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C <br />11 <br />11 <br />MIAMI -DADE COUNTY — INTERNAL SERVICES DEPARTMENT (ISD) <br />MLAM ISD FORM NO. 11 <br />EXPERIENCE & QUALIFICATION / PREFERENCE / REFERENCE FORM <br />INSTRUCTIONS <br />This form must be submitted by each team member (Prime, A/E Sub - consultant, and /or non -A/E sub-consultant), <br />as applicable. Applicable firm must list previous similar type project in which it has performed work. <br />The reference provided below should be for one project and must comply with the requirements listed in <br />Sections 1.2, Scope of Services, Experience and Qualifications /Preferences, and 2.1, Format and Contents, of the NTPC. <br />APPLICABILITY TO EXPERIENCE & QUALIFICATIONS PREFERENCE (S) <br />This project reference complies with the Experience and Qualification(s) and /or Preference(s) required under Section 1.2, <br />Scope of Services, of the NTPC. Eyes OR ❑ Not Applicable <br />If yes, please indicate which of the Experience and Qualification(s) and /or Preference(s) that is met with this project <br />reference. <br />Programming, Design, Construction Admin., New /Innovative Solutions <br />REFERENCE PROJECT INFORMATION <br />Firm Name: R.E. Chisholm Architects, Inc., REC /(Design Architect - WA/AE of Record on 2 facilities) <br />Reference Project Name /Address: Chapman Partnership for the Homeless, Inc. Homeless Assisance Center <br />Name(s) and Role(s) of Consultant Personnel Working on this Reference Project: <br />Robert E. Chisholm, FAIA, NCARB, Principal -in- Charge and Matthew Polak, AIA, LEED AP, Project Manager <br />Reference Project Description: 70,000 SF Homeless Assistance Center (2 new facilities + various remodelings & additions <br />Scope of Services Provided: Architecture <br />Total Compensation for Services: 5 Pro.Bono Project Start Date: /1996 Project Completion Date: /2013 <br />Construction Start Date: Construction Completion Date: <br />Project Construction Cost: $ $8,000,000.00 <br />/1996 /2013 <br />Reference Company Name: Reference Contact Name: Daniel Vincent, Pres. <br />Reference Telephone Number: Facsimile Number: E -mail: dvincent@cphi.org <br />305.329.3026 305.329.3051 <br />SPACE BELOW IS TO BE UTILIZED TO EXPAND ON THE SCOPE OF SERVICES PROVIDED FOR THIS PROJECT REFERENCE. <br />PLEASE DESCRIBE YOUR FIRM'S INVOLVEMENT IN THE REFERENCE PROJECT. PROVIDE DETAILS TO SUPPORT WHETHER <br />EACH TEAM MEMBER'S PARTICULAR EXPERTISE RELEVANT TO THE PROJECT WAS GAINED UNDER CURRENT <br />EMPLOYMENT, OR AS A MEMBER OF ANOTHER FIRM. (ADDITIONAL SHEETS OF PAPER MAY BE USED TO INCLUDE <br />INFORMATION). <br />