HTML Design with W3C Validation

Hi, I am looking for writing code for a Design using HTML, CSS & JS. The code should be Mobile responsive across all devices with W3C validated code. Design is as follows: Visit [login to view URL] Click on CREATE YOUR PLAN > You will see a Black Window on the Right which is compatible across all devices. Need to make simple questions as mentioned in the form itself. I will be providing the fields which will be added in this form design. Please Note I only need the design and 18-20 questions with icons to select and go option. We will be using progress bar below instead of Numbers. Thanks Kindly Bid the final amount else the Bid will be Rejected.