Discipline Mass. Registr. #

MBE/WBE Certified (If

Applicable)


Name Of Firm



Applicable)


Name Of Firm



Applicable)


Name Of Firm



Applicable)

Project Manager for Study

Project Manager for Design


7. Brief Resume of ONLY those Prime Applicant and Sub-Consultant personnel requested in the Advertisement. Include Resumes of Project Managers. Resumes should be consistent with the persons listed on the Organizational Chart in Question # 6. Additional sheets should be provided only as required for the number of Key Personnel requested in the Advertisement and they must be in the format provided. By including a Firm as a Sub-Consultant, the Prime Applicant certifies that the listed Firm has agreed to work on this Project, should the team be selected.

a. Name and Title Within Firm: a. Name and Title Within Firm:

b. Project Assignment: b. Project Assignment:

c. Name and Address Of Office In Which Individual Identified In 7a Resides: c. Name and Address Of Office In Which Individual Identified In 7a Resides: MBE MBE

WBE WBE

d. Years Experience: With This Firm: With Other Firms: d. Years Experience: With This Firm: With Other Firms:

e. Education: Degree(s) /Year/Specialization e. Education: Degree(s) /Year/Specialization

f. Active Registration: Year First Registered/Discipline/Mass Registration Number f. Active Registration: Year First Registered/Discipline/Mass Registration Number

g. Current Work Assignments and Availability For This Project:

g. Current Work Assignments and Availability For This Project:

h. Other Experience and Qualifications Relevant To The Proposed Project: (Identify Firm By Which Employed, If Not Current Firm):

h. Other Experience and Qualifications Relevant To The Proposed Project: (Identify Firm By Which Employed, If Not Current Firm):


8a. Current and Relevant Work By Prime Applicant Or Joint-Venture Members. Include ONLY Work Which Best Illustrates Current Qualifications In The Areas Listed In The Advertisement (List Up To But Not More Than 5 Projects).

a. Project Name And Location Principal-In-Charge

b. Brief Description Of Project And Services (Include Reference To Relevant Experience)

C. Client’s Name, Address And Phone Number (Include Name Of Contact Person)

d. Completion Date (Actual Or Estimated)

e. Project Cost (In Thousands)

Construction Costs (Actual, Or Estimated If Not Completed)

Fee for Work for Which Firm Was Responsible

(1)

(2)

(3)

(4)

(5)


8b. List Current and Relevant Work By Sub-Consultants Which Best Illustrates Current Qualifications In The Areas Listed In The Advertisement (Up To But Not More Than 5 Projects For Each Sub-Consultant). Use Additional Sheets Only As Required For The Number Of Sub-Consultants Requested In The Advertisement.

Sub-Consultant Name:

a. Project Name and Location Principal-In-Charge

b. Brief Description Of Project and Services (Include Reference To Relevant Experience

c. Client’s Name, Address And Phone Number. Include Name Of Contact Person

d. Completion Date (Actual Or Estimated)

e. Project Cost (In Thousands)

Construction Costs (Actual, Or Estimated If Not Completed)

Fee For Work For Which Firm Was/Is Responsible

(1)

(2)

(3)

(4)

(5)


9. List All Projects Within The Past 5 Years For Which Prime Applicant Has Performed, Or Has Entered Into A Contract To Perform, Any Design Services For All Public Agencies Within The Commonwealth. (Add/subtract rows or pages as needed)

# of Total Projects:

# of Active Projects: Total Construction Cost (In Thousands) of Active Projects (excluding studies):

Role P, C, JV

*

Phases St., Sch., D.D.,

C.D.,A.C.* Project Name, Location and Principal-In-Charge

Awarding Authority (Include Contact Name and Phone Number)

Construction Costs (In Thousands) (Actual, Or Estimated If Not Completed)

Completion Date (Actual or Estimated) (R)Renovation or (N)New

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

* P = Principal; C = Consultant; JV = Joint Venture; St. = Study; Sch. = Schematic; D.D. = Design Development; C.D. = Construction Documents; A.C. = Administration of Contract


10. Use This Space To Provide Any Additional Information Or Description Of Resources Supporting The Qualifications Of Your Firm And That Of Your Sub-Consultants For The Proposed Project. If Needed, Up To Three, Double-Sided 8 ½” X 11” Supplementary Sheets Will Be Accepted. APPLICANTS ARE ENCOURAGED TO RESPOND SPECIFICALLY IN THIS SECTION TO THE AREAS OF EXPERIENCE REQUESTED IN THE ADVERTISEMENT.

Be Specific – No Boiler Plate

11. Professional Liability Insurance: Name of Company Aggregate Amount Policy Number Expiration Date

12. Have monies been paid by you, or on your behalf, as a result of Professional Liability Claims (in any jurisdiction) occurring within the last 5 years and in excess of $50,000 per incident? Answer YES or NO. If YES, please include the name(s) of the Project(s) and Client(s), and an explanation (attach separate sheet if necessary).

13. Name Of Sole Proprietor Or Names Of All Firm Partners and Officers:

Name Title MA Reg # Status/Discipline Name Title MA Reg # Status/Discipline a. d. b. e. c. f.

14.

If Corporation, Provide Names Of All Members Of The Board Of Directors: Name Title MA Reg # Status/Discipline Name Title MA Reg # Status/Discipline a. d. b. e. c. f.

15. Names Of All Owners (Stocks Or Other Ownership):

Name And Title % Ownership MA. Reg.# Status/Discipline Name And Title % Ownership MA. Reg.# Status/Discipline

a. d. b. e. c. f.

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I hereby certify that the undersigned is an Authorized Signatory of Firm and is a Principal or Officer of Firm. I further certify that this firm is a “Designer”, as that term is defined in Chapter 7C, Section 44 of the General Laws, or that the services required are limited to construction management or the preparation of master plans, studies, surveys, soil tests, cost estimates or programs. The information contained in this application is true, accurate and sworn to by the undersigned under the pains and penalties of perjury.

Submitted by (Signature)

__________________________________________________

Printed Name and Title

_______________________________

Date

____________