Section 740.APPENDIX B   Review and Evaluation Licensed Professional Engineer Information

•           Firm name.

•           Address.

•           Telephone/fax.

•           Principal officials and titles.

•           Number of full-time employees.

•           Business structure (corporation, partnership, LLP, LLC, PSC).

•           Licensed by Secretary of State? #___________

•           Licensed by Dept. of Professional Regulation? #___________

•           Name of Illinois Registered Managing Agent.

            Names of insurance carriers and amount of coverage:

Worker's Compensation:_____________________________________________

General Liability:___________________________________________________

Professional Liability:________________________________________________

•           Does the stated professional liability policy include coverage for "environmental" claims related to release of pollutants?  If not covered, or covered by a different carrier or in a different amount, so state.

•           Has the firm or owners ever filed bankruptcy?  If "yes," state when and explain.

•           Is the firm an outgrowth, result, continuation or reorganization of a former business?  If "yes," explain background.

•           List RELPEs and other key full-time employees that will participate on this project with the RELPE.  Provide resumes for each, including Illinois P.E. License #, certifications, project role, years of experience in related work and education.

•           List five projects similar in nature and identify the role of the RELPE.

•           Are employees to be assigned to the project in compliance with 29 CFR 1910.120 (HAZWOPER training and medical surveillance) as applicable to their role on the project?