For Architecture, Engineering, Land Surveyor and Landscape Architecture firms with annual gross billings of up to $5,000,000 you may fill out this application for an indication.  For all other professions or firms above $5,000,000 in billings please contact our office to complete an application.

Total Gross Billings
Most recently completed fiscal year	$
Second year prior	$
Third year prior	$
Are greater than 10% of your billings attributable to:
Asbestos Services	Yes No
Condominium Design	Yes No
Design/Build	Yes No
Mold Services	Yes No
Product Design	Yes No
Is your firm owned by or do you own another entity which provides construction related services?
Yes  No
Explanation to any "Yes" answers:
Disciplines and Project types
Please indicate the percentage of the following disciplines in which the Applicant is engaged (total must equal 100%)
% Architecture	% HVAC Engineering
% Civil Engineering	% Land Surveying
% Construction Management	% Mechanical Engineering
% Electrical Engineering	% Sanitary Engineering
% Environmental Engineering	% Structural Engineering
% Forensic Engineering	% Transportation Engineering
% Geotechnical Engineering	% Landscape Architecture
% Other (describe)	% Other (describe)
Please indicate the percentages of billings derived from each project type.
% Apartments	% Jails/Justice
% Bridges	% Manufacturing
% Chemical/Petro Chemical	% Office Buildings
% Churches/Religious	% Parking Structures
% Commercial Buildings	% Schools/Colleges
% Condominiums	% Shopping Centers/Retail
% Convention Centers	% Storm Water Systems
% Custom Homes	% Tract Homes
% Dams	% Transportation
% Hospitals/Healthcare	% Tunnels
% Hotels/Motels	% Utilities
% Industrial Buildings	% Wastewater Treatment Plants
% Industrial Waste Treatment	% Other
In the past 10 years have any claims, suits, demands been made against the firm, its predecessor or any past or present Principles?  Yes  No
If yes, how many?
Total amounts paid or in reserve?	$
Risk Management
Does your firm:
1. Use written in-house quality control procedures?	Yes  No
2. Have an automated master specification system?	Yes  No
3. Have an in-house program for continuing education?	Yes  No
4. Have a TQM program?	Yes  No
5. Participate in an Organizational Peer Review?	Yes  No
Number of employees who have had at least six hours of continuing education in the past 12 months:
Does your firm:
1.  Use limitation of liability provisions in contracts?	Yes  No
2.  Use some form of written contract on every project?	Yes  No
If no, please list the percentages of your firm's services rendered under verbal contracts:  %
Please list the percentage of your firm's services rendered under AIA or EJCDC standard forms of agreement:  %
What is the percentage of your firm's total gross billings that were for subcontracted services?  %
Do you obtain certificates of professional liability insurance from your sub-contractors?	Yes  No
For Surveyors Only
Are all registered land surveyors members of ACSM?	Yes  No
Services percentages breakdown should total 100%:
% Subdivision Work, Topograhic, Construction Stakeout, Hydrographic
% Engineering Services
% All Other Services