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City of Sunny Isles Beach |Request for Qualifications No. 18-08-01 27 <br />PROJECT VERIFICATION FORM <br />Proposer shall have provided Underground Consultation Services for at least three (3) Projects over the <br />past five (5) years of similar size, nature and complexity with a construction amount exceeding <br />$1,000,000 and provide evidence using the spaces below. <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 />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 />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 />Contract Amount: $__________________________________________________ <br />END OF SECTION <br />City of Holly Hill <br />1065 Ridgewood Avenue <br />Holly Hill, Florida 32117 <br />Walt Smyser <br />Public Works Deputy Director <br />wsmyser@hollyhillfl.org <br />386-248-9463 <br />Utility coordination and conversion <br />2015 - Ongoing <br />Construction cost: $2.9 million (est); Fees: $138,600 <br />City of South Daytona <br />1770 Seagrave Street <br />South Daytona, Florida 32119 <br />Les Gillis <br />Public Works Director <br />lgillis@southdaytona.org <br />386-322-3080 <br />Utility coordination and relocation <br />Construction cost: $4.5 million; Fees: $453,000 <br />City of North Myrtle Beach <br />1018 Second Avenue South <br />North Myrtle Beach, South Carolina 29582 <br />Kevin Blayton, PE <br />Director of Public Works/City Engineer <br />kdblayton@nmb.us <br />843-280-5538 <br />Utility coordination and conversion <br />2017 - 2018 <br />Construction cost: $1.6 million; Fees: $99,500 <br />2004 - 2013