Standard Form: CPRA 24-102 (Rev. 8/2016) Professional Services Contracts 1. Advertisement Title 2a. Announcement date 2b. RSIQ number 3a. Name and mailing address of the firm’s office performing the 3b. Name, title, telephone number and email address of the work official with signing authority for this contract. 3c. Name, telephone number and email address of the point of contact for this contract (if different from 3b.) 3d. Firm’s Louisiana License number Full-time personnel on firm’s payroll: 4. All Personnel Project Specific Personnel Domiciled in LA NOT Domiciled in LA a. Engineers, with current Louisiana P.E. registration _______ _______ b. Environmental Engineers, with current Louisiana P.E. registration (not included in 4a) _______ _______ c. Engineer Interns _______ _______ d. Technical Support Personnel (non-engineers) _______ _______ e. Environmental personnel (non-engineers) _______ _______ f. Planning personnel (non-engineers) _______ _______ g. Other personnel not included in above categories (If project specific, list titles _______ _______ and total numbers for each below) _______________________________________________________________ Total personnel (sum of a g) _______ _______ – 5a. If one or more sub-consultants will be used, provide the information requested below for each.
Standard Form: CPRA 24-102 (Rev. 8/2016) Professional Services Contracts 1. Advertisement Title 2a. Announcement date 2b. RSIQ number 3a. Name and mailing address of the firm’s office performing the work 3b. Name, title, telephone number and email address of the official with signing authority for this contract. 3c. Name, telephone number and email address of the point of contact for this contract (if different from 3b.) 3d. Firm’s Louisiana License number 4. Full-time personnel on firm’s payroll: All Personnel Project Specific Personnel Domiciled in LA NOT Domiciled in LA a. Engineers, with current Louisiana P.E. registration _______ b. Environmental Engineers, with current Louisiana P.E. registration (not included in 4a) _______ c. Engineer Interns _______ d. Technical Support Personnel (non-engineers) _______ e. Environmental personnel (non-engineers) _______ f. Planning personnel (non-engineers) _______ g. Other personnel not included in above categories (If project specific, list titles _______ and total numbers for each below) _______________________________________________________________ Total personnel (sum of a – g) _______ _______ _______ _______ _______ _______ _______ _______ _______ 5a. If one or more sub-consultants will be used, provide the information requested below for each.
Enclosure-4-CPRA-SF24-102-08-2016.docx