Form TC40-1 "Consulting Engineer and Related Services Prequalification Application" - Kentucky

What Is Form TC40-1?

This is a legal form that was released by the Kentucky Transportation Cabinet - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Kentucky Transportation Cabinet;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TC40-1 by clicking the link below or browse more documents and templates provided by the Kentucky Transportation Cabinet.

ADVERTISEMENT
ADVERTISEMENT

Download Form TC40-1 "Consulting Engineer and Related Services Prequalification Application" - Kentucky

Download PDF

Fill PDF online

Rate (4.4 / 5) 92 votes
Page background image
KENTUCKY TRANSPORTATION CABINET
TC 40-1
Division of Professional Services
Mar. 2022
CONSULTING ENGINEER AND RELATED SERVICES
Page 1 of 18
PREQUALIFICATION APPLICATION
NAME OF FIRM:
DATE:
STATE:
YEAR ESTABLISHED:
MAIN OFFICE:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
KENTUCKY BRANCH OFFICE #1:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
KENTUCKY BRANCH OFFICE #2:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
CHECK THE PREFERRED MAILING ADDRESS:
Main Office
Kentucky Branch Office #1
Kentucky Branch Office #2
WEB SITE ADDRESS:
E-MAIL ADDRESS:
FAX NUMBER:
This application is based on the following factors: (Check appropriate designation)
CERTIFIED DBE
TOTAL EMPLOYEES
ORGANIZATION
TYPE OF APPLICATION
IN KENTUCKY
IN FIRM
Individual
New
Yes
Minority Female
Partnership
Updated
No
Minority Male
(If yes, attach a copy of
Corporation
Reinstatement
Non-Minority Female
KYTC certification letter.)
Professional Limited
Total Employees in Firm
Liability Company
Total Employees in
Kentucky Offices
Total PE’s in Kentucky
Offices
Federal Indentification Number:
Is firm licensed with Kentucky State Board of Licensure for Professional Engineers and Land Surveyors?
Yes
No
License Number:
I certify the information contained within this application is accurate. SUBMISSION OF FALSE INFORMATION IS
CAUSE FOR DENIAL OF PREQUALIFICATION WITH THE KENTUCKY TRANSPORTATION CABINET.
Name of Firm or Individual Submitting Application:
Signature:
Name of Person Signing:
Title of Person Signing:
Date:
KENTUCKY TRANSPORTATION CABINET
TC 40-1
Division of Professional Services
Mar. 2022
CONSULTING ENGINEER AND RELATED SERVICES
Page 1 of 18
PREQUALIFICATION APPLICATION
NAME OF FIRM:
DATE:
STATE:
YEAR ESTABLISHED:
MAIN OFFICE:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
KENTUCKY BRANCH OFFICE #1:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
KENTUCKY BRANCH OFFICE #2:
TELEPHONE NUMBER:
Street:
City:
State:
Zip:
CHECK THE PREFERRED MAILING ADDRESS:
Main Office
Kentucky Branch Office #1
Kentucky Branch Office #2
WEB SITE ADDRESS:
E-MAIL ADDRESS:
FAX NUMBER:
This application is based on the following factors: (Check appropriate designation)
CERTIFIED DBE
TOTAL EMPLOYEES
ORGANIZATION
TYPE OF APPLICATION
IN KENTUCKY
IN FIRM
Individual
New
Yes
Minority Female
Partnership
Updated
No
Minority Male
(If yes, attach a copy of
Corporation
Reinstatement
Non-Minority Female
KYTC certification letter.)
Professional Limited
Total Employees in Firm
Liability Company
Total Employees in
Kentucky Offices
Total PE’s in Kentucky
Offices
Federal Indentification Number:
Is firm licensed with Kentucky State Board of Licensure for Professional Engineers and Land Surveyors?
Yes
No
License Number:
I certify the information contained within this application is accurate. SUBMISSION OF FALSE INFORMATION IS
CAUSE FOR DENIAL OF PREQUALIFICATION WITH THE KENTUCKY TRANSPORTATION CABINET.
Name of Firm or Individual Submitting Application:
Signature:
Name of Person Signing:
Title of Person Signing:
Date:
TC 40-1 Rev Mar. 2022 Page 2 of 18
Name of Firm:
Date:
INDICATE TYPES OF PROJECTS FOR WHICH YOUR FIRM REQUESTS PREQUALIFICATION
ROADWAY DESIGN
RIGHT OF WAY SERVICES
Rural Roadway Design
Acquisition
Urban Roadway Design
Relocation
Surveying
Appraisal
Photogrammetry & Related Services
Appraisal Review
Advanced Traffic Engineering Design & Modeling
Advanced Drainage & Design
MAINTENANCE / BRIDGE MAINTENANCE SERVICES
Value Engineering
In-depth Structure Inspection
E-Plan Room
Underwater Structure Inspection
Tunnel Inspection
Landscaping Arboriculture
UTILITY DESIGN
Communication
AVIATION
Electrical Level 1
Airport Master Planning
Electrical Level 2
Airport Design
Gas Level 1
Airport Noise Analysis
Gas Level 2
Aviation Project Inspection
Water & Sewer Level 1
Water & Sewer Level 2
ENVIRONMENTAL AQUATIC & TERRESTRIAL
Petroleum
ECOSYSTEMS ANALYSIS
Utility Preconstruction Coordination
Fisheries
Utility Construction Inspection
Freshwater Macroinvertebrates
STRUCTURE DESIGN
Water Quality
Spans Under 500 Feet
Botany
Spans Greater Than 500 Feet
Terrestrial Zoology
Wetlands
GEOTECHNICAL SERVICES
Geotechnical Drilling
ENVIRONMENTAL ARCHAEOLOGY & OTHER
Geotechnical Engineering
SERVICES
Geotechnical Laboratory Testing
Prehistoric Archaeology
Historic Archaeology
TRAFFIC OPERATIONS
Highway Noise Analysis
Traffic Engineering
Air Quality Analysis
Stream & Wetland Mitigation
Electrical Engineering Traffic Signals
Electrical Engineering Roadway Lighting
Socio-Economic Analysis
Cultural-Historic Analysis
Environmental Document Writing & Coordination
TRANSPORTATION PLANNING
Transportation Planning Engineering
Advanced Transportation Planning Engineering
ENVIRONMENTAL & UST SERVICES
Road Centerline Data Collection
UST & Hazmat Preliminary Site Assessment (Phase I)
Traffic Data Collection
UST Closure Assessment
Traffic Forecasting
UST Site Investigation (Phase II)
Travel Demand & Simulation Modeling
UST Corrective Action
Pedestrian & Bicycle Facility Planning & Design
Hazmat Site Investigation (Phase II)
Conceptual Transportation Planning
Hazmat Corrective Action
CONSTRUCTION ENGINEERING SERVICES
INTELLIGENT TRANSPORTATION SYSTEMS
Construction Project Supervision
Architecture Development
Bridge Painting Project Inspection
System Design, Deployment & Integration
Bridge Painting Project Management
System Maintenance, Management & Operations
Structural Steel Fabrication Inspection
Technology / System Evaluation
Construction Scheduling / Claims Analysis
TRANSPORTATION DELIVERY SYSTEMS
Transit Technical Studies
Transit Management
Transit Marketing / Advertising
TC 40-1 Rev Mar. 2022 Page 3 of 18
Name of Firm:
Date:
TOTAL NUMBER OF FULL-TIME PERSONNEL IN YOUR ORGANIZATION
INCLUDING KEY PERSONNEL
KENTUCKY
OFFICES IN
PRIMARY FUNCTIONAL CLASSIFICATION
TOTAL
OFFICES
OTHER STATES
0
Structural Engineers
0
Highway Design Engineers
0
Surveyors (PLS’s)
0
Certified Photogramitrists
0
Transportation Planning Engineers
0
Licensed Landscape Architects
0
EIT’s
0
Geotechnical Engineers
0
Construction Engineers
0
Environmental Engineers
0
Traffic Engineers
0
NBIS Team Leaders
0
Certified Diver / Civil Engineer (PE)
0
NTIS Team Leaders
0
Technologist / Technician
0
Planners
0
Draftsman
0
CADD Operators
0
Geotechnical Technicians
Drillers
0
TC 40-1 Rev Mar. 2022 Page 4 of 18
Name of Firm:
Date:
TOTAL NUMBER OF FULL-TIME PERSONNEL IN YOUR ORGANIZATION
INCLUDING KEY PERSONNEL
KENTUCKY
OFFICES IN
PRIMARY FUNCTIONAL CLASSIFICATION
TOTAL
OFFICES
OTHER STATES
0
Construction Inspectors
0
Geologists
0
Architects
0
Archaeologists
0
Socio-Economic Specialists
0
Noise Specialists
0
Air Quality Specialists
0
Historians
0
Terrestrial Ecosystem Specialists
0
Aquatic Ecosystem Specialists
0
Hazardous Waste / UST Specialists
0
EIS / Technical Writers
0
Mechanical Engineers
0
Electrical Engineers
0
Certified Welding Inspectors (AWS QCI CWI)
0
Non-Destructive Testing Inspector of Welds
0
Right of Way Project Managers
0
Right of Way Buying Agents
0
Right of Way Relocation Agents
0
Independent Fee Buyers
Drainage Design Engineers
0
0
Other (Please List)
TC 40-1 Rev Mar. 2022 Page 5 of 18
Name of Firm:
Date:
OWNERS AND OFFICERS OF FIRM (include title):
Key Personnel of Firm:
(Names and years of experience of full time employees only)
Highway Design Engineers (indicate specialty):
A.
L.
UST / Hazmat Specialists:
B.
Structural Engineers:
M.
Landscape Architects:
C.
Transportation Planning Engineers:
N.
EIS Writers:
D.
Traffic Engineers:
O.
Historians:
E.
Surveyors:
P.
Socio-Economic Specialists:
F.
Planners (indicate specialty):
Q.
Air Quality Experts:
G.
Construction Engineers:
R.
Noise Specialists
H.
Electrical Engineers (indicate specialty):
S.
Aquatic Ecosystem Specialists
1. Fisheries
2. Macroinvertebrates
3. Water Quality
I.
Environmental Engineers:
T.
Terrestrial Ecosystem Specialists
1. Botany
2. Zoology
3. Wetlands
J.
Geotechnical:
U.
Archaeologists
1. Prehistoric
2. Historic
K.
Geologists:
V. Right of Way Project Managers:
Page of 18