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University of Colorado at Boulder Department of Environmental Health and Safety Asbestos and Lead Consulting Services Pre Registration Form Company Name ______________________________ Contact Name___________________________ Phone___________________________ Email__________________________________ Introduction The University of Colorado Boulder (UCB) Requests a Statement of Qualifications (RFQ) for providing as-needed Industrial Hygiene (IH) services related to asbestos and lead projects on the University of Colorado, Boulder campus. A qualified firm shall have certified staff and experience in at least one of the following asbestos/lead disciplines: Asbestos building inspections Asbestos project design Asbestos project management Air monitoring specialist Lead inspector Lead risk assessments Qualified IH firms working on the UCB campus must be: Registered Asbestos consulting firm with the Colorado Department of Public Health and Environment (CDPHE) o CDPHE Registration #_______________Expiration Date___________ o # Years working in asbestos and lead field? ___________ In good standing with CDPHE with no recorded Notices of Violation in the past 5 years Trained and authorized by CU EHS to access the Material Management Database Selection process IH Firms will be evaluated and qualified based on CDPHE Asbestos Consultant Registration and personnel currently certified by CDPHE for each discipline. Each firm will be required to provide proof of State certified staff on a yearly basis to maintain current status on the qualified IH provider list. It is the responsibility of all qualified firms to Department of Environmental Health & Safety 1000 Regent Drive, UCB 413 Boulder, Colorado 80309-0413 (303) 492-6025 FAX: (303) 492-2854 Page 1 of 2 University of Colorado at Boulder Department of Environmental Health and Safety remain certified by CDPHE until the next required submittal date. If there is an increase or decrease to a consulting Firm’s asbestos and lead capabilities the IH Firm is responsible for contacting CU EHS ([email protected]) with an update of the changes. All IH firms providing asbestos and lead services on campus must fully understand the requirements and expectations set forth in the campus Asbestos program, IH specifications and General Abatement Contractor specifications. Additionally, IH firms must comply with UCB standards/policies and all other applicable state and federal regulations when working on campus. Submittal requirement Check the box for each of the disciplines your firm is qualified by CDPHE to perform: Asbestos/Lead Discipline CU EHS Approval EHS Use only Qualified to Provide Asbestos Building Inspections Asbestos Air Monitoring Asbestos Project deign Asbestos project management Lead Inspector Lead Risk Assessments Populate the following table for each team member who would be assigned to projects at UCB: Employee Name Asbestos Building Inspector Cert # Expiration Air Monitoring Specialist Cert # Expiration Asbestos project Designer Cert # Lead Inspector Expiration Cert # Expiration Lead Risk Assessor Cert # # of Years in Industry Expiration Has your firm been trained on proper use of Material Management database and has been given authorization by CU EHS? Yes _______ No _______ Upon completion, submit this document with the As-Needed Consultant Registration Form to The University of Colorado’s Planning Design and Construction Department. Department of Environmental Health & Safety 1000 Regent Drive, UCB 413 Boulder, Colorado 80309-0413 (303) 492-6025 FAX: (303) 492-2854 Page 2 of 2