HomeMy WebLinkAboutqualification statement4.3. Qualification Statement
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.
COMPANY NAME: e"lP6ZY ,441.4)) .40,Q ► p ?7r Ahaire614A'C61 /Av.
COMPANY OFFICERS:
President eV,Afiir iiteMetriTode Vice President er/t'!VMi iiiclordivArodu
Secretary "4,4w A4 M S'O.0 Treasurer �. ��"S'�' /ti'd'iQ l•Sd.r.r -- _
COMPANY OWNERSHIP:
e642n0e'i O /WS0 iJ
A
/b 0 % of ownership
N % of ownership
% of ownership
/ % of ownership
LICENSES:
1. ( or Municipal Occupational License No. 3 / A, 0 — t2
(attac'� < copy with bid),/�4
2. Occupational License Classification d /VI4AiQ's.c u.9 : -Sr il'e,'-
3. Occupational License Expiration Date: Ter 1 „ , e 3' L
4. Metro -Dade County Certificate of Competency No.
(attached copy if requested in Bid or RFP) O/'
S. Social Security or Federal I.D. No. 63 �� t d%J
EXPERIENCE:
6. Number of Years your organization has been in business: f ,e-3.
7. Number of Years experience BIDDER/PROPOSE (person, principal of firm, owner) has had in operation of the type
required by the specifications of the Bid or RFP: 7
S. Number of Years experience BIDDER/PROPOSER (firm, corporation, proprietorship) has had in operation of the type
required by the specifications of the Bid or RFP: yeaer
City of Miami Bid No. 03-04-012
Bid Response Form - Qualification Statement (Page 2 of 2)
9. Experience Record: List references who may be contacted to ascertain information on past and/or present contracts, work,
jobs, that BIDDER/PROPOSER has perfomred of a type similar to that required by specifications of the City's Bid or REP
with whom you have done business with in the past three (3) years:
FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
�►1Jr4 -04.0 Aga Cidde64071r In�lit4 LRuvro A1444.1719QAAJee
AN Lai / 111
Mi.4 /t , Fa p/AZ fr, _ R 70 5ti - 04 7
CONTACT PERSON: ivogoorrd ioRfd / A PHONE NO. 0,0 ; "...c 4612 (CA
FIRM NAME/ADDRESS
, if -laMocwhteco, r
//1 rv, IN s 9'J xeu 7"'e Az-D
0409, Imo( 3i.%
CONTACT PERSON: scoeyer14.4:' yi .+r
21
FIRM NAME/ADDRESS
*lid i4 3 ,f/At51
CONTACT PERSON: JQoll GiRAtaw., 4i.c'
DATE OF JOB DESCRIPTION OF JOB
Y 2410X r#Vt r1
PHONE NO. J') �"' 4110
DATE OF JOB DESCRIPTION OF JOB
409W.ti 4444.wei'W/1.od
told 67650 Ay
PHONE NO. .64) 59 44 4',9i0
FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
CstAAA 40/03 AlgioN ism Awn w el'
Ii/47 3-
CONTACT PERSONAIM/KA 37.4,0,0/AL:101-7 jir PHONE NC :62r)31/4 --1?'67
City of Miami
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISOUALIFY YOUR BID,
Bid No. 03-044112