The State of of 1977 (effective July 1, 1978) requires the to provide the following information to individuals who are asked to supply personal information about themselves. Information furnished on the Self-Certification form may, in some cases, identify personal information of an individual. I hereby certify under penalty of perjury under the laws of the State of California that I have read this application and know the contents thereof, and that the business category indicated above reflects the true and correct status of the business in accordance with Federal Small Business Administration criteria and Federal Acquisition Regulations, FAR 19, pertaining to small, disadvantaged, women-owned, and disabled veteran business enterprises. I understand that falsely certifying the status of this business, obstructing, impeding or otherwise inhibiting any University of California official who is attempting to verify the information on this form may result in suspension from participation in University of California business contracts for a period up to five (5) years and the imposition of any civil penalties allowed by law. NAME OF FIRM: NAME: TITLE: SIGNATURE: DATE: WORK TYPE (AREAS OF EXPERTISE) MAJOR SPECIALTIES Architecture Building/Facilities Programming Civil Engineering Electrical Engineering Engineering Geo Technical Engineering Interior Design; Planning Landscape Architecture Mechanical Engineering Planning (Community, Regional, Areawide, State) Planning (Site, Installation, and Project) Project Management/Scheduling Structural Engineering SUPPLEMENTAL SPECIALTIES Air Balancing/Testing Asbestos/Consulting/Surveys/Reports/Analysis Assessment Engineering Construction Management Cost Estimating Economic Impact; Feasibility Study Educational Facilities; Classrooms Environmental Engineering Environmental Impact Studies, Assessments or Statements Environmental Testing/Analysis Equipment Planning Fire Protection Garages; Vehicle Maintenance Facilities; Parking Hazardous Waste; Management/Planning Health Systems Planning Decks Hospital Equipment Hospital & Medical Facilities Laboratories; Medical Research Facilities Master Planning; Feasibility Reports Research Labs/Facilities Seismic Designs & Studies Site Analysis Soils & Geologic Studies; Foundations Special Environments; Clean Rooms, etc. Specification Writing Testing & Inspection Services Traffic & Transportation Engineering Value Analysis; Life-Cycle Costing Zoning; Land Use Studies OTHERS (list below) DEFINITIONS FOR BUSINESS SIZE
The State of of 1977 (effective July 1, 1978) requires the to provide the following information to individuals who are asked to supply personal information about themselves. Information furnished on the Self-Certification form may, in some cases, identify personal information of an individual. I hereby certify under penalty of perjury under the laws of the State of California that I have read this application and know the contents thereof, and that the business category indicated above reflects the true and correct status of the business in accordance with Federal Small Business Administration criteria and Federal Acquisition Regulations, FAR 19, pertaining to small, disadvantaged, women-owned, and disabled veteran business enterprises. I understand that falsely certifying the status of this business, obstructing, impeding or otherwise inhibiting any University of California official who is attempting to verify the information on this form may result in suspension from participation in University of California business contracts for a period up to five (5) years and the imposition of any civil penalties allowed by law. NAME OF FIRM: NAME: TITLE: SIGNATURE: DATE: WORK TYPE (AREAS OF EXPERTISE) MAJOR SPECIALTIES Architecture Building/Facilities Programming Civil Engineering Electrical Engineering Engineering Geo Technical Engineering Interior Design; Planning Landscape Architecture Mechanical Engineering Planning (Community, Regional, Areawide, State) Planning (Site, Installation, and Project) Project Management/Scheduling Structural Engineering SUPPLEMENTAL SPECIALTIES Air Balancing/Testing Asbestos/Consulting/Surveys/Reports/Analysis Assessment Engineering Construction Management Cost Estimating Economic Impact; Feasibility Study Educational Facilities; Classrooms Environmental Engineering Environmental Impact Studies, Assessments or Statements Environmental Testing/Analysis Equipment Planning Fire Protection Garages; Vehicle Maintenance Facilities; Parking Decks Hazardous Waste; Management/Planning Health Systems Planning Hospital Equipment Hospital & Medical Facilities Laboratories; Medical Research Facilities Master Planning; Feasibility Reports Research Labs/Facilities Seismic Designs & Studies Site Analysis Soils & Geologic Studies; Foundations Special Environments; Clean Rooms, etc. Specification Writing Testing & Inspection Services Traffic & Transportation Engineering Value Analysis; Life-Cycle Costing Zoning; Land Use Studies OTHERS (list below) DEFINITIONS FOR BUSINESS SIZE
Consultant-ProfileForm(04-01-17).docx