Employee General Information

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Quest.doc

1 March 2019

The numbers at the end of each line/area in parenthesis preceded by either an "A" or an "N", indicate the

alpha or numeric character space allowed in that field. Do not exceed the limits of our database.

Employee General Information

Firm Sequence Number (if unknown, leave blank)____________________________ (A8)

Firm Name __________________________________________________________ (A120)

Employee Sequence Number (if unknown, leave blank)_________________________(A8)

Employee Name __ ____________________________________________________ (A30)

Last First Middle

Personnel Number____________ (N15) (Sequential order of employees being entered beginning with 01, 02, 03, etc or any number you assign.)

Employee Branch Number _______________ (N2) (Enter 00 if the employee works in the main office. Enter 01, 02, etc., indicating the branch office number

where the employee works.)

Employee Expertise (Engineer, Surveyor, Planner, Architect, Landscape Architect, Technician or

Scientist) ___________________________________________________ (A20)

Employee Certification Information

Use the space you need to provide us with the information needed to meet the minimum

academic or professional requirement for all categories that the employee is requesting.

1. Degree Type _____________________________________ (A10)

(Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Year Month Day

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description.)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Year Month Day

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Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

2. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

3. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

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Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

4. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

5. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

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Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

6. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

7. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

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Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

8. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

9. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

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Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

10. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

11. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

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Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

12. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

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13. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

14. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________(A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

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Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

15. Degree Type _____________________________________ (A10) (Type of degree, if any, held by this individual.)

Training Type __________________________________________________ (A2)

(Type of training or license, if any, in their field of study i.e. Biology/P.E, RPLS.)

Training Date ____________________________________ (A8) Month Day Year

Personnel and/or Laboratory Certification Type ____________________________ (A6) (Reference Attachment C, Personnel Certification Type Codes or Laboratory Certification Type Codes for

Type code and description or, 112000 for Surveyor, 1000000 for P.E..)

Issue Date ________________________________ (A8) Month Day Year

Expiration Date ____________________________ (A8) Month Day Year

Certification Number _______________________________________________ (A20) (The number assigned to the certificate or License.)

Issuing Agency ___________________________________________ (A30)

(The name of the agency/board that issued the degree/certificate/license, such as University of Texas/State of

Texas/ State of OK /AIA/TNRC/Wetland Training Institute/TBPLS etc.)

Employee Category of Work Information

Select From the Precertification Work Categories listed on Attachment B

Reference Attachment B - Precertification Requirements by Category - for Category Numbers.

Enter leading "0's" before each single digit category number, for example, Category 1.1.1 would

be entered as 01.01.01. All Categories listed here must also be listed under your projects.

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

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Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

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Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Category ________________________ (N6) Category________________________ (N6)

Project Information

* = required fields

* please user 4 digits when entering year fields

* Please use current date for (Date completed), if on-going project

Note: We do not want a description of a project. We need to see the actual work that you

performed on the project that demonstrates to us how you meet the minimum requirement for any

category you want. In other words, how did you get from point a to point c? What was the

actual work?

Project 1

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

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*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

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_________________________________________________________________ (A60)

2. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

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_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 2

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

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Project Manager Name: __________________________________________ (A30)

Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

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_________________________________________________________________ (A60)

5. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 3

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*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

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1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

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8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 4

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

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Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

Emp-Quest-2019.doc

21 March 2019

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

22 March 2019

Project 5

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

Emp-Quest-2019.doc

23 March 2019

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

Emp-Quest-2019.doc

24 March 2019

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 6

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Emp-Quest-2019.doc

25 March 2019

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

26 March 2019

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

27 March 2019

_________________________________________________________________ (A60)

Project 7

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Emp-Quest-2019.doc

28 March 2019

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

29 March 2019

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 8

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

Emp-Quest-2019.doc

30 March 2019

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Emp-Quest-2019.doc

31 March 2019

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

32 March 2019

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 9

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Emp-Quest-2019.doc

33 March 2019

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

3. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

Emp-Quest-2019.doc

34 March 2019

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

Project 10

*Project Name _____________________________________________________ (A60)

*Location __________________________________________________ (A30) (Highway/road or bridge name or the City/County/State, or physical address.)

*Date Began __________________________________ (A8) Month Date Year

* Date Completed ______________________________ (A8) Month Date Year

*Enter A General Description of the Work Done on this Project. You may abbreviate as

Emp-Quest-2019.doc

35 March 2019

long as we can tell what you are trying to say:

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

___________________________________________________________________ (A60)

Contract Number: ____________________ (A15)

Project Manager Name: __________________________________________ (A30) Last First Middle

Client Name: _____________________________________________ (A30)

Client Phone Number: ________________________ (A10)

Client contact Name:_____________________________________________ (A30)

**Enter Construction Cost and Project Fees in Whole Dollars – Decimals, Commas and/or

Special Characters are NOT allowed

Estimated Construction Cost: ____________________ (N12)

Estimated Project Fees: _________________________________ (N12)

Select Up to 10 Categories of Work That Pertain To This Project

You May Describe The Actual Work Completed For Each Category, But It Is Not Required.

***Caution, Only 120 Characters, (2 Lines), Will be Stored in the System

1. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

2.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

Emp-Quest-2019.doc

36 March 2019

_________________________________________________________________ (A60)

3.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

4.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

5.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

6.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

7.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

8.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

9.Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

Emp-Quest-2019.doc

37 March 2019

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

10. Select A Category of Work: ________________ (A8)

Description of Work Completed in This Category (Up to 2 Lines/Optional):

_________________________________________________________________ (A60)

_________________________________________________________________ (A60)

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