HomeMy WebLinkAboutR-99-0364h
J-99-449
5/11/99
RESOLUTION NO. +W 4-
A RESOLUTION OF THE MIAMI CITY COMMISSION
ACCEPTING THE BID OF E.D.F.M. CORPORATION,
FOR THE FURNISHING AND INSTALLATION OF
BLEACHERS ON CONCRETE SLABS AT VARIOUS CITY
PARKS, FOR THE DEPARTMENT OF PARKS AND
RECREATION, IN AN AMOUNT NOT TO EXCEED
$150,116; ALLOCATING FUNDS THEREFOR FROM
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS AND
FROM A STATE LEGISLATIVE GRANT FOR CAPITAL
IMPROVEMENT PROJECT NOS. 331403, 331310,
331351, 331070, 331384, AND 331391, AND FROM
A STATE LEGISLATIVE GRANT FOR PROJECT
NO. 331360, AS APPROPRIATED BY GENERAL
APPROPRIATION ORDINANCE NO. 11705, AS
AMENDED.
WHEREAS, the Department of Parks and Recreation, through
community feedback, has determined that a need exists for the
acquisition and installation of bleachers in time for the
football season; and
WHEREAS, pursuant to public notice, sealed bids were
received April 19, 1999, for the furnishing and installation of
bleachers on concrete slabs at various city parks for the
Department of Parks and Recreation; and
WHEREAS, Invitations for Bid No. 98-99-081 M/WBE were mailed
CITY COMMSSION
MEETING OF
MfAy 1 1 1999
Resolution No.
99-- 364
'...
to thirty-five (35) potential bidders; and
WHEREAS, two (2) bids were received; and
WHEREAS, funding is available from Community Development
Block Grant funds for Capital Improvement Project Nos. 331403,
331310, 331351, 331070, 331384, and 331391, and from a State
Legislative Grant for Project No. 331360, as appropriated by
General Appropriation Ordinance No. 11705, as amended; and
WHEREAS, the City Manager and the Director of the Department
of Parks and Recreation recommend that the bid received from
E.D.F.M. Corporation be accepted as the lowest most responsible
and responsive bid;
NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY
OF MIAMI, FLORIDA:
Section 1. The recitals and findings contained in the
Preamble to this Resolution are hereby adopted by reference
thereto and incorporated herein as if fully set forth in this
Section.
Section 2. The bid submitted by E.D.F.M. Corporation,
for the furnishing and installation of bleachers on concrete
slabs at various City parks for the Department of Parks and
Recreation, in an amount not to exceed $150,116, is hereby
accepted, with funds therefor hereby allocated from Community
Development Block Grant funds for Capital Improvement Project
Nos. 331403, 331310, 331351, 331070, 331384, and 331391, and from
- 2 -
1-1
M
a State Legislative Grant for Project No. 331360, as appropriated
by General Appropriation Ordinance No. 11705, as amended.
Section 3. This Resolution shall become effective
immediately upon its adoption and signature of the Mayor.1/
PASSED AND ADOPTED this lltll_ day of May , 1999•
ATTEST:
JOE CAROLLO, MAYOR
In accordance with Miami Code Sec. 2.36, since the Mayor did not indicate approval of
this legislation by signing it in the designated place provided, ::1 i i; ni^I?.tior no i
becomes effective with the elapse otAiii&
tmmiss; action;
regarding same, without the Mayor
ty Clerk
WALTER J. FOEMAN
CITY CLERK
APPROVEBeAOSIO10
73:RCL
AND CORRECTNESS
�i If the Mayor does not sign this Resolution, it shall become effective at
the end of ten calendar days from the date it was passed and adopted.
If the Mayor vetoes this Resolution, it shall become effective
immediately upon override of the veto by the City Commission.
- 3 -
99- 364
t
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1• RCY 13Y : C I 'I Y OF M I AM I : i - 1 1 -919 : 8 : 1 t 1 +30 54-132 I P54 -• CONINI. A. TL:FLF..: N Y.
05-11-99 06:24 From -PARKS i RECREATION +305416T154 1-657 F.OT/OE F-358
CITY OF MIAMI, FLORIDA
INTER -OFFICE MEMORANDUM
TO The Honorable Mayor and DATE: 1 1 MAY 1 1 IBM PLE
Members of the City Commission IRRi
suarECT : Authorizing the Furnishing
and Inatallation of sleaCbers
on Concrete slabs at Varioua
REFERENCES: City Parka
/n4xqW a�i "w Pom
City Manager ENCLOSURES
RBCOFIMMAITON
it is respectfully recommended that the City Commission
adopt the attached Resolution authorizing the furnishing and
installation of bleachers on concrete slabs at various city
parks from E. D. F. M. Corporation, female/Dade County
vendor, located at 10021 S. W. 99 Avenue, Miami, Florida for
a total amount not to exceed $150,116.00 pursuant to bid No.
98-99-61 M/WBE, for the Department of Parks and Recreation.
Funding is available from Community Development Block Grants
in Capital Improvement Program Project Nos. 331351, 331070,
231384, 331391, 331310, 331403 and from a State Legislative
Grant for Project No. 331360.
BACKGROUNDS
The Department of Parks and Recreation has received
community input as to the needs of the City's baseball and
football fields from the neighborhood residents. Among the
items determined to be of great need were bleachers for
these bailfields. Some of the most heavily used ballfields
are located at Range, Williams, Radley, Gibson, Shenandoah,
and Grapeland Parks. Pursuant to public notice, four (4)
sealed bids were received for bleachers for the ballf ield,
but two (2) were deemed non -responsive due to lack of
certification by the City. Award of the bid is recommended
to E. D. M. F. Corporation, a female/Dade County vendor
which submitted the lowest responsive and responsible bid.
Tnt_al Arnnunr of 13i d: $1501116
Source of wun_do: Community Development Block Grant
Funds (CDBG) Capital Improvement
Project No. 331351, 331070,331384,
331391, 331310, and 331403. State
Legislative Grant for Project
331060 Index Codes 589301-660.
99-- 364
D(V
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RCS' BY: C1'I'Y of %1IA111 : 5-11-99 : R:11 : +0O54162151- COMM. A. 'I'EELE:k :3
C5,11-88 08:Z5 From-FARKS A RECP.EATION +3054162154 T-BUT P.03/06 F-358
Minnritry parr_inination: Awarded to a Female Firm
p11h1 i One legal advertisement
AAAAAAahlP Prnj ct: N/A
DIHW/ AR/j ag
Attachment
c: Raul Martinez, Assistant City Manager
Alberto Ruder, Parks and Recreation Department Director
99- 364
It.,
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05-11-99 06.3a From -PARKS ri RGCREATION +3054162154 T-66e P.01/06 F-SU
G1TY OF MiIAMI, FLOPMA
INTER -OFFICE MEMORANDUM
TO: The Honorable Mayor and Members DATE MAY i ( 1999 FILE:
of the Commission
SLBJECT : Bid No. 95-99-081
' Local Vendor Participation/Response
Donald . Warshaw
FROM: City Manager REFERENCES
ENCLOSURES:
The subject bid opened 11:00 am, Monday April I9, 1999, for the furnishing and installation of
Bleachers on Concrete Slabs at Various City Parks. Invitation for Bids were hand -delivered
through the City's Local Vendor Outreach Program and via mailed. As a follow-up, the vendor(s)
who did not bid was contacted on April 31, 1999, to determine the reason(s) for not bidding:
Name of Vendor Vendor Response(s)
I . Aventura Engineering Unable to submit bid
2. A-1 Artistic Landscaping, Inc. Don't do this qpe of work
3. Saturn Construe. & Vovelopinent Unable to Contact
4. Wis's Engineering Unable to submit bid
bHW:B\VH:]SC:abf
Cary Lopez
i'viercedes Oteiza
Edy Laraque
Wisconsin Mclachla
99- ��4
ww -
06-11-99 COW From -PARKS & RECREATION +3054162154. T-662 P.06/OB F-3E9
CITY OF MIAMI
SY. NLMiA.RY OF CONTRACTS AWARDED
FOR: FURNISHING AND INSTALLATION OF BLEACHERS
ON CONCRETE SLABS AT VARIOUS CITY PARKS
AWARDED TO: E.D.F.M CORPORATION
TIME PERIOD NUMBER OF BIDS DOLLAR AMOUNTS
From: 1998- Present
SI NMARY OF CONT[LA.C-M, DOC
NONE
99 - 364
05-11-99 06:41 From-FARKS & RECREATION 43056162154 T-666 P 07/09 F-359
Bid AWARD RECOMMENDATION DORM
BID NUMBER: 98-99-081 M%WBE COMMODITY/SERVICEaallfield Bleachers s Concrete Slabs
DEPARTMENT / DIVISION: Parks and Recreation
TERM OF CONTRACT': Short Term Contract
NUMBER OF BIDS DISTRIBUTED: 35 NUMBER OF BIDS RECEIVED: 2 (2 non -responsive)
s METHOD OF AWARD: To the 1owe rRt resnongivn an,,;,rFSDons ihlift- hiAaprtak meet-inQ
speci.ficat.iona-. City re eryev thA ria ,t + ,ygarA cri i tF.m haai a
RECOMMENDED VENDOR(S): STATUS; CONTRACT VALUE:
E.D.F.M. Corporation Female/N.iazi-Dade �150,116.00
TOTAL: $150 ,116.00
THE FOLLOWING TO BE COMPLETW BY USER DEPARTMENT:
JUSTIFICATION: The Department of Parks and Recreation has received input from residents
and various teams who use the city's ballfields that there is a need for
new bleachers at sow_of the most used ballfields.
S31351 '105404
153 f 3S8 -- -10 1405
-
�31
331 Loa
*Co=uni.ty Develop-ment Block Grants
ACCOUNT CODE($): 331310 589301-860 $21,913 ✓
331403 589301-860 v25,442x 331360 589301-860 $21,912 (State Grant)/
331351 589301-860 $38,349� 331384 589301-860 $ 8,304*'
91' 589301-860 04,196*.�"
DEPARTMENT APPROVAL: BUDGET REVIEW APPROVAL: PURCHASING APPROVAL:
Department Di r1 Luze Brennan U y . arter /
Designee Dir for (acting) D ector
OTHER FUNDING APPROVALS, IF APPLICAB : TITLE: Director, Community Dev.
wendolyn warren
99- 364
taw
ITEM: DESCRi PT10N:
A Gibson Park
1. Fumish and install 1 set of 5-raw
bleachers.
2. Furnish labor and materials to
oonsbruct 15'x10'eonorele slab 4"
thick
3. Provision lot Specie Items
(not to exom d $1,600.01))
TOTAL COST
B Grapeland Park
1. Furnish and install 3 Sets of 5-row
bleachers.
' 2. Fumish labor and materials to
cwstrudUuee 15*xITeoncretestabs
4" thick.
3. Provision tar Special Items
(not to exceed $1,500.00)
TOTAL COST
C Hadley Park
1. Fumish and install 2 sets of 5-now
bleachers.
2. Fumish and install 1 set of 10 rows
bleachers.
-_3. Furnish labor and materials to
construct three 15'x10'concrete stabs
4° thick.
4. Piovision for Special Items
(not to exceed $1,5W.09)
TOTAL COST
<W
TABULATION OF BIDS FOR 13ALLFIULD BLEACHERS AND CONCRETE SLABS
BID NO 98.99-081 MANBE -'-
August Construclion Co. Inc.; ;
E.D.F.M. Corporation
Holmes and Associates,
Titan ConsWetion
7341 N.W. 32 Ave.
10021 S.W. 9M Ave.
20D N.W. 55 St., Ste. 212
Group, Inc,
Miami, Fla. 33147
Miami, Fla. 33176
Miami, Fla. 33127
1401 S.W. 1 St., Ste. 212
0
Miami -Dade Co. / Black
Miami -Dade Co. I Female
Local I Female
Miami, Fla. 33135
Local I Black
�+
(Cer6hed by City)
(Certified by City)
(Not CertMed by City)
(Not Certified by Cfty)
23
TOTAL COST
TOTAL COST
TOTAL COST
TOTAL COST
a
H
$ 4,525.00
$ 4,837.00 '
N
N
m
m
O
O
N
N
z
$
9,060.00
$
1,967.00:
$
1.500.0D ..
$
i "WO.00 R
E
$
15,085.00
S
6.304.00: S
P
0
$
13,526.00
$
14,512.00 N
-
S
5,901.00 I
V
E
$
1,500.00
$
1,500.00
$
25,404.00
$
21,813.00
$
12,468.00 _
$
'.0,674.00
$
6,234.0D -
$
9,217-00 :.
5
9,414.00.
$
5,051-00
$
1,5flD.00
$
1,500.00
$
29,616.00 =
$
25,442.00
R
C-
S
P
O
N
S
it
Y
E
■
pin
Page A 2 cant.
TABULATION OF BIDS FOR BALLFiEL0131EACHERS AND CONCRETE SLABS
BID NO 98-99-081 MNVBE
-August Construction Co. Inca
7341 N.W. 32 Ave.
Miami, Fla, 33147
Wemi-Dade Co. I Black
(Certified by City)
0 Range Park
TOTAL COST
1. Furnish and install 3 sets of 5-row
bleachers.
$
13,571.00
$
2. Furnish and install 1 set of 10 row.
bleachers.
$
10,860.00 ,
$
3. Furnish Jabot and materials to
construct Otres 19x10'caoncrete slabs
$
7,068.00 '
$
4" thick.
4. Fumish labor and materials to
$
6,245.00
$
construct one 25'x20' concrete stab
.5. Provision for Special Items
$
1,b00A0
$
(not to exceed $1,500.00)
- TOTAL COST
;
39,065.00
$
E Shenandoah Park
1. Furnish and install 3sets of 5+Dw
$
13,571.00
$
: - bleachers.
2. Fumish labor and materials to
construct three 15'xIU concrete slab
$
10,378.00 .
$
3. Provision for Special items
(not to exceed $1,500.00) _
, $
1,500.00
$
:. TOTAL COST
$
25,449.00 .
$
F . -_' Williams Park
1. Furnish and install 3 sets of 10-row
--bleachers. �.
S
33,267.00 `
•; $
2. Furnish tabor and materials lc
construct three 2SWU concrete slab
$
14,260.00
- $
3. Provision for Special Items
<(not to exceed $1,500.00)
TOTAL'.. COST
i
49,007.00
$
Approved by:
y S. Carter, DJrectu►
E.D.F,l4I. Corporation
10021 S.W. 9fith Ave.
Miami, Fla. 33176
Miami -Dade Co. ! Female
(Certifir.d by City)
TOTAL COST
13,372.00
10,355.00
4,137.00
4.832.01)
1,500.00
34,196.00 .
14,511.00 . -
5,901.fl0 '
1,5t10.00 _
21,912.00
Holmes and Assoclales,
20D N.W. 55 SI , Ste_ 212
Miami, Fla. 33127
Local / Female
Not Certified by City)
TOTAL COST
27,C48.00
9,201.00
38,349.00
Approved by: +
R;041!
oree
Date* ___ .�
N
O
N
R
E
S
P
O
N
S
I
V
E
Titan Construction
Group, Inc. o
1401 S.W. 1 St., Ste, 212
Miami. Fla, 33135
Local ! Black T
a
(NotCerliried by City)
a
TOTALCOST H
1-3
A
N
m
O
N
o
R
E
S
P
O
N
S
1 W
a
V A
E
A
t_
-w r
05-11-09 v0819 From -PARK$ i RECREATION T-He P.02/O5 F-359
tiaa No. V8-99-81-M/WBE
6.1 DID INFORMATION FO1,L.1
Mailing Date: April t, 1999 Buyer: Pamela Burns, CPPJJ
Bid No.: 98-99.81-MVWBE Telephone: 305-416-1905
Please quote on this form(s) net prices for the item(s) attached. Return signed original and retain a copy for your
riles. Prices should include all costs, including transportation to destination. The City reserves the right to acceptor
reject all or any part of this bid. Prices should be firm for a minimum of 90 days.
Reference to manufacturers' names or catalog numbers are for identification only. If alternates are quoted,
complete information must be given.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices.
420rU: BALLFIELD BLEACHERS & CONCRETE SLABS
We have read your Invitation for Bids, completed the necessary documents, and propose to ftunish and deliver,
F.O.B. DESTINATION, the items or service specified herein.
ALL BIDS MUST BE SUBMITTED IN TRIPLICATE OR YOtM BID MAY BE DISQUALIFIED.
6 number of calendar days required to complete work after Notice to Proceed or issuance of
purchase order.
._0 number of calendar days required before commencement of work.
Delivery will be made within calendar days after receipt of purchase order.
Terms: 2%-I0 days -.Q_ Net 30 days ✓ Additional discount of 0 % if awarded all items.
O (include cash discount for prompt payment, if any) Other Discounts: O
Contact Person/Telephone:
Term of Warranty for equipment: I V d? a. r
Term of Warranty for labor.
All exceptions to this bid have beesi documented in the section below.
EXCEPTIONS: ADD IV e
1 certify that any and all information contained in this bid is true; and I further certify that this bid is made without
prior understanding, agreement, or connection with any corporation, farm, or person submitting a bid for the satne
materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. I agree to abide
by all terms and conditions of this bid and certify that I am authorized to sign this bid for the bidder, Please print
the following and sign your name:
Firm's Name: t, V.E "Yr - 0 0 R P (J k a � O'kJ Telephone: # I P-y' eSY,
Principal Business Address: w 99n V, Fax: os a279• h0 .
7tf/l�yrLio�ah1` 3�19� Name; 7�/ 9
Mailing Address: S 0—>r7 a Tide: R . 5i A _
Authoriz Signature:
E-Mail Address: lf% Beeper:_ o6 27 — O
99- 9E4
.k._
CS-i 1-99 W 19 From -PARKS i RECREATION 0064162154 T-666 P• 03/06 F-SE9
— . IAJV VI� A11U[N
_ INSTRUCTIONS:
This questionnaire is to be included with your bid. Do not leave any questions unanswered. When the question
does not apply, write the word(s) "None", or "Not Applicable', as appropriate. Please print.
.k..
COMPANY NAME: E�_D r7M
COMPANY OFFICERS:
President L' l f t Q iM R �q Ve-L Vice President GPKWX3JC QPA rites
Secretary Treasurer
COMPANY OWNERSHIPS
t CLQrh R00k � of ownership
t,nqylcb 2 95 Of ownership
% of ownership
of ownership
a;
LICENSM:
I . County or Municipal Occupt tionai Lieease No. "
(attach copy with bid)
2. Occupational License Classification j_�n'(' 1" _
3. Occup&onal License Expiration Date:
Q. Metro -Dade County Certificate of Competency No, C,(2 C . O a L= 0
(atraebed copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No._�"
EXPERIENCE:
6. Number of Years your organ.indon bus been in business: -
7. Number of Years experience BIDDERIPROPOSER (person, principal of fnn, owner) has had in operation
of the type required by the specifications of the Bid or RFP:_ 1 " 1
8. Number of Years experience BMDERIPROPOSER (firm, corporation, proprietorship) has had in
operation of the type required by the specifications of the Bid or RFP: 11
99- 364
+_
— w -
06-11-88 08:40 From -PARKS & RECREATION +3054162154 T-666 P.04/06 F-HO
_ _-•.__--_ wAVAL _,,, .,V...,..:'L" e+srrtitta Ar.v. -MCAt IUA Atr'IDAVIT
Please Check One Box Only j ] Hispanic emale [ ] Black j) Not Applicable
If business is not 51 % minority/female owned, affidavit does n i apply. If not applicable, notarization is not required.
I (We), the undersigned agree to the following conditions:
1) that we have read Section 2.25 of the General Terms and meet the fifty-one percent (51%) ownership and
management requirement for minority/women registration status and will abide by all of the policies and
regulations governing the City of Miami Minority and Women Business Enterprise Procedures;
2) that if at anytime information submitted by the undersigned applicant in his/her Bidder Application should
prove to be false, inaccurate, or misleading, applicant's name will be struck from the City of Miami's
Master Bidder list with no further consideration given to this applicant;
3) that the City of Miami maintains the right, through award of bid/contract, to revoke the award, should it be
found that false, inaccurate or misleading information or a change in the original information have
occurred;
4) to notify the City of Miami within thirty (30) days of any change in the ftrm's ownetsitip, control,
management or status as an ongoing minority/women business concern as indicated on the Bidder
Application, and that the City of Miami, upon a finding to the contrary, may render a firm's registration
with the City null and void and cease to include that firm in its registered list of minority and women.
owned businesses;
5) that the City of Miami has a right to diligently verify all information submitted by applicant in his/her • .
Bidder Application to monitor the status of the Minority/Women Business Enterprise, once registered;
6) that the City of Miami may share a fiim's registration information concerning its minority/wornen status ..• and its capability with other municipal or state agencies for the sole purpose of accessing the firm to their
procurement opportunities, unless otherwise specified by the fum in writing.
I (We) certify under the penalties of perjury that the information contained in any and all application documents
submitted to the City of Miami is correct as per Ordinance No. 10062 as amended.
(If Wing as a corporate officer, kindly affix corporate sea])
-Y �(Natne, Thk & Date) (Name, Title & Date
_ )
1"f l application must be signed by at least one general partner of a partnership or the proprietor of a sole
.-proprietorship or all partners of a joint venture.
NOTARIZATION
COUNTY, SS
COUNTY OF DADE Date:
4,42persoaally� d before me and
acknowledged the foregoing instrume as his/her act and deed,
That he/she has produced as identification.
Lourdes be rskV
�,�• 'Sicz
�•; F. MYCOMMISSION
cr 7, 2002 EXPIRES NOTARY PUBL1 .
2 eor ar ia°ryNkw�sioi+rot it c
My Commission Expires:
FAILURE TO COMPLETE SIGN AND RETURN THIS FORM MAY DISQUALIFY THIS BID
99- 364
BID ITEM:
CITY OF MIAMI OF THE CITY CLERK
BID SECURITY LIST
BALLFIELD BLEACHERS & CONCRETE SLABS r Y
n.n
BIDNO: �a-yy-col ri/ WDC
DATE BID(S) OPENED: AP R I L 1 99 - 1,999 TIME 11 : 00 a.m.
BIDDER
TOTAL BID
AMOUNT
BID BOND (ER)
CASHIER'S CHECK
AUGUST CONSTRUCTION CO. INC.
See attach
ad bid
TITAN CONSTRUCTION GROUP, INC.
" "
MADAME RENITA HOLMES
"
EDFM CORPORATION
"
NO BID
VEND ALL ENTERPRICES
_ �_ ..., •,,,, ,.��� �,,,I �, ..;-.-,
�-�n s'•.w c,n�-:
cffcrs
TL'Cci'ic9Ll
II
hoFehy re;^c:,Cx cis
�are
r(
Y L
c received (, ��� ) envelops on behalf of
�r*dn receiving bid(s)
PURCHASING DEPARTMENT on
(City Department) (D e)
SIGNED
Deputy City Cl rk
t.-
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0
K•
if ri
CITY OF MIAMI
ADVERTISEMENT FOR BIDS
Sealed bids will be received by the City of Miami City Clerk at his office located at City Hall,
3500 Pan American Drive, Miami, FI. 33133 for the following:
BID NO.98-99-081-M/WBE Ballfield Bleachers & Concrete Slabs at Six City Parks
OPENING DATE: 11:00 A.M. Monday, April 19, 1999
This bid has been designated as a set aside for certified Black or Female general contractors
(individuals) and/or M/WBE general contracting firms certified as Black or Female owned, in
accordance with Ordinance No. 10062 as amended. It is required that bidders interested in
participating in this project be M/WBE certified with the City of Miami's Minority/Women
Business Enterprise Program, and have their M/WBE certification in current status, prior to bid
opening date. Firms/sole proprietors interested in becoming M/WBE certified with the City are
required to contact the City of Miami Minority Enterprise Office, Ms. Effie McCartney, M/WBE
Supervisor, at (305) 416-1921 or Anita Moore at (305) 416-1913 for certification information.
FAILURE TO MEET THE ABOVE SET ASIDE REQUIREMENTS MAY DEEM YOUR BID NON -RESPONSIVE.
Detailed specifications for this bid are available upon request at the City of Miami, Purchasing
Department, 444 SW 2nd Avenue, Sixth Floor, Miami, Florida 33130. Telephone No. 416-1906.
AD NO. 4992
Donald H. Warshaw CITY OF MIAMI
City Manager LOGO
�1
1;_
ai
City of
Miami
G,
�-
REQUISITION FOR
ADVERTISEMENT
This number must
appear in the
„ ,%;/
advertisement
INSTRUCTION$: Please
a gnd attach a f the advertisement
with this
1. Department:
2. Division:
p
3. Account Code number:
4. Is this a confirmation:
4
5. Prepared by:
❑ Yes ❑ No
6. Size of advertisement:
7. Starting date:
8. Telephone number:
9. Number of times this advertisement is to be
10. Ty a of advertisement:
❑
published:
Legal ❑ Classified
Display
11. Remarks:
12.
milli
Publication
Dates) of
Advertisement
Invoice No.
Amount
7
13.
❑ Approved
❑ Disapproved
Department Director/Designee `Date`
Approved for Payment
Date
C GS/PC 503 Rev. 12/89 1 DISTRIBUTIO
N: r Whitehite
and
Canary
an Canarto y GDepartmentrement Management) ana retain i, copy.
t,..