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ARCHITECT - ENGINEER QUALIFICATIONS <br />PART II - GENERAL QUALIFICATIONS <br />(If a firm has branch offices, complete for each specific branch office seeking work.) <br />3. YEAR ESTABLISHED <br />a. TYPE <br />b. SMALL BUSINESS STATUS <br />7. NAME OF FIRM (If Block 2a is a Branch Office) <br />6b. TELEPHONE NUMBER <br />Other Employees <br />a. Federal Work <br />a. SIGNATURE b.DATE <br />c. NAME AND TITLE <br />11. ANNUAL AVERAGE PROFESSIONAL <br />SERVICES REVENUES OF FIRM <br />FOR LAST 3 YEARS <br />(Insert revenue index number shown at right) <br />12. AUTHORIZED REPRESENTATIVE <br />The foregoing is a statement of facts. <br />PROFESSIONAL SERVICES REVENUE INDEX NUMBER <br />1. Less than $100,000 <br />2. $100,000 to less than $250,000 <br />3. $250,000 to less than $500,000 <br />4. $500,000 to less than $1 million <br />5. $1 million to less than $2 million <br />6. $2 million to less than $5 million <br />7. $3 million to less than $10 million <br />8. $10 million to less than $25 million <br />9. $25 million to less than $50 million <br />10. $50 million or greater <br />b. Non-Federal Work <br />c. Total Work <br />Total <br />6a. POINT OF CONTACT NAME AND TITLE <br />2c. CITY <br />2b. STREET <br />2a. FIRM (or Branch OFfice) NAME <br />2d. STATE 2e. ZIP CODE <br />6c. E-MAIL ADDRESS <br />4. UNIQUE ENTITY IDENTIFIER <br />5. OWNERSHIP <br />8b. YEAR ESTABLISHED8a. FORMER FIRM NAME(S) (If any) <br />10. PROFILE OF FIRM’S EXPERIENCE <br />AND ANNUAL AVERAGE REVENUE FOR LAST 5 YEARS9. EMPLOYEES DISCIPLINE <br />a. Function <br />Code b. Discipline <br />a. Profile <br />Code <br />c. Number of Employees <br />(1) FIRM (2) BRANCH <br />c. Revenue Index <br />Number <br />(see below) <br />b. Experience <br />8c. UNIQUE ENTITY IDENTIFIER <br />STANDARD FORM 330 (REV. 8/2016) - SF330-PART II_USUPAE <br />2014 <br />CORPORATION <br />BROWARD COUNTY SMALL BUSINESS <br />FLORIDA <br />US UTILITY POTHOLING & AIR EXCAVATION <br />4630 NE 11TH AVENUE <br />OAKLAND PARK 33334 <br />85-9310166 <br />954.937.1488 <br />02 1 25AdministrativeConstruction Management <br />20Cost Estimating <br />0 <br />8 <br />8 <br />CFaust@USUtilityPotholing.com <br />CHARLES R. FAUST JR.MANAGING MEMBER <br />June 5, 2020 <br />CHUCK FAUST <br />MANAGING MEMBER <br />1. SOLICITATION NUMBER (If any) <br />20-07-01 <br />219