DS Sample DSB Form

Page 1

1.

Commonwealth of Massachusetts

2. Project # 14-04

FITCHBURG STATE UNIVERSITY

ORIGINAL

FITCHBURG, MASSACHUSETTS

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

3e.

Date Present and Predecessor Firms Were Established:

Federal ID #:

(if applicable) (if applicable)

Alex Adkins, AIA, LEED AP (MA Reg #7703) Alex Adkins, AIA, LEED AP (MA Reg #7703)

3f.

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

3g.

Name and Address Of Parent Company, If Any:

3h.

Check Below If Your Firm Is Either: (1) SDO Certified Minority Business Enterprise (MBE) (2) SDO Certified Woman Business Enterprise (WBE) (3) SDO Certified Minority Woman Business Enterprise (M/WBE)

Huygens, & Tappe, Inc., 1967 Huygens & DiMella, Inc., 1981 Huygens DiMella Shaffer Associates, Inc., 1987 DiMella Shaffer Associates, Inc., 1994

3c.

Name Of Proposed Project Manager:

For Study: For Design:

DiMella Shaffer 281 Summer Street Boston, MA 02210

3b.

This space for use by Awarding Authority only.

STUDY AND DESIGN FOR BUILDING RENOVATIONS, REPAIRS AND UPGRADES

DSB Application Form (Updated May 2014)

3a.

Project Name/Location For Which Firm Is Filing:

04-2429796

3d.

Name and Title Of Principal-In-Charge Of The Project (MA Registration Required): Edward K. Hodges, AIA, Principal, (MA Reg #7831)

Email Address: Telephone No: 4.

ehodges@dimellashaffer.com [617] 426-5004

[617] 426-0046

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 Architects Acoustical Engrs. Civil Engrs. Code Specialists Construction Inspectors Cost Estimators Drafters

5.

Fax No.:

  

11 19

29

( ( ( ( ( ( ( (

) 18 ) )

) ) ) ) )

Ecologists Electrical Engrs. Environmental Engrs. Fire Protection Engrs. Geotech. Engrs. Industrial Hygienists Interior Designers Landscape Architects

Has this Joint Venture previously worked together?

Updated May 2014

4

( ( ( ( ( ( ( (

2

) ) ) ) ) ) ) )

Licensed Site Profs. Mechanical Engrs. Planners: Urban./Reg. Specification Writers Structural Engrs. Surveyors

( ( ( ( ( ( ( (

) ) ) ) ) ) ) )

Other

Total

63

( ( ( ( ( ( ( (

20

) ) ) ) ) ) ) )

DSB Application Form Page 1


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DS Sample DSB Form by Idamys Montoni - Issuu