B Review and Evaluation Licensed Professional Engineer Information

Section 740.APPENDIX B   Review and Evaluation Licensed Professional Engineer Information •           Firm name. •           Address. •           Telephone/fax. •           Principal officials and titles. •           Number of full-time employees. •           Business structure (corporation, partnership, LLP, LLC, PSC). •           Licensed by Secretary of State? #___________ •           Licensed by Dept. of Professional Regulation? #___________ •           Name of Illinois Registered Managing Agent. Names of insurance carriers and amount of coverage: Worker's Compensation:_____________________________________________ General Liability:___________________________________________________ Professional Liability:________________________________________________ •           Does the stated professional liability policy include coverage for "environmental" claims related to release of pollutants?  If not covered, or covered by a different carrier or in a different amount, so state. •           Has the firm or owners ever filed bankruptcy?  If "yes," state when and explain. •           Is the firm an outgrowth, result, continuation or reorganization of a former business?  If "yes," explain background. •           List RELPEs and other key full-time employees that will participate on this project with the RELPE.  Provide resumes for each, including Illinois P.E. License #, certifications, project role, years of experience in related work and education. •           List five projects similar in nature and identify the role of the RELPE. •           Are employees to be assigned to the project in compliance with 29 CFR 1910.120 (HAZWOPER training and medical surveillance) as applicable to their role on the project?