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Exn�a�t e <br /> Federal Quaiification Based Seiection (QBS} Checklist <br /> Local Pubfic Agency Gitv af Decatur <br /> Section Number 09-C10933-01-BR <br /> Project Number 6WGY(165) <br /> Job Number D97-00�9-19 <br /> The LPA must complete Exhibit C, if federal funds are used for this engineering agreement and the value will exceed <br /> $25,000. The �PA must follaw federal small purchase procedures, if federal funds are used and the engineering agreement <br /> has a vaiue (ess than$25,000. <br /> ❑ Farm No#Applicable (engineering services fess than $25,000} <br /> 1. Do #he written QBS policies and procedures discuss the initia! administration (procurement, management, and <br /> administration) concerning engineering and design related consultant services? � Yes ❑ No <br /> 2. Do the written QBS policies and pracedures follow the requirements as autlined in Sectian 5-5 and specifically <br /> Sectian 5-5.06{e} of the BLRS Manuai? � Yes ❑ Na <br /> If no, fDOT's approval date. <br /> 3. Was the scope of services far this praject ciearly defined? � Yes ❑ Na <br /> � 4. Was public no#ice given for this project? � Yes ❑ Na Due date of submittaL• 07/18/2018 <br /> Method(s) used for advertisement and dates af advertisement. Decatur Tribune 6-27-18 & 7-4-18 <br /> Also advertized on the Cit 's website and emaii listin . <br /> 5. Da the written QBS policies and procedures cover confiicts of interest? �Yes ❑ No <br /> 6. Da the written QBS poficies and pracedures use covered methods of verificatian for suspension and debarment? <br /> � Yes ❑ No <br /> 7. Do the written QBS policies and procedures discuss the method of evaluation? �Yes ❑ Na <br /> Griteria for this project Weighting Criteria for this projec# Weight'rng <br /> Pro�,Understandinq&A�proach 25°lfl Assigned Personnel 25°!0 <br /> Firm"s Experience 20% Firm's Abilit�Capacitv 10% <br /> Technica( Project Management 10% Proximity to the Citv 5°/a <br /> DBE Use 5% % �I <br /> 8. Do the writ#en QBS policies and procedures discuss the method of se(ection"? � Yes ❑ No <br /> Selection committee (tit(es) far this project: PubGc Works Direc#or. Ci#y Enqineer. Asst. Citv Enp., <br /> Transpartatian Consultant Cauntv Enqineer ADM Representatives <br /> Top three cansuftants selected for this project in arder: 1} AECt�M <br /> 2) GMT 3} Hanson <br /> If less than 3 responses were received, IDC�T"s approval date: <br /> 9. Was an estimated cos#af engineering far#his project developed in-house prior ta contract negQtiatian? <br /> � Yes ❑ No <br /> 10. Were negotiations for this project performed in accardance with#ederal requirements? � Yes ❑ No <br /> 11. Were acceptable costs for this praject verified? <br /> ❑ Yes ❑ No � L.PA wil{ rely an IDt�T review and appravai of costs. <br /> 12. Do the written QBS policies and procedures cover review and approving far payment, before forwarding the request <br /> for reimbursemen#to IDQT for further review and approval? � Yes ❑ No <br /> 13. Do the written C.�BS policies and pracedures cover ongoing and finalizing administration of the praject (manitoring, <br /> evaluation, closing-out a cantract, record retention, responsibility, remedies to violations or �reaches to a contract, <br /> and resolution af disputes)? � Yes ❑ No <br /> Page 8 of 8 BLR 05610(Rev. 11/Q9/17) <br /> Printed an 9124I20i8 10:24:12 AM <br />