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rl <br />r! <br />ri <br />r� <br />l <br />t <br />I <br />r <br />i- <br />L1 <br />rl <br />Li <br />i <br />l <br />MDX PROCUREMENT /CONTRACT NO.: RFS -11.08 <br />MDX WORK PROGRAM NO.: 87409.050 <br />MDX PROJECT /SERVICE TITLE: CONSTRUCTION ENGINEERING AND INSPECTION fCE &Il SERVICES FOR THE <br />DESIGN-BUILD PROJECT FOR SR 874 MAINLINE RECONSTRUCTION <br />Proposers shall have this form completed by each proposed reference and include in their Proposal. Proposers shall ensure the form <br />is completed in its entirety. MDX may verify the information provided herein. Please note: In order to avoid violation of the Cone of <br />Silence, Proposers that wish to use MDX, or its representatives, including the members of the Technical Evaluation Committee (TEC) <br />as a reference, shall fill out and submit in the Proposal this form with the Personnel, Reference, and Contract Information <br />compieLea. IVIUA W1II IJCI IU1111 d I I - -- <br />4 <br />PERSONNEL INFORMATION <br />Proposer: Cima Engineering Corp <br />Name of Proposed Personnel: Jose Gonzalez, P . E <br />Proposed Role for this Contract I <br />Senior Project Engineer <br />(i.e. Project Manager etc. ): <br />Employed by (Company Name if not Proposer): <br />Circa Engineering Corp <br />REFERENCE INFORMATION <br />. _ <br />Name of Reference <br />Richard. Pereira P . E <br />(person completing form & available for follow -up): <br />Title: <br />Transportation Director <br />-- <br />Phone Number: <br />954 -985 2300 Ext 10640 <br />_ <br />RichardPereira @semtribe . com <br />E -Mail Address: <br />CONTRACT INFORMATION <br />Agency Work Performed for: Seminole Indian Tribe Of Florida <br />Contract Title /Name: <br />Reconstruc BIA route 1281 bridge /approach <br />Full CET Management,Claims Review,As- Builts, <br />Brief Description of Services Performed <br />Work Orders, Correspondence, Public Relations, <br />Utility Coordination and Troubleshooting. <br />Role Performed (i.e. Project Manager etc.) <br />Senior Project Engineer <br />Services performed as a Prime or as a Subconsultant: <br />Prime ® Subconsultant ❑ to <br />Type of Agency <br />Federal Agency <br />(Government, State, Local etc.): <br />April /2010 <br />March /2011 <br />Start Date Individual Worked on Contract (Month /Year): <br />End Date Individual Worked on Contract (Month /Year): <br />$2.3 Million <br />Contract Amount: <br />TECHNICAL ABILITY INFORMATION <br />Level of Experience for Services Performed: Outstanding 21' Excellent ❑ Good ❑ Fair ❑ Poor ❑ <br />Quality of the Services Performed: <br />Outstanding 11a" Excellent ❑ Good ❑ Fair ❑ Poor ❑ <br />Personnel's Ability to Meet Contracted Time Frames: <br />Outstanding 53'� Excellent ❑ Good ❑ Fair ❑ Poor ❑ <br />Personnel's Response to Special Requests: <br />Outstanding W Excellent ❑ Good ❑ Fair ❑ Poor ❑ <br />Additional Comments <br />Signature from Reference: ' ���— Date: <br />RATING SCALE: <br />Outstanding 90 —100 Excellent 80 — 89 Good 70 - 79 Fair 66 69_ Poor 65 and below <br />Personnel Reference Information Form <br />�i <br />