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(b) Page 2 of Standard Form.

. CATEGORY

OUTSIDE ASSOCIATES AND CONSULTANTS USUALLY EMPLOYED BY YOUR FIRM (Furnish a separate completed questionnaire for each firm or individual listed below but see note c, page 9) B. NAME OF FIRM OR INDIVIDUAL AND ADDRESS

a. CATEGORY

b. NAME OF FIRM OR INDIVIDUAL AND ADDRESS

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14. INDICATE THE SCOPE OF SERVICES PROVIDED BY YOUR FIRM WITHOUT USE OF OUTSIDE ASSOCIATES OR CONSULTANTS ON TYPES OF PROJECTS INDICATED IN ITEM 13 (i.e. Architec tural, Mechanical, Electrical, Structural, etc.)

STANDARD FORM 251

JUNE 1961

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16.

PRESENT ACTIVITIES ON WHICH YOUR FIRM IS DESIGNATED ARCHITECT OR ENGINEER OF RECORD

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(e) Page 5 of Standard Form.

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PRESENT ACTIVITIES ON WHICH YOUR FIRM IS ASSOCIATED WITH OTHERS (Indicate phase of work for which your firm is responsible)

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(f) Page 6 of Standard Form.

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LOCATION

SPECIMEN

FIRM
ASSOCIATED
WITH

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