New York State Department of Transportation



Purpose:

This form is to be submitted by land surveying or related services firms who have been notified by NYSDOT that they are on the shortlist of highest-ranked firms. THIS FORM SHOULD BE SUBMITTED BY A CONSULTANT ONLY WHEN THEY ARE REQUESTED TO DO SO BY NYSDOT. The form’s purpose is to provide additional information regarding the firm’s qualifications to undertake a specific project. Only one form should be submitted for each team (prime or joint-venture plus subconsultants) – SEPARATE FORMS SHOULD NOT BE SUBMITTED FOR SUBCONSULTANTS. Responses should be as complete and accurate as possible, contain data relevant to the specific project, and be provided by the required due date to the NYSDOT office specified in the request. ALL INFORMATION CONTAINED IN THE FORM SHOULD BE CURRENT AND FACTUAL.

To be selected for a shortlist, firms must submit an electronic Expression of Interest (e-EOI) for a specific project in response to a NYSDOT advertisement. They must also have an “electronic inventory” certified and displayed on NYSDOT’s website at dot.state.ny.us. All firms that submit e-EOI’s are evaluated against the needs of the contract and a shortlist of the highest-ranked firms is generated. Shortlisted firms are then notified and asked to send in the NYSDOT 255 Shortlist Submission Form.

The form must be submitted as a single electronic document in Adobe Acrobat (.pdf) format, and sent to the email address of the NYSDOT Contract Management Bureau analyst specified in the advertisement (________@.dot.state.ny.us). File names should be 8 characters beginning with a 4 character abbreviation of your firm name and ending with the first 4 digits of the Key PIN for the project (e.g. abcd1234.pdf). DO NOT INCLUDE ANY GRAPHICS EXCEPT AS NEEDED FOR THE ORGANIZATIONAL CHART (ITEM 7) AND ANY REQUESTED ROW MAPS.

In addition to this electronic file submittal, one (1) paper copy of the following material must be mailed separately to NYSDOT:

1) NYSDOT Current Remaining Workload Disclosure Form (CONR 386) for each firm included on your team (prime, joint venture partner or subconsultant)

2) Disadvantaged/Minority/Women’s Business Enterprise (D/M/WBE) certification letters for each subconsultant on your team for which you are claiming D/M/WBE scoring credit.

3) Backup information to justify responses provided for special factors (if any) in your previously submitted e-EOI. This information is only submitted for documentation and is not used by the consultant selection committee.

1. “Certificate of Authorization” to Practice Land Surveying in NYS for each firm on your team.

Paper submittals must be clearly addressed to:

NYS Department of Transportation

Contract Management Bureau

Director, Contract Management Bureau

Attention:______________ (analyst specified in the project advertisement)

50 Wolf Road, 1st Floor

Albany, NY 12232-0203

Definitions:

“Land Surveying” as defined in Section 7203 of the NYS Education Law.

“Principals” are those individuals in a firm who possess legal responsibility for its management. They may be owners, partners, corporate officers, associates, administrators, etc.

“Discipline,” as used in this questionnaire, refers to the primary technological capability of individuals in the responding firm. Possession of an academic degree, professional registration, certification, or extensive experience in a particular field of practice normally reflects an individual’s primary technical discipline.

“Joint Venture” shall not be proposed due to the scope of the work and size of the agreement.

Instructions for Filing (Numbers below correspond to numbers contained in form):

1. Provide the Key D contract number, the Key PIN, and the name and Regional location of this contract for which this form is being submitted. Key information is labeled in the contract advertisement.

2a. Indicate whether or not the prime has a current “Certificate of Authorization” to Practice Land Surveying in NYS.

2b. Provide the 8 digit NYSDOT Consultant Identification Number (CIN) of the prime firm (or joint venture) submitting this form for the contract.

3. Provide the name and address of the prime firm (or joint venture) where correspondence regarding this contract should be directed. Also provide the county where this office is located. Also, provide the firm name, location (city, state) and 8-digit CIN for all additional offices of the prime firm (or joint venture partners) that will be performing work on the contract.

3a Name, Title, Telephone Number and LS License Number of Company Officer proposed to be responsible for delivery of these services.

Provide the firm name, location (city, state) and 8-digit CIN for all additional offices of the prime firm (or joint venture partners) that will be performing work on this contract.

3b. Prime Firm’s Proposed Number of Full Crews Available to Work on Contract and the location of the crews’ base of operations. The base of operations is office from which field crews will be measuring their travel expenses to the project site.

3c. Name, Title and Telephone No of Project Manager (Coordinator for Project Tasks). This person will be responsible for the day-to-day management of project tasks.

3d. Address of office to perform work, if different from item 3.

3e. Name and License Number who will Sign and Seal ROW Acquisition Maps for this Contract.

4. Insert the number of consultant personnel by discipline:

(A) that will be utilized on the subject contract

(B) that are available

Part-time personnel, personnel not employed on the date of the form, or personnel employed on an “as needed” basis should NOT be counted here. Numbers on line

(B) should match with the corresponding numbers in the General Staff Information section of the firm’s “electronic inventory” as shown on NYSDOT’s website (or with the combined numbers of all partner firms for a joint-venture). While some personnel may be qualified in several disciplines, each person should be counted only once in accord with his or her primary function..With the use of multi-disciplined staff performing various tasks, calculate the number of full-time equivalents as the number of personnel listed.

5. Respondents intending to use outside (as opposed to in-house or permanently and formally affiliated) consultants or associates should provide names and addresses of all such individuals or firms, their particular areas of technical/professional expertise as it relates to this contract, their percent of work (defined as the estimated percentage of the direct technical labor for the ENTIRE contract to be performed by the subconsultant), an indication of whether or not the firm has a current “NYS Certificate of Authorization” to Practice Land Surveying, and the number of full time crews available to work on the contract with the location of their base of operations.

6. Provide a contract organizational chart depicting the key individuals (including their name, firm affiliation and project title) that make up the land surveying portion of your proposed team. This must be limited to one page in length, with a font size no smaller than 10 point. NO OTHER INFORMATION SHOULD BE INCLUDED ON THIS PAGE.

7. Regardless of whether respondent is a joint venture or an independent firm, provide brief resumes of key personnel expected to participate on this contract. Care should be taken to limit resumes to only those personnel and specialists for whom resumes are requested by NYSDOT. Do not provide resumes for alternate staff. Font size must be no smaller than 10 point, and each resume may be no more than one page in length. Each resume must include:

7a. Employee Name, Title or Position:

7b. Current Employer, and years employed by them in Surveying Profession.

7c. The contract assignment or role which that person will be expected to fulfill in connection with this contract. Include ASCE or NICET grade where applicable

7d. The highest academic degree achieved and the discipline covered (if more than one highest degree, such as two Ph.D.’s, list both), the year received and the particular technical/professional discipline which that individual will bring to the contract.

7e. Land Surveying License: Current NYS License Number:

7f. Total Number of Years Working in the Land Surveying Profession.

7g. For each experience listing (in chronological order) state: 1) the employer at that time; 2) whether the type of work qualifies as Survey, or as ROW Mapping; 3) the position held and the dates during which this work occurred; and 4) a brief description of the work performed.

8. Familiarity Use this space to provide any additional information or description of resources supporting your firm’s qualifications for the proposed contract. (Duplicate page as necessary for Prime and Sub-Consultants.) As a minimum, the following should be included:

8a. List of types, brands, models and precision of all GPS, Total Station and Levels to be used on this contract.

8b. List of the current versions of MicroStation, InRoads, data collection software, survey processing software, GPS processing software, DTM creation software, and vertical control leveling software.

8c. List of any file format conversions necessary to conform to the NYS CADD Standards and Procedure Manual’s Chapter 2 requirements.

8d. Attach 1 or 2 recent examples of ROW Maps prepared for NYSDOT by the prime firm and all applicable sub-consultants. These must be in pdf format.

Through narrative discussion, show reason why the firm or joint venture submitting this questionnaire believes it is especially qualified to undertake the contract. Relevant information may include familiarity with the specific Region or any other special knowledge relating to the unique conditions of this work, as well as experience of the firm or staff with other projects/contracts similar to this. You may also describe the firm’s experience relevant to the proposed staff.

If proposing a joint venture, describe clearly in item 9 the manner in which the contract will be managed by the joint venture and the technical work coordinated and accomplished by the joint venture.

Item 8 must be limited to four pages in length, with a font size no smaller than 10 point, unless otherwise specified in the advertisement.

9. Completed forms should be dated and contain the name of the architect-engineer principal responsible for the conduct of the work in the event it is awarded to the organization submitting this form, or by the principal of each firm for a joint-venture. Also list the name and telephone number of the individual who prepared the form.

|NYSDOT 255 |1. Contract ID Number /Contract Title: |2a. Does the Primary Firm Possess a Current NYS “Certificate of Authorization” to |

|TASS SHORTLIST | |Practice Land Surveying in NYS (Yes or No) |

|SUBMITTAL FORM | |Please attach a copy of the certificate. |

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| | |2b. Consultant Identification Number (CIN): |

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|3. Primary Firm Name & Address: |3a. Name, Title, Telephone Number and LS License Number of Company Officer proposed to be responsible |

| |for delivery of these services. |

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|Firm Name/location/CIN of all additional prime offices performing work: |3b. Prime Firm’s Proposed Number of Full Crews Available to Work on this Contract and the location of |

| |the crews’ base of operations: |

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|3c. Name, Title and Telephone No of Project Manager (Coordinator for Project Tasks): |3d. Address of office to perform work, if different from item 3: |

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| |3e. Name and License Number who will Sign and Seal ROW Acquisition Maps for this Contract: |

|4. Personnel by Discipline: (List each person only once, by primary function.) Enter proposed consultant personnel to be utilized on this contract on line (A) and total of In-house personnel on line (B). |

|Include only current full time employees, do not include part-time or proposed staff. With the use of multi-disciplined staff performing various tasks, calculate the number of full-time equivalents as the number |

|of personnel listed. |

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|(A) ___ (B) ___ Licensed Land Surveyors (A) ___ (B) ___ Photogrammetrists (A) ___ (B) ___ CADD Technicians (A) ___ (B) ___ ROW Mappers (non-licensed) |

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|(A) ___ (B) ___ Field Surveyors (non-licensed) (A) ___ (B) ___ TASS Managers (A) ___ (B) ___ Data Processors (A) ___ (B) ___ Other: __________________ |

NOTES: For the purposes of completing item #4 of this Form 255:

1) Surveying work (done by Field Surveyors) shall assume to describe field or office work necessary to complete geodetic control and/or related 2D base mapping or 3D digital terrain models.

NOTES: For the purposes of completing item #4 of this Form 255 (cont.):

2) ROW Mapping (done by ROW Mappers) shall assume to describe field survey, deed research or office work necessary in the determination of highway boundaries and for creation of ROW Appropriation Maps.

3) Data Processors shall assume to be those who primary job is to download and process survey field data in the office for the purpose of determining control or creating 2D or 3D mapping.

4) CADD Technicians shall assume to be those who solely provide drafting duties on CAD workstations.

5. List outside key Sub-Consultants/Associates anticipated for use on this contract (indicate if they are an alternate)

|Name & Address of Firm |Specialty |Percentage of Work |Does Sub have current NYS |Sub’s Number of Full Time Crews|

|Name & Phone Number of Project Manager |(Specify types of work to be performed |to be Performed by |“Certificate of Authorization” |Available to Work on this |

|(Attach a current Organizational Chart for the Land Surveying |on this Contract) |Sub-Consultant |(Y or N) to practice Land |Contract, and the location of |

|portion of the Firm.) | | |Surveying. |their base of operations: |

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|6. CONTRACT ORGANIZATIONAL CHART - Use this space to provide a contract organizational chart depicting the key individuals for the Land Surveying portion of the Firm. (including their name, firm affiliation and |

|project title) that make up your proposed team. This must be limited to one page in length, with a font size no smaller than 10 point. NO OTHER INFORMATION SHOULD BE INCLUDED ON THIS PAGE. |

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|7. Brief resume of key personnel anticipated to directly work on this contract. (minimum 10 point font, no more than one page per resume. LIMIT NUMBER OF RESUMES TO NO MORE THAN THE FOLLOWING: 1) PROJECT/TASS |

|MANAGER; 2) LICENSED LAND SURVEYORS; 3) EACH SURVEY CREW LEADER (Party Chief Only), |

|4) OFFICE PERSON FOR DATA PROCESSING (if applicable), 5) UP TO 2 RESUMES FOR ROW MAPPING STAFF (who could work on this project). DO NOT INCLUDE COMPANY OWNER/OFFICER, (unless working on project). Duplicate this |

|page as necessary for Prime and Sub-Consultants. (Resumes should not be included for any individuals who are no longer employed by the Firm.) |

|a. Employee Name, Title or Position: |b. Current Employer, and years employed by them in Surveying Profession: |

|c. Assignment/Position for Proposed Contract: |d. Education: Degree(s)/College: |

|e. Land Surveying License, Current NYS License Number: |f. Total Number of Years Working in the Land Surveying Profession: |

|g. For each experience listing (in chronological order) state: 1) the employer at that time; 2) whether the type of work qualifies as Control or DTM Survey, or as ROW Mapping; 3) the position held, name of projects,|

|and the dates during which this work occurred; and 4) briefly quantify and describe work performed which best illustrates relevant experience. |

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|PRIME OR SUB-CONSULTANT’S NAME: |

|(Duplicate page as necessary) |

|8. FAMILIARITY: Use this space to provide any additional information or description of resources supporting your firm’s qualifications for the proposed contract. (Duplicate page as necessary for Prime and |

|Sub-Consultants.) As a minimum, the following should be included: |

|1) List of types, brands, models and precision of all GPS, Total Station and Levels to be used on this project. |

|2) List of the current versions of MicroStation, InRoads, data collection software, survey processing software, GPS processing software, DTM creation software, and vertical control leveling software. |

|3) Description of CADD capabilities and any file format conversions necessary to conform to the NYS CADD Standards and Procedure Manual’s Chapter 2 requirements. |

|4) Include as part of the NYSDOT 255, 1 or 2 recent examples of ROW Maps prepared for NYSDOT by the prime firm and all applicable sub-consultants. These must be in pdf format. |

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|If proposing a joint venture, clearly describe the manner in which the work will be managed by the joint venture and the technical work coordinated and accomplished by the joint venture. You may also describe the|

|firm’s experience relevant to the proposed staff. This item must be limited to four pages of text plus a page for each ROW Map Sheet, with a font size no smaller than 10 point, unless otherwise specified in the |

|contract advertisement. |

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|9. The following individual certifies that the foregoing firm information, personnel resumes, project work descriptions and technology listings are current and| |

|accurate. | |

|(This must be certified by an officer/principal of the firm, or of each partner firm of the joint-venture) | |

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|Name and Title:_______________________________________________________________________________ |Date:_________________________ |

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