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HomeMy WebLinkAboutappendix-affidavitsMiami -Dade County Bid No.: 1802-4/09-OTR APPENDIX AFFIDAVITS FORMAL BIDS Mia '7ounty Bid No.: 1802-4/09-OTR "m� Nn MIAMI-DADE COUNTY BID AFFIDAVITS • DISABILITY NONDISCRIMINATION AFFIDAVIT (Resolution R-385-95) I, being duly first sworn, state that this firm, corporation, or organization is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this contract complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction. The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327, 42 U.S.C. Sections 225 and 611 including Title I, Employment; Title II, Public Services; Title III, Public Accommodations and Services Operated by Private Entities; Title IV, Telecommunications; and Title V, Miscellaneous Provisions. The Rehabilitation Act of 1973, 29 U.S.C. Section 794 The Federal Transit Act, as amended 49 U.S.C. Section 1612 The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631 • MIAMI-DADE COUNTY DEBARMENT DISCLOSURE AFFIDAVIT (Ordinance 93-129) See Section 1 (1.3H) I, being duly first sworn, upon oath deposes and says that the bidder of this contract or his agents, officers, principals, stockholders, subcontractors or their affiliates are not debarred by Miami -Dade County. • MIAMI-DADE COUNTY COLLECTION OF TAXES, FEES AND PARKING TICKETS AFFIDAVIT (Ordinance 95-178) Section 1 (1.3 E) I, being first duly sworn state that in compliance with the procedures contained in Section 2-8.1(c) of the Code of Miami -Dade County, and as amended by Ordinance 95-178, this firm hereby certifies that the foregoing statements are true and correct. That all delinquent and currently due fees or taxes (including, but not limited to, real and personal property taxes, convention and tourist development taxes, utility taxes, and occupational license taxes) collected in the normal course by the Miami -Dade County Tax Collector and County issued parking tickets for vehicles registered in the name of the above firm, have been paid. ■ AFFIDAVIT RELATING TO INDIVIDUALS AND ENTITIES ATTESTING BEING CURRENT IN THEIR OBLIGATIONS TO MIAMI-DADE COUNTY (Ordinance 99-162) See Section 1 (1.3 N) I, being first duly sworn state that in compliance with County Ordinance 99-162, the bidder is not in arrears in any payment under a contract, promissory note or other loan document with the County, or any of its agencies or instrumentalities, including the Public Health Trust (hereinafter referred to as "County"), either directly or indirectly through a firm, corporation, partnership or joint venture in which the individual or entity has a controlling financial interest as that term is defined in Section 2-11.1(b)(8) of the County Code. c:lbid package affidavitslinformal bids.doc Page I of 8 Revised 10/24/01 Bid No.: 1802-4/09-OTR MIAMI-DADE COUNTY DOMESTIC VIOLENCE LEAVE AFFIDAVIT Ordinance 99-5 & Resolution R-185-00) That in compliance with Ordinance No 99-5, Resolution No. R-185-00 and the Code of Miami -Dade County, Florida, the following information is provided and is in compliance with all items in the aforementioned legislation. As an employer having, in the regular course of business, fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty (20) or more calendar work weeks in the current or preceding calendar year, do hereby certify to be in compliance with the Domestic Leave Ordinance, codified at 11A-60 et. Seq., of the Miami -Dade -County Code, and that the obligation to provide domestic violence leave to employees shall be a contractual obligation. BY SIGNING AND NOTARIZING THIS PAGE YOU ARE ATTESTING TO AFFIDAVITS ON PAGES 1 AND 2 MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE ■ By: 20 Signature of Affiant Date I I I 1 1 I l I Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20 He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of c:lbid package affidavitslinformal bids.doc Notary Seal Page 2 of 8 Revised 10/2440I Miami -Dade County Bid No.: 1802-4/09-OTR LIVING WAGE AFFIDAVIT (County Ordinance 99-44) I, being first duly sworn hereby state and certify that in compliance with County Ordinance 99-44 and Section 2-8.9 of the Miami -Dade County Code, by accepting award of this contract, the bidder or proposer agrees to pay the living wage required by County Ordinance 99-44 to all employees assigned to this contract. The bidder or proposer further understands that the current living wage applied to this contract is $9.25 per hour plus health benefits as described in the ordinance, or $10.59 per hour without health benefits. The Living Wage required by Ordinance 99-44 is subject to indexing as set -forth in Section "C" (Indexing). By: 20 Signature of Affiant Date I I I 1 1 1 / 1 Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20 He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of c:lbid package affidavitslformal bids.doc Notary Seal Page 3 of 8 Revised 10/29/02 Miami -Dade County Bid No.: 1802-4/09-0TR AFFIRMATIVE ACTION PLAN/PROCUREMENT POLICY AFFIDAVIT (Code of Miami -Dade County Section 2=8.1.5) (Ordinance No. 98-30) I, being duly first swom, hereby state that the bidder of this contract: ❑ has a current Affirmative Action Plan and Procurement Policy, as required by Section 2-8.1.5 of the Code of Miami -Dade County, processed and approved for filing with the Miami -Dade County Department of Business Development (DBD) under the file No. and the expiration date of ❑ had annual gross revenues in excess of $5,000,000.00 for the previous year and does not have a current Affirmative Action Plan and Procurement Policy as required by Section 2-8.1.5 of the Code' of Miami -Dade County, processed and approved for filing with the Miami -Dade County DBD. I will contact DBD at 305-349-5960 regarding this requirement. ❑ had annual gross revenues less than $5,000,000.00 for the previous year; therefore Section 2-8.1.5 of the Code of Miami -Dade County is not applicable. However, I will contact DBD at 305-349-5960 in order to submit the required affidavit and exemption request. Witness: Signature Signature Witness: By: Signature Legal Name and Title The foregoing instrument was acknowledged before me this day of , 20 FOR AN INDIVIDUAL ACTING IN HIS OWN RIGHT: By: FOR A CORPORATION, PARTNERSHIP OR JOINT VENTURE: By: having the title of with ❑ a corporation ❑ partnership ❑ joint venture PLEASE NOTE: Section 2-10.4(4)(a) of the Code of Miami -Dade County (Ordinance No. 82-37) requires that all properly licensed architectural, engineering, landscape architectural, and land surveyors have an affirmative action plan an file with the County. Section 2-8.1.5 of the Code of Miami -Dade County requires that firms that have annual gross revenues in excess of five (5) million dollars have an affirmative action plan and procurement policy on file with the County. Firms that have a Board of Directors that are representative of the population make-up of the nation may be exempt. For questions regarding these requirements, please contact the Miami -Dade County Department of Business Development at 305-349-.1950. c:Ibid package affidavitslinformal bids.doc Page 4 of 8 Revised 02/04 Miami -Dane County Bid No.: 1802-4/09-OTR CODE OF BUSINESS ETHICS Code of Miami -Dade County Section 2-8,1(i) 1, being duly sworn, hereby state and certify that this firm has adopted a Code of Business Ethics that is fully complaint with the requirements of Section 2-8.1(i) of the Code of Miami -Dade County as amended. I further acknowledge that failure to comply with the adopted Code of Business Ethics shall render any contract with Miami -Dade County voidable, and subject this firm to debarment from County work pursuant to Section 10-38(h)(2) of the Code of Miami -Dade County as amended. 1 further acknowledge that failure to submit this affidavit shall render this firm ineligible for contract award. By: 20 Signature of Affiant Date l- / / / / / / / Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20 He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of Notary Seal cabid package affidavitslinfarmal bids -doe Page 5 of 8 Revised 08/23/01 Miami -Dade County Bid No.: 1802-4/09-OTR FAIR SUBCONTRACTING PRACTICES (Ordinance 97-35) In compliance with Miami -Dade County Ordinance 97-35, the Bidder shall submit with the bid proposal a detailed statement of its policies and procedures (use separate sheet if necessary) for awarding subcontractors in accordance with Section 1, Paragraph 1.15 ❑ NO SUBCONTRACTORS WILL BE UTILIZED FOR THIS CONTRACT Signature Date c:lbid package affidavitslinfonnal bids.doc Page 6 of 8 Revised 01/15/04 Miami -Dade County Bid No.: 1802-4/09-OTR SUBCONTRACTOR/SUPPLIER LISTING (Ordinance 97-104) Firm Name of Prime Contractor/Respondent: Bid No.: Title: This forms, or a comparable listing meeting the requirements of Ordinance No. 97-104 MUST be completed, signed and submitted by all bidders and respondents on County contracts for purchases of supplies, materials or services, including professional services which involve expenditures of S100,000 or more, and all bidders and respondents on County or Public Health Trust construction contracts which involve expenditures of $100,000 or more. A bidder or respondent who is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or materials to be supplied from those identified, except upon written approval of the County. This form, or a comparable listing meeting the requirements of Ordinance No. 97-104, MUST be completed, signed and submitted even though the bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer should enter the word "NONE" under the appropriate heading of sub form 100 in those instances where no subcontractors or suppliers will be used on the contract. Business Name and Address of First Tier Subcontractor/Subconsultant Principal Owner Scope of Work to be Performed by Subcontractor/Subconsultant (Principal Owner) Gender Race Business Name and Address of Direct Supplier Principal Owner Supplies/Materials/Services to be Provided by Supplier (Principa Gender Owner) Race certify that the representations contained in this Subcontractor/Supplier Listing are to the best of my knowledge true and accurate Prime Contractor/Respondent's Signature c. au Yucnab.. .y uV1.figj VJIW.VV6. Print Name (Duplicate if additional space is needed) FORM 100 Cage 7 of a Print Title Revises Ulii5/U4 Date Miami -Dade County Bid No.: 1802-4/09-OTR CERTIFICATION OF RECYCLED ENVIRONMENTALLY ACCEPTABLE PACKAGING PRODUCT CONTENT RESOLUTION (R-738-92 MIAMI-DARE COUNTY t." `7 MINIMUM CERTIFIED CONTENT Bid Item Number RECYCLED PRODUCTS RECOVERED MATERIALS RECYCABLE PRODUCTS % Composition Type of Material % Composition Type of Material Composition Type of Material DEFINITIONS "Recycled Material" shall be defined as any waste material or by-products that have been recovered or diverted from solid waste. "Recycled Product" shall be defined as any product which is in whole or in part composed of recovered materials. "Recyclable Product" shall be defined as the ability of a product and its packaging to be reused, reconditioned for use, or recycled through existing recycling collection programs. "Waste Reducing Product" shall be defined as any product which will result in less waste generated due to its use rather than another product designed to serve the same function with a greater waste generation rate. This shall include, but not limited to those products that can be reused, refilled or have a longer life expectancy and contain a lesser amount of toxic constituents. I have the knowledge to certify and do so by certify that the Minimum Materials Content in our product(s) are as specified on this form and conform with the definitions as shown above. NAME ADDRESS CITY STATE ZIP SIGNATURE TITLE cabid package atfidavitslinformal bids,doc Page 8 of 8 Revised 08/23/01 MIAM=DADE COUNTY COUNTY ADDENDUM NO. 1 August 20, 2004 TO: All Prospective Bidders SUBJECT: BID NO.: 1802-4/09-OTR TITLE: Shoes And Boots (Safety) BID OPENING DATE: August 25, 2004 This Addendum is and does become a part of the above mentioned bid. Please note the following change(s): CHANGE BID OPENING DATE TO READ: SEPTEMBER 1, 2004 SECTION 2.0, PARAGRAPH 2.6, LAST PARAGRAPH NOW READS: The County reserves the right to add or delete vendors, which meet or exceed the qualification criteria, stated herein, during the term of this contract, as it deems necessary and in the best interests of the County. SECTION 2.0, PARAGRAPH 2.6; CHANGE THE LAST PARAGRAPH TO READ: The County reserves the right to add or delete vendors, which meet or exceed the qualification criteria, stated herein, during the term of this contract, provided that the manufacturer which your company represents or distributes has not been previously awarded on this contract, as it deems necessary and in the best interests of the County. ALL OTHER INFORMATION REMAINS THE SAME Pablo Martinez, Senior Procurement Contracting Agent BID PACKAGE ADDENDUM Revised 4/I2J44