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HomeMy WebLinkAboutacknowledgement of addendaMiami -Dade County Bid No.: 1802-4/09-OTR BID SUBMITTAL FOR: SHOES AND BOOTS (SAFETY) ACKNOWLEDGEMENT OF ADDENDA INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES PART I: LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID Addendum #1, Dated Addendum #2, Dated Addendum #3, Dated Addendum 44, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated Addendum #9, Dated PART II: ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: AUTHORIZED SIGNATURE: DATE: TITLE OF OFFICER: 26 Revised 04-04 Miami -Dade County Bid No.: 1802-4/09-OTR MIAMI DADS 11111111 BID SUBMITTAL FORM Bid Title: SHOES AND BOOTS (SAFETY) By signing this Bid Submittal Form the Bidder certifies that it satisfies all legal requirements (as an entity) to do business with the County, including all Conflict of Interest and Code of Ethics provisions in Section 2-11 of the Miami -Dade County Code. Any County employee or member of his o:r her immediate family seeking to contract with the County shall seek a conflict of interest opinion from the Miami -Dade County Ethics Commission prior to submittal of a Bid response or application of any type to contract with the County by the employee or his or her immediate family and file a copy of that request for opinion and any opinion or waiver from the Board of County Commissioners with the Clerk of the Board. The affected employee shall file with the Clerk of the Board a statement in a form satisfactory to the Clerk disclosing the employee's interest or the interest of his or her immediate family in the proposed contract and the nature of the intended contract at the same time as or before submitting a Bid, response, or application of any type to contract with the County. Also a copy of the request for a conflict of interest opinion from the Ethics Commission and any corresponding opinion, or any waiver issued by the Board of County Commissioners, must be submitted with the response to the solicitation. In accordance with Sec. 2-11.1(s) of the County Code as amended, prior to conducting any lobbying regarding this solicitation. the Bidde j jst file the appropriate form with the Clerk of the Board stating that a particular lobbyist is authorized to represent the Bidder. Failure to file the appropriate form in relation to each solicitation may be considered as evidence that the Bidder is not a responsible contractor. The Bidder confirms that this Bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Bid for the same goods and/or services and in all respects is without collusion, and that the Bidder will accept any resultant award. Further, the undersigned acknowledges that award of a contract is contingent upon vendor registration. Failure to register as a vendor within the specified time may result in your firm not being considered for award. Pursuant to Section 2-8.6, any individual, corporation, partnership, joint venture or other legal entity having an officer, director, or executive who has been convicted of a felony during the past ten (10) years shall disclose this information prior to entering into a contract with or receiving funding from the, County. 0 Place a check mark here to affirm compliance with this disclosure requirement. COUNTY USER ACCESS PROGRAM (UAP): Joint purchase and entity revenue sharing program For the County's information, the bidder is requested to indicate, at 'A' and B' below, its general interest in participating in the Joint Purchase Program of the County User Access Program (UAP) described in Section 2.21 of this contract solicitation, if that section is present in this solicitation document. Vendor participation in the Joint Purchase portion of the UAP is yoluntarv, and the bidder's expression of general interest at 'A' and B' below is for the County's information only and shall not be binding on the bidder. A. If awarded this County contract, would you be interest in participating in the Joint Purchase portion of the UAP with respect to other governmental, quasi -governmental or not -for -profit entities located within the geographical boundaries of Miami -Dade County? Yes No And B. If awarded this County contract, would you be interested in participating in the Joint Purchase portion of the UAP with respect to other governmental, quasi -governmental or not -for -profit entities located outside the geographical boundaries of Miami -Dade County? Yes No Firm Name: Street Address: Mailing Address (if different): Telephone No. Fax No. Email Address: FEIN No. / - / / / / / / Prompt Payment Terms: % days net days (Please see paragraph 1.2 H of General Terms and Conditions) Signature: (Signature of authorized agent) Print Name: Title: Failure to sign this page shall render your Bid non -responsive. 27 • Revised 04-04