STANDARD FORM (SF) 254	Architect-Engineer and Related Services Questionnaire		Form Approved OMB No. 9000-0004
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the FAR Secretariat (VRS), Off ice of Federal Acquisition and Regulatory Policy, GSA, Washington, D.C. 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0004), Washington, D.C. 20503.
Purpose: The policy of the Federal Government in acquiring architectural, engineering, and related professional services is to encourage firms lawfully engaged in the practice of those professions to submit annually a statement of qualifications and performance data. Standard Form 254, “Architect-Engineer and Related Services Questionnaire,” is provided for that purpose. Interested A-E firms (including new, small, and/or minority firms) should complete and file SF 254’s with each Federal agency and with appropriate regional or district offices for which the A-E is qualified to perform services. The agency head for each proposed project shall evaluate these qualification resumes, together with any other performance data on file or requested by the agency, in relation to the proposed project. The SF 254 may be used as a basis for selecting firms for discussions, or for screening firms preliminary to inviting submission of additional information. Definitions: “Architect-Engineer Services” are defined in Part 36 of the Federal Acquisition Regulation. “Parent Company” is that firm, company, corporation, association or conglomerate which is the major stockholder or highest tier owner of the firm completing this questionnaire; i.e., Firm A is owned by Firm B which is, in turn, a subsidiary of Corporation C. The “parent company” of Firm A is Corporation C. “Principals” are those individuals in a firm who possess legal responsibility for its management. They may be owners, partners, corporate officers, associates, administrators, etc. “Discipline,” as used in this questionnaire, refers to the primary technological capability of individuals in the responding firm. Possession of an academic degree, professional registration, certification, or extensive experience in a particular field of practice normally reflects an individual’s primary technical discipline. “Joint Venture” is a collaborative undertaking by two or more firms or individuals for which the participants are both jointly and individually responsible. “Consultant,” as used in this questionnaire, is a highly specialized individual or firm having significant input and responsibility for certain aspects of a project and possessing unusual or unique capabilities for assuring success of the finished work. “Prime” refers to that firm which may be coordinating the concerted and complementary inputs of several firms, individuals or related services to produce a completed study or facility. The “prime would normally be regarded as having full responsibility and liability for quality of performance by itself as well as by subcontractor professionals under its jurisdiction.		“Branch Office” is a satellite, or subsidiary extension, of a headquarters office of a company, regardless of any differences in name or legal structure of such a branch due to local or state laws. “Branch offices” are normally subject to the management decisions, bookkeeping, and policies of the main office. Instructions for Filing (Numbers below correspond to numbers contained in form): 1. Type accurate and complete name of submitting firm, its address, and zip code. 1a. Indicate whether form is being submitted in behalf of a parent firm or a branch office. (Branch office submissions should list only personnel in, and experience of, that office.) 2. Provide data the firm was established under the name shown in question 1. 3. Show date on which form is prepared. All information submitted shall be current and accurate as of this date. 4. Enter type of ownership, or legal structure, of firm (sole proprietor, partnership, corporation, joint venture, etc.) Check appropriate boxes indicating if firm is (a) a small business concern; (b) a small business concern owned and operated by socially and economically disadvantaged individuals; and (c) Woman-owned (See 48 CFR 19.101 and 52.219-9). 5. Branches of subsidiaries of large or parent companies, or conglomerates, should insert name and address of highest-tier owner. 5a. If present firm is the successor to, or outgrowth of, one or more predecessor firms, show name(s) of former entity(ies) and the year(s) of their original establishment. 6. List not more than two principals from submitting firm who may be contacted by the agency receiving this form. (Different principles may be listed on forms going to another agency.) Listed principals must be empowered to speak for the firm on the policy and contractual matters. 7. Beginning with the submitting office, list name, location, total number of personnel, and telephone numbers for all associated or branch offices, (including any headquarters or foreign offices) which provides A-E and related services. 7a. Show total personnel in all offices. (Should be sum of all personnel, all branches.) 8. Show total number of employees, by discipline, in submitting office. (*If form is being submitted by main headquarters office, firm should list total employees, by discipline, in all offices.) While some personnel may be qualified in several disciplines, each person should be counted only once in accord with his or her primary function. Include clerical personnel as “administrative.” Write in any additional disciplines—sociologists, biologists, etc.—and number of people in each, in blank spaces.

NSN 7540-01-152-8073 254-104 STANDARD FORM 254 (REV. 11-92)

Previous edition not usable. Prescribed by GSA – FAR (48 CFR) 53.236-(b)

STANDARD

FORM (SF)

254

Architect-Engineer

and Related Services

Questionnaire

9. Using chart (below) insert appropriate index number to indicate range of professional services fees received by submitting firm each calendar year for last five years, most recent year first. Fee summaries should be broken down to reflect the fees received each year for (a) work performed directly for the Federal Government (not including grant and loan projects) or as a sub to other professionals performing work directly for the Federal Government; (b) all other domestic work, U.S. and possessions, including Federally-assisted projects, and (c) all other foreign work.

Ranges of Professional Services Fees

INDEX INDEX

1. Less than $100,000 5. $1 million to $2 million

2. $100,000 to $250,000 6. $2 million to $5 million

3. $250,000 to $500,000 7. $5 million to $10 million

4. $500,000 to $1 million 8. $10 million or greater

10. Select and enter, in numerical sequence, not more than thirty (30) “Experience Profile Code” numbers from the listing (next page) which most accurately reflect submitting firm’s demonstrated technical capabilities and project experience. Carefully review list. (It is recognized some profile codes may be part of other services or projects contained on list; firms are encouraged to select profile codes which best indicate type and scope of services provided on past projects .) For each code number, show total number of projects and gross fees (in thousands) received for profile projects performed by firm during past few years. If firm has one or more capabilities not included on list, insert same in blank spaces at end of list and show numbers in question 10 on the form. In such cases, the filled-in listing must accompany the complete SF 254 when submitted to the Federal agencies.

11. Using the “Experience Profile Code” numbers in the same sequence as entered in item 10, give details of at least one recent (within the last five years) representative project for each code number, up to a maximum of thirty (30) separate projects, or portions of projects, for which firm was responsible. (Project examples may be used more than once to illustrate different services rendered on the same job. Example: a dining hall may be part of an auditorium or educational facility.) Firms which select less than thirty “profile codes” may list two or more project examples (to illustrate specialization) for each code number so long as total of all project examples does not exceed thirty (30). After each code number in question 11, show: (a) whether firm was “P,” the prime professional, or “C,” a consultant, or “JV,” part of a joint venture on that particular project (new firms, in existence less than five (5) years may use the symbol “IE” to indicate “Individual Experience” as opposed to

firm experience); (b) provide name and location of the specific project which typifies firm’s (or individual’s) performance under that code category; (c) give name and address of the owner of that project (if government agency indicate responsible office); (d) show the estimated construction cost (or other applicable cost) for that portion of the project for which the firm was primarily responsible. (Where no construction was involved, show approximate cost of firm’s work); and (e) state year work on that particular project was, or will be, completed.

12. The completed SF 254 should be signed by a principal of the firm, preferably the chief executive officer.

13. Additional data, brochures, photos, etc. should not accompany this form unless specifically requested.

NEW FIRMS (not recognized or recently-amalgamated firms) are eligible and encouraged to seek work from the Federal Government in connection with performance of projects for which they are qualified. Such firms are encouraged to complete and submit Standard Form 254 to appropriate agencies. Questions on the form dealing with personnel or experience may be answered by citing experience and capabilities of individuals in the firm, based on performance and responsibility while in the employee of others. In so doing, notation of this fact should be made on the form. In question 9, write in “N/A” to indicate “not applicable” for those years prior to firm’s organization.

STANDARD FORM 254 PAGE 2 (REV. 11-92)

Experience Profile Code Numbers

for use with questions 10 and 11

042 Harbors; Jetties; Piers; Ship Terminal Facilities

043 Heating; Ventilating; Air Conditioning

044 Health Systems Planning

045 High-rise; Air-Rights-Type Buildings

046 Highways; Streets; Airfield Paving; Parking Lots

047 Historical Preservation

048 Hospital and Medical Facilities

049 Hotels; Models

050 Housing (Residential; Multi-Family; Apartments; Condominiums)

051 Hydraulics and Pneumatics

052 Industrial Buildings; Manufacturing Plants

053 Industrial Processes; Quality Control

054 Industrial Waste Treatment

055 Interior Design; Space Planning

056 Irrigation; Drainage

057 Judicial and Courtroom Facilities

058 Laboratories; Medical Research Facilities

059 Landscape Architecture

060 Libraries; Museums; Galleries

061 Lighting (Interiors; Display; Theatre, etc.)

062 Lighting (Exteriors; Streets; Memorials; Athletic Fields, etc.)

063 Materials Handling Systems; Conveyors; Sorters

064 Metallurgy

065 Microclimatology; Tropical Engineering

066 Military Design Standards

067 Mining and Mineralogy

068 Missile Facilities (Silos; Fuels; Transport)

069 Modular Systems Design; Pre-Fabricated Structures or Components

070 Naval Architecture; Off-Shore Platforms

071 Nuclear Facilities; Nuclear Shielding

072 Office Buildings; Industrial Parks

073 Oceanographic Engineering

074 Ordnance; Munitions; Special Weapons

075 Petroleum Exploration

076 Petroleum and Fuel (Storage and Distribution)

077 Pipelines (Cross-Country – Liquid and Gas)

078 Planning (Community, Regional, Areawide and State)

079 Planning (Site, Installation, and Project)

080 Plumbing and Piping Design

081 Pneumatic Structures; Air-Support Buildings

082 Postal Facilities

083 Power Generation; Transmission; Distribution

084 Prison and Correctional Facilities

085 Product; Machine and Equipment Design

086 Radar; Sonar; Radio and Radar Telescope

087 Railroad; Rapid Transit

088 Recreation Facilities (Parks; Marinas, etc.)

089 Rehabilitation (Buildings; Structures; Facilities)

090 Resource Recovery; Recycling

091 Radio Frequency Systems and Shieldings

092 Rivers; Canals; Waterways; Flood Control

093 Safety Engineering; Accident Studies; OSHA Studies

094 Security Systems; Intruder and Smoke Detection

095 Seismic Designs and Studies

096 Sewage Collection; Treatment; Disposal

097 Soils and Geologic Studies; Foundations

098 Solar Energy Utilization

099 Solid Wastes; Incineration; Landfill

100 Special Environments; Clean Rooms, etc.

101 Structural Design; Special Structures

102 Surveying; Platting; Mapping; Flood Plain Studies

103 Swimming Pools

104 Storm Water Handling and Facilities

105 Telephone Systems (Rural; Mobile; Intercom, etc.)

106 Testing and Inspection Services

107 Traffic and Transportation Engineering

108 Towers (Self-Supporting and Guyed Systems)

109 Tunnels and Subways

110 Urban Renewals; Community Development

111 Utilities (Gas and Steam)

112 Value Analysis; Life-Cycle Costing

113 Warehouses and Depots

114 Water Resources; Hydrology; Ground Water

115 Water Supply; Treatment and Distribution

116 Wind Tunnels; Research/Testing Facilities Design

117 Zoning; Land Use Studies

201 Environmental Program and Compliance Auditing

202 Environmental Program Development_

203 UST Assessment/Remediation Program Mgmt.

204 Environmental Plans___________________

205 ________________________________________

001 Acoustics, Noise Abatement

002 Aerial Photogrammetry

003 Agricultural Development; Grain Storage; Farm Mechanization

004 Air Pollution Control

005 Airports; Navaids; Airport Lighting; Aircraft Fueling

006 Airports; Terminals and Hangers; Freight Handling

007 Arctic Facilities

008 Auditoriums and Theatres

009 Automation; Controls; Instrumentation

010 Barracks; Dormitories

011 Bridges

012 Cemeteries (Planning and Relocation)

013 Chemical Processing and Storage

014 Churches; Chapels

015 Codes; Standards; Ordinances

016 Cold Storage; Refrigeration; Fast Freeze

017 Commercial Building (low rise); Shopping Centers

018 Communications Systems; TV; Microwave

019 Computer Facilities; Computer Service

020 Conservation and Resource Management

021 Construction Management

022 Corrosion Control; Cathodic Protection; Electrolysis

023 Cost Estimating

024 Dams (Concrete; Arch)

025 Dams (Earth; Rock); Dikes; Levees

026 Desalinization (Process and Facilities)

027 Dining Halls; Clubs; Restaurants

028 Ecological and Archeological Investigations

029 Educational Facilities; Classrooms

030 Electronics

031 Elevators; Escalators; People-Movers

032 Energy Conservation; New Energy Sources

033 Environmental Impact Studies, Assessments, or Statements

034 Fallout Shelters; Blast-Resistant Design

035 Field Houses; Gyms; Stadiums

036 Fire Protection

037 Fisheries; Fish Ladders

038 Forestry and Forest Products

039 Garages; Vehicle Maintenance Facilities; Parking Decks

040 Gas Systems (Propane; Natural, etc.)

041 Graphic Design

STANDARD FORM 254 PAGE 3 (REV. 11-92)

STANDARD

FORM (SF)

254

Architect-Engineer

And Related Services

Questionnaire

1. Firm Name/Business Address:

Epes Environmental and Consulting, PLLC

410 N. Main Street

Water Valley, MS 38965

1a. Submittal is for [X] Parent Company Branch or Subsidiary Office

2. Year Present Firm

Established 2002

3. Date Prepared:

4. Specify type of ownership and check below, if

applicable.

A. Small Business (Hubzone qualified)

B. Small Disadvantaged Business

C. Woman-owned Business

5. Name of Parent Company, if any:

5a. Former Parent Company Name(s), if any, and Year(s) Established:

6. Names of not more than Two Principals to Contact: Title/Telephone 6A. Dun&Bradstreet No. 132930640

1) Pierce Epes, P.E., Principal Engineer/Owner, Tel (662)473-9800 www.EpeseEnviro.com

Fax(662)473-3179 e-mail: Pierce.Epes@epesenviro.com

7. Present Offices: City / State / Telephone / No. Personnel Each Office 7a. Total Personnel 2

Water Valley, MS Tel: (662)473-9800 / 2 personnel

Fax (662)473-3179

8. Personnel by Discipline: (List each person only once, by primary function.)

_1_ Administrative

___ Architects

___ Chemical Engineers

___ Civil Engineers

___ Construction Inspectors

___ Draftsmen

___ Ecologists

___ Economists

___ Electrical Engineers

___ Estimators

___ Geologists

___ Hydrologists

___ Interior Designers

___ Landscape Architects

___ Mechanical Engineers

___ Mining Engineers

___ Oceanographers

___ Planners: Urban/Regional

___ Sanitary Engineers

___ Soils Engineers

___ Specification Writers

___ Structural Engineers

___ Surveyors

___ Transportation Engineers

__2 Environmental Engineer_

___ ________________________

9. Summary of Professional Services Fees

Received: (Insert index number) Last 5 Years (most recent year first)

Ranges of Professional Services Fees

INDEX

1. Less than $100,000

2. $100,000 to $250,000

3. $250,000 to $500,000

4. $500,000 to $1 million

5. $1 million to $2 million

6. $2 million to $5 million

7. $5 million to $10 million

8. $10 million or greater

Direct Federal contract work, including overseas

All other domestic work

All other foreign work *

1999

___N/A_____N/A_____N/A__

1999

___N/A______N/A___ __N/A__

1999

___N/A______N/A_____N/A__

1999

___N/A_____N/A_____N/A__

2003

___N/A______1______N/A_

*Firms interested in foreign work, but without such experience, check here: Xx

STANDARD FORM 254 PAGE 4 (REV. 11-92)

10. Profile of Firm’s Project Experience, Last 5 Years

Profile

Code

1) 021

2) 032

3) 033

4) 043

5) 054

6) 079

7) 089

8) 093

9) 114

10) 115

Number of

Projects

25+

Total Gross Fees

(in thousands)

N/A

Profile

Code

11) 201

12) 202

13) 203

14) 204

15)

16)

17)

18)

19)

20)

Number of

Projects

30+

40+

Total Gross Fees

(in thousands)

N/A

Profile

Code

21)

22)

23)

24)

25)

26)

27)

28)

29)

30)

Number of

Projects

Total Gross Fees

(in thousands)

11. Project Examples, Last 5 Years *N/A performed as in-house engineer for company

Profile

Code

“P,” “C,” “JV,” or “IE”

Project Name and Location

Owner Name and Address

Cost of Work

(in thousands)

Completion Date (Actual or Estimated)

032

021

1 Chiller Plant Upgrade
Upgrade of 2100 ton central HVAC chiller plant to primary secondary loop with pressure controlled VFD drive pumps on secondary loop system.

Baxter Healthcare, Cleveland MS

$155

05/03

032

2 Lighting Upgrade

Lighting system upgrade from T12 system to electronic ballast and T8, included costing, capital acquisition.

Baxter Healthcare, Cleveland MS

$35

08/01

033

3 Phase I Environmental Site Assessment
Phase I ESA for Yalobusha Economic Development Foundation for property transfer to new business enterprise

Yalobusha EDF

08/02

054

4 W Plant Evaluation/O&M Prep.

Wastewater treatment facility evaluation and operations recommendations, Process Control manual Development.

Itta Bena, MS

Confidential, Itta Bena, MS

8/03

054

079

5Biotower and odor control installation, 500,000gpd industrial wastewater treatment and biofilter type odor control

Frito-Lay, Charlotte, NC

$450

08/99

054

079

6 Wastewater Pretreatment Plant, Lubbock TX

Designed and project managed installation of pumps, screening, plate clarifier, and solids handling facility for snack, chip manufacturer

Frito-Lay, Lubbock TX

$300

03/00

058

079

021

7 Chem. Lab Phase III upgrade,

Included chemical storage room, hood room, balance room, and office space, completed while adjacent lab still in operation, Cleveland, MS

Baxter Healthcare, 911 N. Davis Street, Cleveland, MS

$45

08/00

STANDARD FORM 254 PAGE 5 (REV. 11-92)

058 079 021	IE	8 Bio/Micro-Laboratory Upgrade Installation of bio-containment hoods, lab renovation, cabinets, flooring, and utilities	Baxter Healthcare, 911 N. Davis Street, Cleveland, MS	$35	02/02
089 079	IE	9 Reroofing Projects (150,000 sqft) Replacement of conventional roofing with single ply membrane roofing for large manufacturing site.	Baxter Healthcare	$600	05/02
100 079 021 043	IE	10 Pharmaceutical Vial Filling Facility, Cleveland, MS Designed and project managed installation of filling suite for vial production including 6 clean rooms (to Class 100,000 with humidity control) and 2 areas of class 100 zones, designed all HVAC, surfaces, floors, pressure balanced using VFD on AHUs.	Baxter Healthcare, 911 N. Davis Street, Cleveland, MS	$450	10/01
100 079 021 043	IE	11 Coordinate Measurement Machine Cleanroom, Class 100,000 cleanroom designed and installed to meet +-1F change over 24 hr period.	Baxter Healthcare, 911 N. Davis Street, Cleveland, MS	$35	5/01
100 079 021 043	IE	12 Electron Beam Sterilization Room, Room designed for controlled access and climate control for e-beam medical equipment sterilizer.	Baxter Healthcare, 911 N. Davis Street, Cleveland, MS	$40	10/01
114 115 079	IE	13 Deep Well System Installation, Irving Tx 2200 ft deep well system installation for snack food manufacturer including well, storage, chlorination, and connection to in plant supply piping	Frito-Lay, Inc. Irving Texas	$1,200	01/00
114 115 079	IE	14 Well System Installation, Modesto, CA Well system installation for snack food manufacturer including well, storage, chlorination and connection to in-plant supply piping.	Frito-;Lay, Modesto, CA	$450	12/99
114 115 079	IE	15 Well System Installation, Charlotte, NC Well system installation for snack food manufacturer including well, storage, chlorination and connection to in-plant supply piping	Frito-Lay, Charlotte, NC	$550	02/00
201	IE	16 Environmental Audits (30+ as lead auditor) Lead auditor for compliance/program audits to determine compliance with local, state, EPA, and company environmental policies including transportation facilities and UST sites.	Frito-Lay Facilities, US and Canada	$250	N/A
202	IE	17Corporate Wide Pollution Prevention Program, USA-Canada Development of corporate P2 program for major snack food company including energy/resource conservation.	Frito-Lay Corporate, Plano, TX	$100	06/98
203	IE	18 ISO14001 Program Development Developed policies, procedures, and training for implementation of ISO14001 Environmental Management System including SOPs for a large manufacturing facility.	Borg Warner Corp. Water Valley , MS	$50	10/02

STANDARD FORM 254 PAGE 6 (REV. 11-92)

203	IE	19 Underground Storage Tank Program Management (40+ sites) Managed site assessments, remedial planning and remediation for corporate UST program for major snack food company.	Frito-Lay Facilities, US	$500/yr	N/A
204	IE	20 SPCC Plan Preparation Completed SPCC plan and upgrade recommendations for large manufacturing facility.	Baxter Healthcare, Cleveland MS	$3	03/03
204	IE	21 RCRA Contingency Plan Preparation Completed RCRA Contingency Plan for large manufacturing facility that is intermittent LQG.	Baxter Healthcare, Cleveland MS	$3	03/03








12. The foregoing is a statement of facts Signature: ________________________________________________ Typed Name and Title: _Pierce Epes, P.E., Principal/Owner				Date:

*U.S. GPO: 1993-351-246 STANDARD FORM 254 PAGE 7 (REV. 11-92)