Engineer, Architect, & Related Services
Pre-Qualification Form Annual Update
City of Council Bluffs, Iowa • Engineering Division • Attn: City Engineer
209 Pearl St • Council Bluffs, Iowa 51503 • mcox@councilbluffs-ia.gov
Purpose: This form is provided to update information previously submitted on the Pre-Qualification Form. Firms must complete and submit this form
electronically to the email address listed above.
Instructions:
Standard Work Categories - Please indicate any changes to the type(s) of work your firm has experience with and is interested in performing by placing a
checkmark in the appropriate box or boxes. Numbers below correspond to numbers contained on the form. If there have been no changes to the work
categories, place a checkmark in the corresponding box.
1. Firm name and address of primary office providing services to the City of Council Bluffs.
2. Legal qualifications. Note any changes since last submitted.
3. Name, title, email address, and telephone number of two primary contacts.
4. Updated list of projects. Attach additional pages or submit as a separate file, if needed. Only complete for new or different projects not previously listed.
5. Include resumes for key personnel that are new to the firm.
Standard Work Categories for Professional Services
Aquatic Systems Levees Streetscape
Bridges Pump Station Structures
Buildings and Facilities Roadway Traffic Operations
Demolition and Site Restoration Sanitary Sewer Trails
Golf Course Architecture Storm Sewer Wastewater Plant
Landscape Architecture
Support Services
Bridge Inspection ROW Services Community Master Planning
Construction Observation Surveying Facility Planning
Disaster Response Value Engineering Public Involvement
Geotechnical Engineering Transportation Planning
Materials Testing Environmental Studies and Compliance
Permitting Hydraulic and Hydrologic Studies
No changes
1. Firm Name and Address: __________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2a.
Has the firm been disqualified from working on any public agency
contracts? Yes No
2c. Please explain any changes:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
2b. Is the firm involved in any litigation or subject to enforcement
actions by a state or federal agency?
Yes No
3. Principals or Primary Contacts:
1) Name: ______________________________________________ Title: __________________________________________________
Email address: ________________________________________ Phone No.: _____________________________________________
2) Name: ______________________________________________ Title: __________________________________________________
Email address: ________________________________________ Phone No.: _____________________________________________
4a. List of Current Projects:
1) ____________________________________________________
2) ____________________________________________________
3) ____________________________________________________
4b. List of Completed Projects:
(attach additional pages, if needed)
1) __________________________________________________
2) __________________________________________________
3) __________________________________________________
5. Attach Resumes for Key Personnel
The foregoing is a statement of facts.
Signature: _______________________________________________ Date: _________________________________________________
Print Name: ______________________________________________ Title: _________________________________________________
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