Contract No. XX-XXXX

This is a Standard Form to provide information concerning the current workload of the firms interested in the project. The values shown should not include fees to be paid to subconsultants and subcontractors or for rentals/purchases of equipment.

PROJECT NAME(S)/LOCATION(S): FIRM NAME________________________________

______________________________ CONTACT PERSON_________________________

______________________________ PHONE NUMBER____________________________

______________________________ ADDRESS OF OFFICE(S) TO PERFORM WORK:

______________________________ _________________________________________

______________________________ _________________________________________

IS YOUR FIRM A: M/WBE? (YES/NO) _________________________________________

(circle as appropriate)

__________________________________________________________________________________________________________

NUMBER OF PERSONNEL (PROPOSED OFFICE(S)): ADMINISTRATIVE ____________ TECHNICAL ____________

PROFESSIONAL ____________

------------------------------------------------------------------------------------------------------------------------------------------------------------------

I. REMAINING TBTA WORK OF PROPOSED OFFICE(S) (from pg 2.) WITH:

______________ DIVISION: $ _______________ DEPARTMENT: $ ______________

(specify)

II. EXPECTED BILLINGS FOR NEXT 18 MONTHS:

A. TBTA WORK; total expected billings in next 18 months. $ __________

B. WORK WITH OTHER PUBLIC AGENCIES; total expected billings $ __________

In the next 18 months

C. PRIVATE WORK; total expected billings on projects in the next 18 months. $ __________

TOTAL (A + B + C) $__________

III. CERTIFIED MINORITY / WOMEN'S BUSINESS ENTERPRISE (M/WBE) FIRMS(S) FOR NON-FEDERAL AID PROJECTS PROPOSED FOR USE ON THIS PROJECT:

SUBCONSULTANT FIRM NAME & ADDRESS PROPOSED PERCENTAGE WORKLOAD WITH TBTA

OF PROJECT _______________________

(Specify)

______________________________________________ $_______________________ $______________________

______________________________________________ $_______________________ $______________________

______________________________________________ $_______________________ $______________________

IV. OTHER FIRM(S) PROPOSED FOR USE ON THIS PROJECT:

SUBCONSULTANT FIRM NAME & ADDRESS PROPOSED PERCENTAGE WORKLOAD WITH TBTA

OF PROJECT _______________________

(Specify)

______________________________________________ $_______________________ $______________________

______________________________________________ $_______________________ $______________________

______________________________________________ $_______________________ $______________________

V. CERTIFICATION

I hereby certify that the above figures are actual contract amounts (when available) or my best estimate of expected billings.

_______________________________________________ __________________________________________________

DATE SIGNATURE (OFFICER OR PARTNER)

FIRM NAME:_______________________________________

CONTRACT No._______________________________________

REMAINING WORK WITH TBTA

List all projects on which you are currently working for TBTA and those which you have been designated to perform. These shall be categorized as indicated below (Design, Construction Inspection or Miscellaneous).

DESIGN DIVISION (Includes A/E Design and Construction Support Services):

TOTAL FIRMWIDE PROPOSED OFFICE(S)

DESIGN WORKLOAD: $ DESIGN WORKLOAD: $

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

CONSTRUCTION DIVISION (Includes Only Construction Inspection):

TOTAL FIRMWIDE PROPOSED OFFICE(S)

C/I WORKLOAD: $ C/I WORKLOAD: $

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

MISCELLANEOUS (Includes Planning, Testing and any other agreements not covered above):

TOTAL FIRMWIDE MISCELLANEOUS PROPOSED OFFICE(S) MISCELLANEOUS

WORKLOAD: $ WORKLOAD: $

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

TOTAL FIRMWIDE OVERALL WORKLOAD PROPOSED OFFICE(S) OVERALL WORKLOAD

WITH AUTHORITY : $ WITH AUTHORITY : $

___________________________________________________________________________________________________________

Y0U MAY ATTACH ADDITIONAL SHEETS OF REMAINING WORK FOLLOWING THE SAME FORMAT AS USED ABOVE.