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Home My WebLink AboutQuestionnaire00500.—LIPPLEMENT TO BID FORM: {QUESTIONNAIRE THIS COMPLETED FORM SHOULD BE SUBMITTED WITH THE BID, HOWEVER, SUBMISSION OF THE FORM OR ANY ADDITIONAL INFORMATION NOT INCLUDED IN THE SUBMITTED FORM AS DETERMINED IN THE SOLE DISCRETION OF THE CITY, MAY BE SUBMITTED WITHIN SEVEN (7) CALENDAR DAYS OF THE CITY'S REQUEST. FAILURE TO SUBMIT THE FORM OR ADDITIONAL INFORMATION UPON REQUEST BY THE CITY SHALL RESULT IN THE REJECTION OF THE BID AS NON-RESPONSIVE. The undersigned authorized representative of the Bidder certifies the truth and accuracy of all statements and the answers contained herein. 1. How many years has your organization been in business while possessing one of the licenses, certifications, or registrations? Licen ertification(Registration Name and N mber # Years �W C( --;c C6C150' C1C11L4 (S 1A. What business are you in? Cia_ 19 2. What is the last project of this nature that you have comple ed? -FOOT sx 25 ( NVJ s-�. 3. Have you ever failed to complete any work awarded to ou? If so, where and why 4. Give owner names, addresses and telephone numbers, and Surety and project names, for all projects for which you have performed work, where your Surety has intervened to assis�t� in completion of the project, whether or not a claim was made. FlagamyWest End Phase It and Fairlawn Phase 116 Sewer improvements Sid No.: 06-07-012 Page 147 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: 644 (�C C -M- 4 e tlr 'rhOkk & (name) (address) (phone #) -( olG (name) (address) (phone #) Ct c ,r>7�crYlt - �! y S ttiJ 2`� `` (name) (address) (phone #) 6. List the following information concerning all contracts in progress as of the date of submission of this bid. (In case of co -venture, list the information for all co -venturers.) TOTAL DATE OF % OF NAME OF OWNER & CONTRACT COMPLETION COMPLETION PROJECT PHONE # VALUE PER CONTRACT TO DAT - _ 4C p si ,i 4 ► u q -r i ��4 7 s a ��- ��' �'� �'=� S�� j-�,�i.�h� ►pro X03 � r � j�� a�. �. >rslsc° y �7in xeo OUD 00.03 131,11 (Continue list on insert sheet, if necessary.) 7. Has a representative of the Bidder completely inspected the proposed project and does the Bidder have a complete plan for its performance? Yes ❑ No 8. Will you subcontract any part of this Work? If so, provide the following details for each subcontractor(s) that will perform work in excess of ten percent (10%) of the contract amount. (Attach additional sheets if necessary) Subcontractor Approx. M/WBE Description of Work {iName Percentage Status N (� The foregoing list of Subcontractor(s) may not be amended after award of the Contract without the prior written approval of the Project Manager, whose approval shall not be unreasonably withheld. 9. What equipment do you own that is available for the Work? A-1 i n -0 ry,:;) car) i ,i • <- rx4a c /t od II i s- -- Flagami/West End Phase 11 and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012 Page 148 10, What jequipment will you purchase for the proposed Work? 11. What equipment will you rent for the proposed Work? 12. State the name of your proposed project manager and superintendent and give details of his or her qualifications and experience in managing similar work. 13. State the true, exact, correct and complete name of the partnership, corporation or trade name under which you do business and the address of the place of business, (If a corporation, state the name of the president and secretary. If a partnership, state the names of all partners. If a trade name, state the names of the individuals who do business under the trade name). 13.1 The correct name of the Bidder isrfD 13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation). . px fgfin 13.3 The address of principal place of business is �r 13.4 The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: Flagami/West End Phase it and Fairlawn Phase 118 Sewer Improvements Bid No.: 06-07-012 Page 149 13,10. !-las the Bidder, its principals, officers or predecessor organization($) been debarred or suspended from bidding by any government during the last five (5) years? if yes, provide details. KJD 13.11. Under what conditions does the Bidder request Change Orders? un76�src 'rd" -h apL--e ct 13.12. What is the nature and amount of the three largest change orders submitted by the bidder within the past five years, and their disposition? � fid 'moi -'Y L[Y n Kat/C bin FiagarnvWest End Phase 11 and Fairlawn Phase 118 Sewer Improvements Bid No.: 06-07-012 Page 151 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 1 of 2) Contractors shall furnish the names, addresses, and telephone numbers of a minimum of five (5) firms or government organizations for which the Contractor has provided services for projects of similar size; scope and complexity over'(.3 a five �Ce(5) year period. Y p" 1) Company Name l✓s + „� t' � r� E'(�i Address 5�,r%� �tS-�- LEVLh�Z.3�b13 Contact Person/Contract Amount :Fyed obt h -fliZ -.14 C,s�CjO'7 2j Telephone No. !Fax No��30S 2) Company Name CAL' ir- tJY4-n m 1aM! 1�c LZC Address ri o 6 o O E 1 crin X lam. hJ- !23 .0 a Contact Person/Contract Amount t: fe OLU11 h $ 1. 2-11 12 - Telephone No. /Fax NO.�s 3) Company Name Address Contact Person/Contract AmountS�rv( T) -7t 7r 1 Telephone No. /Fax NoW�ys--) - 54 T4S -61 4) Company Name C'1 1 W Address 44q 9W MOT'l,& Contact Person/Contract Amount Telephone No. Tax No � i 1 L� 1P`� 2 �� 1 L4 I�^ 215 Flagami/West End Phase 11 and Fairlawn Phase lib Sewer Improvements Bid No., 06-07-012 Page 152 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) f 5) Company Name �}ern# D� C�%oKJ Address 1 YD Qty% iS . 42,f) Contact Person/Contract Amount -P(b57 U Telephone No. /Fax No. 3�rjS1— u� S� 5� — g00'7 6) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 7) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 8) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. F(agarnWJest End Phase It and Fairlawn Phase Iib Sewer improvements Bid No.: 06-07-012 Page 153 00510. SUPPLEMENT TO BID FORM: OFFICE LOCATION AFFIDAVIT (Page 1 of 2) Please type or print clearly. This Affidavit must be completed in full, signed and notarized ONLY IF YOU MAINTAIN AN OFFICE WITHIN THE CORPORATE LIMITS OF THE CITY OF MIAMI. 11 A Legal Name of Firm: 1" k ' Entity Type: (Check One) ❑ Partnership ❑ Sole Proprietorship [, Corporation Corporation Document No: Occupational License No: PRESENT City: State: PREVIOUS Street Address: City: State Date Established Date of issuance m ; s office"ltication Estab 9hm4 o#,1KdW : der"l8idtler ial-ak How long at 1 location: How long at this location: According to Section 18-85 of the City of Miami Code, as amended: The "City Commission may offer to a responsible and responsive local bidder, who maintains an office in the City of Miami, the opportunity of accepting a bid at the low bid amount, if the original bid amount submitted by the local bidder does not exceed 110 percent of the lowest other responsible and responsive bidder." The intention of this section is to benefit local bona fide bidders]Bidders to promote economic development within the corporate limits of the City of Miami. I (we) certify, under penalty of perjury, that the office location of our firm has not been established with the sole purpose of obtaining the advantage granted bona fide local bidders/Bidders by this section. Flagami/Wesi End Phase If and Fairlawn Phase Il$ Sewer Improvements Bid No.: 06-07-012 Page 154 005io. SQPPLE.M-Nr,<TO BID FORM: OFFICE LOC i ION AFFIDAVIT (Page 2 of s ,. Abth hdze Signature Print Name Print N me "iha / Title Vice Pr2ts3 r J% -- Title Authorized Signature Authorized Signature (Must be signed by the corporate secretary of a Corporation or one general partner of a partnership or the proprietor of a sole proprietorship or all partners of a joint venture.) NOTARIZATION STATE OF FLORIDA, COUNTY OF DADE That: �� 1�4 • 5�� C~�P z✓ personally appeared before me and acknowledged the foregoing instrument as his/her act and deed. That he/she has producedas identification. NOTARY PUBLIC:` `:' jton My Commission Expires: i 4' 2509 C7:�-;. Please submit with your bid copies of Occupational License, professionai and/or trade License to verify local status. The City of Miami also reserves the right to request a copy of the corporate charter, corporate income tax filing return and any other documents(s) to verify the location of the firm's office. Flaaami/West End Phase 11 and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012 Page 155 0550 Local, Small, Disadvantaged and Minority/Women Business Enterprise Participation t Project No.:I�t - ��_� Title: - TV OI 1i1PS" 13Y 11-1 Bidder/Contractor: i ZL)C� c� alc FIV I As previously stated in the Contract Documents, the City encourages the participation of local, small and minority owned businesses. Based on this ongoing effort the City requires that with the submission of the bid, first payment requisition, and at the request of Cihr representative, the Contractor shall submit this report entitled. Failure to submit the report may delay the issuance of payment to the Contractor. Contractor shall submit an updated report when a subcontractor has been added or changed. The following certified local, small, disadvantaged, minority or women owned firms have been awarded subcontracts for this Project. The legend is to be used in completing the appropriate columns. Nameof Finn (Bidder and I Certifying Entities BBE — 81ack- African-American owned Business Enter rise I CM - City of Miami CSBE — Community Small Business Certifying Value of Percentage Subcontractors) I FG —Federal Government Business Designation MD - Miami Dade County Agency Work of Total Other— lease identify SBE — Small Business Enterprise (check all that apply) I WBE — Woman -Owned Business Enterprise (Agencies) Assigned/ Work or List all Awarded Contract a livable HDn�1 ❑ 86E ❑CSBE or SBE ❑DBE ❑HBE �� ct1 !7!MjbllS f ❑ Local ❑ MBE [:3 WBE one ❑BBE ❑ CSBE or SBE ❑ DBE ❑HBE ❑ Local ❑ MBE ❑ WBE ❑ None ❑ BBE ❑ CSBE or SBE ❑ DBE ❑HBE 0 Local ❑ MBE ❑ WBE ❑ None ❑ BBE ❑ CSBE or SBE ❑ DBE ❑HBE ❑ Local ❑ MBE ❑ WBE ❑ None ❑ BBE [3CSBE or SBE ❑ DBE 0HSE ❑ Local Q MBE ❑ WBE ❑ None ❑ BBE ❑ CSBE or SBE ❑ DBE ❑HBE Local ro ❑ MBE ❑ WBE ❑ None LEGEND T es of Firm I Certifying Entities BBE — 81ack- African-American owned Business Enter rise I CM - City of Miami CSBE — Community Small Business I BC - Broward County DBE — Disadvantaged Business Enterprise I FDOT — Florida Department of Transportation HBE — Hispanic Owned Business Enterprise I FG —Federal Government Local — Local Firm within City of Miami city limits MD - Miami Dade County MBE — Minority Business Enterprise MOPS — Miami Dade Public Schools None — nospecial designation Other— lease identify SBE — Small Business Enterprise I WBE — Woman -Owned Business Enterprise NOTE: COPIES OF CERTIFICATIONS MUST BE ATTACHED. LOCAL FIRMS SHALL ATTACH THE LOCAL OFFICE AFFIDAWT Fiagami/VVest End Phase 11 and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012 Page 156