"State Agency a/E Agreement Checklist" - Ohio

State Agency a/E Agreement Checklist is a legal document that was released by the Ohio Attorney General - a government authority operating within Ohio.

Form Details:

  • Released on September 6, 2012;
  • The latest edition currently provided by the Ohio Attorney General;
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Download "State Agency a/E Agreement Checklist" - Ohio

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STATE AGENCY
A/E AGREEMENT CHECKLIST (REVISED SEPTEMBER 6, 2012)
DATE:
AGENCY:
PROJECT NO.:
COORDINATOR:
E-MAIL:
PHONE:
A/E:
(
/
/
/
)
NAME
CITY
STATE
ZIP
PROJECT DESCRIPTION:
CONTRACT PROVISIONS:
Total Project Cost:
$
Total A/E Fee:
$
A/E Fee for Basic Services: $
DOCUMENTS & CERTIFICATES:
Purchase Order Amount(s):
$
Controlling Board Release:
$
Date:
N/A
Workers’ Compensation Certificate:
Date Expires:
R.C. 9.24 Verification Check:
Date:
EDGE Participation:
______ Yes
Good Faith Waiver
CONTRACT AWARD:
Were standard contract forms modified?
Yes
If yes, include
(added or deleted language)
No
explanation.
STATE AGENCY
A/E AGREEMENT CHECKLIST (REVISED SEPTEMBER 6, 2012)
DATE:
AGENCY:
PROJECT NO.:
COORDINATOR:
E-MAIL:
PHONE:
A/E:
(
/
/
/
)
NAME
CITY
STATE
ZIP
PROJECT DESCRIPTION:
CONTRACT PROVISIONS:
Total Project Cost:
$
Total A/E Fee:
$
A/E Fee for Basic Services: $
DOCUMENTS & CERTIFICATES:
Purchase Order Amount(s):
$
Controlling Board Release:
$
Date:
N/A
Workers’ Compensation Certificate:
Date Expires:
R.C. 9.24 Verification Check:
Date:
EDGE Participation:
______ Yes
Good Faith Waiver
CONTRACT AWARD:
Were standard contract forms modified?
Yes
If yes, include
(added or deleted language)
No
explanation.
AGENCY A/E AGREEMENT CHECKLIST (cont’d)
If total A/E fee exceeds $50,000,
number of firms shortlisted and
interviewed:
If less than three, include explanation.
If total A/E fee is less than $50,000,
was the A/E selection process in Ohio
Revised Code Section 153.71
followed?
(See http://codes.ohio.gov/orc/153.71;
for questions, please contact Business
Counsel.)
Yes
No If no, include explanation.
SUBMITTED BY:
Date:
(
)
SIGNATURE OF PROJECT COORDINATOR
APPROVED BY ATTORNEY
GENERAL:
Date:
When submitting an A/E Agreement for Attorney General approval,
please also submit copies of the following:
□ Secretary of State website printout showing the A/E’s name;
□ Purchase Order;
□ Unexpired BWC Certificate;
□ Approved Controlling Board request (when applicable);
□ 9.24 Search printout, initialed by the Project Coordinator; and
□ Relevant exhibits to the A/E Agreement. ATTACH EXHIBIT E, AND EXHIBITS
B AND C IF THEY CONTAIN ANY CHANGES TO THE TERMS AND
CONDITIONS.
Once fully executed, the Attorney General’s Office should return the A/E
Agreement and checklist to:
The Project Coordinator listed above.
The individual(s) listed on cover correspondence accompanying this checklist.
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