Illinois Administrative Code
Title 35 - ENVIRONMENTAL PROTECTION
Part 740 - SITE REMEDIATION PROGRAM
Subpart I - REVIEW OF REMEDIATION COSTS FOR BROWNFIELDS SITE RESTORATION PROGRAM
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?