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City of Sunny Isles Beach |Request for Qualifications No. 18-11-01 27 <br />PROJECT VERIFICATION FORM <br />Respondent must have completed the design and permitting of at least two (2) pump station projects in <br />the past ten (10) years. The completed projects meeting this minimum qualification may have been <br />performed by the individual, firm, or project manager assigned to the Work. <br />1)Name of Client Entity: ______________________________________________ <br />Address: __________________________________________________________ <br />City/State/Zip: ______________________________________________________ <br />Contact: __________________________________________________________ <br />Title: _____________________________________________________________ <br />Email Address:____________________________________________________ <br />Telephone: ________________________________________________________ <br />Scope of Work: _____________________________________________________ <br />Contract Start/End Dates: _____________________________________________ <br />Consultant Contract Amount: $_________________________________________ <br />2)Name of Client Entity: ______________________________________________ <br />Address: __________________________________________________________ <br />City/State/Zip: ______________________________________________________ <br />Contact: __________________________________________________________ <br />Title: _____________________________________________________________ <br />Email Address:____________________________________________________ <br />Telephone: ________________________________________________________ <br />Scope of Work: _____________________________________________________ <br />Contract Start/End Dates: _____________________________________________ <br />Consultant Contract Amount: $_________________________________________ <br />3)Name of Client Entity: ______________________________________________ <br />Address: __________________________________________________________ <br />City/State/Zip: ______________________________________________________ <br />Contact: __________________________________________________________ <br />Title: _____________________________________________________________ <br />Email Address:_____________________________________________________ <br />Telephone: ________________________________________________________ <br />Scope of Work: _____________________________________________________ <br />Contract Start/End Dates: _____________________________________________ <br />Consultant Contract Amount: $_________________________________________ <br />END OF SECTION