OMB Number 2900-0208 Estimated Burden: 4 hours
ARCHITECT - ENGINEER FEE PROPOSAL
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork ReductionAct f 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 4 hours. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. This form or other agreed upon format, is used by VA Resident Engineers to supervise your work and verify the work progression so that you may be paid.
ESTIMATED NUMBER OF CONTRACT DRAWINGS
DESCRIPTION ARCHITECTURAL SITE AND LANDSCAPING STRUCTURAL AND BORINGS
SAN ITARY
PLUM BING
DATE OF PROPOSAL
A/E
VA
PROJ ECT
HEATING AND AIR CONDITIONING
ELECTRICA L
NAME OF ARCHITECT/ ENGINEER
TOTAL NUMBER OF DRAWINGS
PART I - PREPARATIONOF CONTRACT DRAWINGS AND SPECIFICATIONS
LINE
NO. 1A 1B 1C 1D 1E 1F 1G 1H 1I
A. SALARY COSTS
EM PLOYEE HOURS
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
ARCHITECTURAL
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
$
$
$
SUB-TOTAL SITE AND LANDSCAPING
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
2A 2B 2C 2D 2E 2F 2G 2H 2I
SUB-TOTAL STRUCTURAL AND BORINGS
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
3A 3B 3C 3D 3E 3F 3G 3H 3I
SUB-TOTAL SANITARY
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
4A 4B 4C 4D 4E 4F 4G 4H 4I
VA FORM JAN 1999 (R)
SUB-TOTAL
10-6298
PA GE 1 OF 9
PART I - PREPARATIONOF CONTRACT DRAWINGS AND SPECIFICATIONS (Continued)
LINE
NO. 5A 5B 5C
5D 5E 5F 5G 5H
A. SALARY COSTS
EM PLOY EEHOURS
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
PLUMBING
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
$
$
$
5I HEATING AND AIR CONDITIONING 6A 6B 6C 6D
6E 6F 6G 6H
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
SUB-TOTAL
6I ELECTRICAL
7A
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
SUB-TOTAL
7B 7C 7D 7E
7F 7G 7H 8A
SUB-TOTAL
8B 8C
8D 8E 8F 8G 8H
8I
9A
SUB-TOTAL
9B 9C 9D
9E 9F 9G 9H
9I 10
DESIGN REVIEW TRIPS
SUB-TOTAL TOTAL SALARY COSTS
B. MISCELLANEOUS SALARY COSTS
EM PLOY EE-DAYS EM PLOY EE-HOURS
11A 11B 11C 11D 11E
NO. REQUIRED
SUPERVISORS
# DAYS
# PERS. REQUIRED
A/E
VA
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
DESIGNERS DRAFTERS
SPEC. WRITERS
VA FORM JAN 1999 (R)
10-6298
PA GE 2 OF 9
B. MISCELLANEOUS SALARY COSTS (Continued)
LINE
NO. 11F 11G 11H 12A 12B 12C 12D 12E 12F 13A 13B 13C 13D 13E 13F 14A 14B 14C 14D 14E 14F 14G 14H 15 16 17 18 19
DESIGN REVIEW TRIPS
NO. REQUIRED #DAYS # ERS. REQUIRED
EM PLOY EE-DAYS
EM PLOY EE-HOURS
A/E
VA
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
$
SUB-TOTAL
DESIGN STAFF SITE TRIPS
NO. REQUIRED
SUPERVISORS
$
$
DESIGNERS
SUB-TOTAL
PRE-BID(CPM) CONFERENCE
NO. REQUIRED
SUPERVISORS
DESIGNERS
SUB-TOTAL
ANSWERING INQ. & ISSUING AMENDMENTS
SUPERVISORS
DESIGNERS DRAFTERS
SPEC. W RITERS
TYPISTS
SUB-TOTAL
TOTAL MISCELLANEOUSSALARY COSTS TOTAL SALARY COSTS - (Lines 10 + 15)
OVERHEAD:
PROFIT
% OF LINE 16
TOTAL SALARY PROPOSALS- (Lines 16 + 17
C. INCIDENTAL COSTS
LINE
DESIGN REVIEW TRIPS
NO. REQUIRED
FIRST
EM P. TRIPS
TRAVEL COSTS
EM P. DAYS
PER DIEM
COSTS
NO.
#DAYS
# ERS. REQUIRED
A/E
VA
A/E
VA
A/E
VA
A/E
VA
A/E
VA
20A 20B 20C 20D 20E 20F 20G 21A 21B 21C 21D 21E 21F 22A 22B 22C 22D 22E 22F
$
$
$
$
$
$
SECOND
THIRD
FOURTH
SUB-TOTAL
DESIGN STAFF SITE TRIPS
NO. REQUIRED
SUPERVISORS
DESIGNERS
SUB-TOTAL
PRE-BID(CPM) CONFERENCE
NO. REQUIRED
SUPERVISORS
DESIGNERS
SUB-TOTAL
VA FORM JAN 1999 (R)
10-6298
PA GE 3 OF 9
C. INCIDENTAL COSTS (Continued)
LINE
EM P. TRIPS
TRAVEL COSTS
EM P. DAYS
PER DIEM
COSTS
NO.
A/E
VA
A/E
VA
A/E
VA
A/E
VA
A/E
VA
23A 23B 23C 23D 23E 23F 24A 24B 24C 24D 24E 24F 25A 25B 25C 25D 25E 25F 26A 26B 26C 26D 26E 26F
NO. REQUIRED
$
$
$
$
$
$
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
REPRODUCTION OF REVIEW MATERIAL
SUB-TOTAL
RENDERING(PERSPECTIVES)
27A 27B 27C 27D 27E 27F 28A 28B 28C 28D 28E 28F 29A 29B 29C 29D 29E 29F 30 31 SUB-TOTAL TOTAL INCIDENTAL COSTS *TOTAL PROPOSAL (LINE 19 + LINE 30) SUB-TOTAL SUB-TOTAL
$ $
$ $
*NOTE: This part of the fee is that which falls within the 6% limitation. See VAAR Section 836.606-73 for definitive information.
REMARKS
VA FORM JAN 1999 (R)
10-6298
PA GE 4 OF 9
PART II - CONSTRUCTION PERIOD SERVICES
LINE
NO.
A. SHOP DRAWINGS, SUBMITTALS, ETC.,
EM PLOY EE-HOURS
SALARY COSTS
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
ARCHITECTURAL 32A 32B 32C 32D 32E 32F 32G 32H SITE AND LANDSCAPING 33A 33B 33C 33D 33E 33F 33G 33H STRUCTURAL AND BORINGS 34A 34B 34C 34D 34E 34F 34G SANITARY 35A 35B 35C 35D 35E 35F 35G PLUMBING 36A 36B 36C 36D 36E 36F 36G HEATING AND AIRCONDITIONING 37A 37B 37C 37D 37E 37F 37G ELECTRICAL 38A 38B 38C 38D 38E 38F 38G
VA FORM JAN 1999 (R) SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS TYPISTS ESTIMATORS
$
$
$
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
10-6298
PA GE 5 OF 9
PART II - CONSTRUCTION PERIOD SERVICES
LINE
NO.
A. SHOP DRAWINGS, SUBMITTALS, ETC.,
SALARY COSTS (Continued)
EM PLOY EE-HOURS
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
39A 39B 39C 39D 39E 39F 39G 40A 40B 40C 40D 40E 40F 40G 41
LINE
$
$
$
SUB-TOTAL
SUB-TOTAL TOTAL SALARY COSTS
B. RECORD (AS BUILT) DRAWINGS AND SPECIFICATIONS
EM PLOY EE-HOURS
NO.
SALARY COSTS
A/E
VA
HOURLY SALARIES
COSTS
ARCHITECTURAL 42A 42B 42C 42D 42E 42F 42G SITE AND LANDSCAPING 43A 43B 43C 43D 43E 43F 43G STRUCTURAL AND BORINGS 44A 44B 44C 44D 44E 44F 44G SANITARY 45A 45B 45C 45D 45E 45F 45G PLUMBING 46A 46B 46C 46D 46E 46F
VA FORM JAN 1999 (R) SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS
$
$
A/E
$
VA
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
SUB-TOTAL
10-6298
PA GE 6 OF 9
PART II - CONSTRUCTION PERIOD SERVICES
LINE
NO.
B. RECORD (AS BUILT )DRAWINGS
SALARY COSTS (Continued)
AND SPECIFICATIONS
EM PLOY EE-HOURS
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
HEATING AND AIR CONDITIONING 47A 47B 47C 47D 47E 47F 47G ELECTRICAL 48A 48B 48C 48D 48E 48F SUB-TOTAL 49A 49B 49C 49D 49E 49F 50A 50B 50C 50D 50E 50F 51 52 53 54 55 C. INCIDENTAL COSTS 56A 56B 56C 56D 56E 57A 57B 57C 57D 57E 58A 58B 58C 58D 58E 59 60 REMARKS SUB-TOTAL TOTAL TRAVEL COSTS TOTAL PROPOSAL (Lines 55 + 59) SUB-TOTAL SUB-TOTAL
EM P. TRIPS
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS
$
$
$
SUB-TOTAL
SUPERVISORS DESIGNERS DRAFTERS SPECIFICATION WRITERS
SUB-TOTAL
SUB-TOTAL TOTAL SALARY COSTS TOTAL SALARY COSTS (Lines 41 + 51) OVERHEAD PROFIT TOTAL LABOR PROPOSAL (Lines 52 + 53 + 54)
TRAVEL COSTS
EM P. DAYS
PER DIEM
COSTS
A/E
VA
A/E
VA
A/E
VA
A/E
VA
A/E
VA
$
$
$
$
$
$
VA FORM JAN 1999 (R)
10-6298
PA GE 7 OF 9
PART III - SITE V ISITS
LINE
A. SALARY COSTS
PRE-CONSTRUCTION CONFERENCE
NO. VISITS NO. DAYS EMP. PERDAY
EM PLOYEE TR IPS
TOTAL HOURS
NO.
A/E
VA
A/E
VA
HOURLY SALARIES
COSTS
A/E
VA
61A 61B
SITE V ISITS
NO. VISITS ONE EMPLOYEE -DAY EACH
INTERMEDIATE A/ C INSPECTIONS
61C
NO. INSP.
NO. DAY EACH
EMP. PER DAY
FINAL INSPECT ION
61D
NO. DAYS
EMPLOYEESPERDAY
61E
61F 62 63 64 65 A. TRAVEL COSTS
PRE-CONSTRUCTION CONFERENCE EM P. TRIPS
SALARY COSTS: OVERHEAD
SITE VISITS % OF LINE 62 PROFIT
PER DIEM
TOTAL SALARY COSTS (Lines 62 + 63 + 64)
TRAVEL COSTS
EM P. DAYS
COSTS
A/E
VA
A/E
VA
A/E
VA
A/E
VA
A/E
VA
66A
NO. VISITS
NO. DAYS
EMP. PERDAY
SITE V ISITS
66B
NO. VISITS, ONE EMPLOYEE-DAY EACH
INTERMEDIATE A/ C INSPECTIONS
66C
NO. INSP.
NO. DAY EACH
EMP. PER DAY
FINAL INSPECT ION
66D
NO. DAYS
EMPLOYEESPERDAY
66E
66F 67 68 69 70 71 72 TOTAL TRAVEL COSTS SITE VISITS (Lines 65 + 67)
TOTAL PROPOSAL FOR *PART I - CONTRACT DRAWINGS AND SPECIFICATIONS (Line 31) PART II - CONSTRUCTION PERIOD DUTIES (Line 60) PART III - SITE VISITS, AT $ PER VISIT FOR A MAXIMUM OF: (Line 68) TOTAL A/E PROPOSAL (Lines 31 + 60 + 68)
PART IV - CAPITULATION OF A/E PROPOSALS
$ $ $ $
$ $ $ $
*NOTE: This part of the fee is that which falls within the 6% limitation. See VAAR Section 836.606-73 for definitive information. PART V - CERTIF ICAT I ONS
CERTIFICATION OF CURRENT COST OR PRICING DATA This is to certify that, to the best of my knowledge and belief, the cost or pricing data (as defined in section 15.801 of the Federal Acquisition Regulation (FAR) and required under FAR subsection 15.804-2 submitted, either actually or by specific identification in writing to the contracting officer or to the contracting officer's representative in support of ..... areaccurate, complete,andcurrent s of..... . Thiscertificationincludesthe cost or pricingdata supportingany advanceagreements etween he offeror andthe Government that are part of the proposal.
Firm
Name
Tit le Date of Execution
Signat ure
VA FORM JAN 1999 (R)
10-6298
PA GE 8 OF 9
NOTE: The Architect-Engineer shall check the certification below which is applicable to their enterpri se, and if required, provide the necessary substantiat ing informat ion.
CERTIFICATION OF CONCURRENTSUBMISSION OF DISCLOSURE STATEMENTS
The offeror hereby certifies submission, as part of the proposal under this solicitation, copies of the Disclosure Statements as follows: (i) Original and one copy to the cognizant Contracting Officer; (ii)one copy to the cognizant contract auditor; and (iii) one copy to the Cost Accounting Standards Board, 441 G.Street, NW, Washington, DC 20548
DATE OF DISCLOSURE STATEMENT
NAME AND ADDRESS OF COGNIZANT CONTRACTING OFFICERSWHERE FILED
The offeror further certifies that practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices in the Disclosure Statements. CERTIFICATION OF MONETARY EXEMPTION
The offeror hereby certifies that, together with all divisions, subsidiaries, and affiliates under common control, they did not (1) receive a single CAS-covered contract award if $10 million or more; (2) Receive $10 million or more in CAS-covered contract awards during its preceding accounting period; (3) Receive less than $10 million in CAS-covered contract awards during its preceding cost accounting period but such awards were 10 percent or more of total sales.
CERTIFICATION OF PREVIOUSLY SUBMITTED DISCLOSURE STATEMENTS The offeror hereby certifies that the Disclosure Statements were filed as follows: DATE OF DISCLOSURE STATEMENT NAME AND ADDRESS OF COGNIZANT CONTRACTING OFFICERSWHERE FILED
The offeror hereby certifies that practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in this Disclosure Statement
CONCUR - SIGNA TURE A ND TYPED NA M E OF A RCHITECT - ENGINEER
DATE
CONCUR - SIGNA TURE A ND TYPED NA M E OF A RCHITECT - ENGINEER
DATE
CONCUR - SIGNA TURE A ND TYPED NA M E OF A RCHITECT - ENGINEER
DATE
CONCUR - SIGNA TURE A ND TYPED NA M E OF A RCHITECT - ENGINEER
DATE
CONCUR - SIGNATURE AND TYPED NAME OF CONTRACTING OFFICER
DATE
VA FORM JAN 1999 (R)
DISTRIBUTION:(082A)-CC:
AEand ProposedFile /
PA GE 9 OF 9
10-6298