HomeMy WebLinkAboutbid response form4.0 BID RESPONSE FORM
4.1. Certification Statement
Please quote on this form(s) net prices for the item(s) listed. Return signed original and retain a
copy for your files. Prices should include all costs,
including transportation to destination. The
City reserves the right to accept or reject all or ay part
of thehisids. s bid. Prices should be firm for a
minimum of 120 days following the time set opening.
In the event of errors in extension of totals, the unit prices shall govem in determining the
quoted prices.
We. (1) certify that we have read your Invitation for
Ti�INATION completed
itehe msnor servic s specified
sary documents,
and propose to famish and deliver, F.O.B. D
herein.
The undersignedhereby
certifies that neither the contractual party nor any of its principal
owners or personnel
nel have been convicted of any of the violations, or debarred or suspended as
set In section 18-107 or Ordinance No. 12271.
All exceptions to this bid have been documented in the section below (refer to paragraph and
section).
EXCEPTIONS:
Payment Terms: 2% 10 days_ Net 30 daysS
45/4
Delivery will be made within _calendar days after receipt of purchase order.
further certify
We
(1) is certify that any nd ail
or rior� u decontained
rstanding�his agreement d is e;orand
connection with any
that this bid is made withoutp lies, equipment, or
corporation, firm, or person submitting a bid for the same. materials, supplies,
to uip ie by allr
service, and isn it all respects s IFBir and without and certify thatlusion or fraud. am authorized tone s sign) this bid for the bidder.
terms and conditions of t
Please print the following and sign your name:
NAME OF BIDDER: r/i Ed ADDRESS: �� 7
r 4 Cf-
%��
PHONE:
EMAIL:
SR . Q- P 1C. CC/kBEEPER: �^
SIGNED BY:
TITLE:
TO CO f. t., TE sic
City of Miami
Bid No. 04-06-0s
fe0- DATE:3
RE
0Lu
Page 23
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
I HEREBY CERTIFY that at a meeting atio organized and existing under
the Board of Drectors of
SiJimeu� mo p acke , a corporation
the laws of the State of Pl oe r o , held on am ay01 api y IaRa s a'''aa
resolution was duly passed and adopted authorizing (Name)
s
(Title) 4fe uiCk Peesippw.,1 of the corporation to execute bids on behalf of the corporation
and providing that his/her execution thereof, attested by the secretary of the corporation, shall
be the official act and deed of the corporation. I further certify that said resolution remains
In full force and effect.
IN WITNESS WHEREOF, l have hereunto, set my hand this 1 , day of />i.t"+
2Q
Secretary:
Print: Th cf,C,4t 1 /orife-
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
meeting of the Board of Directors of
a partnership organized and existing under
the laws of the State of held on the _day of _, _ as
a
resolution was duly passed and adopted authorizing (Name) ---
(Title) of the to execute bids on behalf of the partnership and provides
that his/her execution thereof, attested by a partner, shall be the official act and deed of the
partnership.
l further certify that said partnership agreement remains in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this , day of..
I HEREBY CERTIFY that at a
20
Partner.
Print:
CERTIFICATE` OF AUTHORITY.
(IF JOINT VENTURE)
Joint venturers must submit a joint veonure agreement behalf of the joint venture. that if the eresnno signing
venture
this bid
Is authorized to sign bid document venture
agreement each member of the joint venture must sign the bid and submit the appropriate
Certificate of Authority (corporate, partnership, or individual).
City of Miami
Bid No. 04-O54 i Hos
Papa 24
Bid Response Form • Certification. Statement (Page 2 of 3)
C T I E F T O
CIF INDMDUAL
individually and doing
I HEREBY CERTIFY that, I (Name) (If ppplicabie} have
business as (dlbla)
executed and am bound by the terms of the bid to which this attestation is attached.
IN WITNESS WHEREOF, I have hereunto set my
hand this day of
20_
Signed:
Print:
STATE OF
) SS:
COUNTY OF•
in niment as acknowledged before me this it- day of �..
The foregoing____,
1 who is personally known to me or who has
2O o S; by ':c `'r�
Produced
oath.
ill JtAI'
sic • 1 RE • NOTARY PUBLIC
Firtfchtl
ST commission ' minim
J Expires janutry 26, 2007
PRINTED, NOTARYpPUBLIOR TYPED
NAM
City of Miami
Bid Na. 04-05-041410,
as identification and who (did / did not) take an
Page 25
4.2. B1D FORM
Item Est. Otv; Unit Price: Extended Amount:
1. Street Sweeper as or equal to Sbr $ I a 750 L gate°
Elgin Pelican SE Dual Street Sweeper
Manufacturer/Model: G▪ it• 5"1+.1
Warranty Period: (min. 1 year)
p I sfrk S4A5e4fi
Optional Items: LL
A. Full Service/Parts Maintenance Agreement (including brushes). $; -2175 6imontl pei TrrxG
mak en % $ IIst tires 4 16 •
In the event the City elects not b choose the Maintenance Agreement, please submit pricing as
8. Labor Rate for Repairs $ ) 05'4 QQ /hour
C. Parts (Catalog Price List shalt be submitted following award) % rom published price
D. Replacement Brushes $ _ /each rod(' 51de e .-ti
3 5- p.°° %ao h per pimobetieen
Number of calendar days required for delivery of
complete apparatus, after receipt of Purchase
Order: 144.S ^ 416 O 41,
NOTE: Any exceptions to minimum specifications shall be detailed on a separate page attached to your
response, titled 'Exceptions 8 Clarifications'.
Bidder.+�44r`a,�*+e.)at1 td+� s 6-9 i �' 0Authooized Signature'
Date: 3) I alb
FAILURE TO COMPLETE. SIGN AND RETURN THIS FORM SHALL DISQUALIFY YOUR BID,
City of Miami r Page 25
Bid No. 04-05-0.NO'
4.3. 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: N tt t iLd `� '� �-''���-- IP 6 0 U-cats
COMPANY OFFICERS:
lat,.,r., �� Vice President .1e �`�� �A
President tt 1 {
�{� T
f1 1�� _ reasurer
Secretary `(t f
COMPANY OWNERSHIP: Ark,
��yy
SAmG�s - • SCQ'• .�C
% of ownership
53 % of ownership
. % of ownership
% of ownership
LICENSES:
1. County or Municipal Occupational License No. (attach copy with bid)
2. Occupational License Classification
3. Occupational License Expiration Date:
4. Metro -Dade County Certificate in of d or RFPtency No.
(attached copy if requested
5. Social Security or Federal I.D. No. ' °i ~ '? S 7 7 / J
yXPERIENCI :
6, Number of Years yoia organization has been in business
3 _3 yZ.S
7. Number of Year experience BIDDER/PROPOSER {person, principal of firm, o ref) has had in operation
AAof the type required by the specifications of the Bid or RFP:. 4f
experience BIDDERIPROPOSER (firer, corporation, proprietorship) has bad in
8. Number of Years operation of the type required by the specifications of the Bid or RFP ________
City of Miami
BId No. 04-05-0dNO'
Pape 27
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 performed of a type similar to that required by
specifications of the City's Bid or RFP with whom you have done business with in the past three (3) years:
FIRM NAME/ADDRESS
DATE OF SALE DESCRIPTION OF SALE
CONTACT PERSON: PHONE NO.:
FIRM NAMEJADDRESS
DATE OF SALE DESCRIPTION OF SALE
CONTACT PERSON: PHONE NO.:
FIRM NAME/ADDRESS
DATE OF SALE DESCRIPTION OF SALE
CONTACT PERSON: PHONE NO.:
FIRM NAME/ADDRESS
DATE OF SALE DESCRIPTION OF SALE
CONTACT PERSON: PHONE NO.:
FAILURE TO FULLY COMJ'IATE, AND RETURN THIS FORM MAY DISOUALIFY YOUR BM
City of Miami
Bid No. 04-06-64NGs
Page 28
4.4. MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT
Please Check One Box Only [ ] Hispanic [ ] Female (] Black [pfeApplicabIe
If business is not 51% minority/female owned , affidavit does not 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 minoritylwomen 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 any time 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 inforruation have
occurred;
4) to notify the City of Miami within thirty (30) days of any change in the firm's ownership, 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 firm's registration information concerning its minority/women 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 firm 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.
Firm Name:
(If signing as a corporate officer, kindly affix corporate seal)
(Name, Title & Date) (Name, Title & Date)
This 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:
That: , personally appeared before tee and
acknowledged the foregoing instrument as his/her act and deed.
That he/she has produced as identification.
NOTARY PUBLIC:
My Commission Expires:
FAILURE TO COMPLETE, SIGN. AND RETURN THIS FORM MAY DISQUALIFY TSLS BID.
City of Miami Page 29
1 +
Bid No. 04-06-00N0
4.5. SAMPLE OF AFFIRMATIVE ACTION POLICY for EQUAL EMPLOYMENT
OPPORTUNITY
AFFIRMATIVE ACTION/
EQUAL EMPLOYMENT OPPORTUNITY - POLICY STATEMENT
Cc viz i P.d./J ire AZ. WO D CIS qualifications and competency and
It is the policy of (Company Name) to base its hiring and promotions on merit, q pe�Y
that its personnel practices will not be influenced by an applicant's or employee's race, color, place of birth,
religion, national origin, sex, age, marital status, veteran and handicapped status. ��
fe.,.Jt1t ediurrt�.tAtvcT ,peu p
One of the management duties of all principals at (Company Name) is to ensure that the following personnel
practices axe being satisfied:
1. Take every necessary affirmative action to attract and retain qualified employees, regardless of race. color,
place of birth, religion, national origin, sex, age, marital status, veteran and handicapped status.
tion and promotion of employees.
2. Maintain equitable principles in the recruitment, hiring, training, compensation P
3. Monitor and review personnel practices to guarantee that equal opportunities are being provided to all
employees, regardless of race, color, place of birth, religion, national origin, sex. age, marital status, veteran
and handicapped status. L
1E i o[U,u/ '- it/ ' rq pursue activities that will serve to
(ompany Name) is committed to take affirmative action and aggressively P
enable all employees and applicants opportunities available throughout this organization.
Clearly, the above actions cannot be accomplished as a secondary duty for any individual, despite the full support of
management. And so, to monitor our efforts, (Company Name) has assigned one of its principals as the
Affirmative. Action Director to monitor all activities of this program.
Employees may contact of assigned pnncipal) at (teleptione number) regarding this Affirmative Action
Policy.
DATE: 3r7 -D5-
FAILURE TO COMPLETE. SIGN. ILND RETURN TFI1S FORM MAY pLSQUALIFY THIS BID
City of Miami
B d No. 04-05-OsNO)
•
•
Page 30
4.6. OFFICE LOCATION AFFIDAVIT
Please type or print clearly.
The Affidavit must be completed in full, signed and notarized ONLY if your office h located within the
corporate limits of the City of Miami.
Legal Name of Firm:
EiWi toaro.e-T - Ptoj»-Ct` a F /o
Date Established:
Corporation Doc. No:
PREVIOUS
Street Address:
City:
According to Ordinance No. 12271(Section 18-85).
offer to a responsible and responsive local bidder, who maintains a Local Office the opportunity of accepting a bid at
The City d ansouion may a0 of the lowest other
the low bid amulet if the original bid amount cartooned by the local vendor
responsible and responsive bidder.
The intention alibis section is to benefit local bona fide biddas/proposers 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 bidden/proposal by this section.
Cad
Occupational License No:
Entity Type: (check oos box �CorpOratiofl ) n Partnership[] Sole Proprietorship Corporation
Date of Issuance:
Signature
Print Naps .t �I Ale
fie UiQe �/
Title•
Authorize Signatias
Print Name
Title
(Must ba sigaod by the corporate secretary of a Corporation or one gcaaal partner of a partnership or the proprietor of a sole proprietoeship or all
partners of a joint venture.)
STATE OF FLORIDA. COUNTY OF DADS 0 Personally known to me: or
L des of X%'� •199-�• (1 wed identifiaitiat:
Swam before Inc tut,ffiio i. a ttuestilanent this Y
Lynn* Andino
commission DOI 80065
Fgilitiilry 26, 2007
of Florida
LyNNv /
Printed mums of Notary public •
Please aubmit with your bid copies of Occapetiooal UCaOse, professioUal and/or trade Lkeme to verify local statue. The City of Miami
also reserves the right to request a copy of the corporate charter, corporate income tax filing return aid any other docamlente(s) to verify
the location of the firm's office
Page 3i
City of Miami
Bid No. 04.06-0440w
•
4.7. STATEMENT OF NO BID
NOTE: If you do La intend to submit a bid on this commodity or service, please return this form in the bid
envelope on or before bid opening. Failure to submit a response after three (3) times without a sufficient
justification of "No Bid" will be cause for removal from the vendor/bidder's list.
Office of the City Clerk
3500 Pan American Drive
Miami, FL 33131-5504
We, the undersigned, have declined to submit a bid on your Bid No. 94-05-023 for STREET SWEEPERS for the
following reasons:
Specifications too "tight", i.e., geared toward one brand or manufacturer only (explain below).
Insufficient time to respond to the Invitation for Bids
We do not offer this product or service.
Our schedule would not permit us to perform.
We are unable to meet specifications.
We are unable to meet bond requirements.
Specifications are unclear (explain below).
We are unable to meet insurance requirements.
_Remove us from your bidders' list for this commodity or service.
_____Other (specify below).
Remarks:
We understand that if this statement is not completed and returned, our company may be deleted from the City of
Miami bidders' list for this commodity or service.
Company Name:
Signature:
Title:
Telephone:
Date:
A completed vendor application should be returned with this form if vendor has not previously submitted an
application and secured a vendor number from the City.
City of Miami
Bid No. 44-06.0aNO)
Page 32
5.0 BID RESPONSE CHECK UST
This checidist is provided to help you conform to ell requirements stipulated In this IFS.
1. Bid Certification Form (Form
This form must be completedand signed to validate your bid
2. Bid Form- (Form 4.2.)
This form must be completed and signed by bidder
3. Bidder Qualification Statement (Form 4.3.)
This form should be completed in its entirety to verity the capability of
bidder to perform/deliver the services/goods specified in the IFB
4, Minority/Women Business Affairs Registration Affidavit, N
applicable (Form 4.4.)
Must be completed only if one or more
Back aHowneric in
r Female.
eusiness
enterprise is at least 51% owned by
5. Affirmative Action Policy for Equal Employment Opportunity
(Form 4.5.)
Should be completed by Bidder. .
Office Location Affidavit, if applicable (Form 4.6.)
Section 18-85 of City Ordinance No. 12271, states that the City
Commission may offer to a responsible a and�p� 9 a bibidder, the who
maintains a Local Office, the opportunity the local vendorew .
bid amount, if the original bid amount submitted of the vt other
not ore than to
responsible and responsive bidder. (Must besigned
ned andnjo� eed by
the local bidder, tooniven'ty local status. attesting for use in
City
reserves the rig
7. Statement of No Bid, only if applicable (Form 4.7.) .
if you do not intend to submit a bid on this commodity or service,
please return this form in the bid envelope on or b fompleted aoreb�medng. If
the 'Statement of No Bid' form is not of Miami bidders list for this
company may be deleted from the City
commodity or service. bid
8. Technical Documentation/Literature/Catalogue of equipment
6.
City of Miami
Bid No. 04-06-0(N0e
Required to be
Submitted with
Bid •
Yes ® No 0
Yes ®
Yes ® No 0
Yes ®No ❑
Yes ® No ❑
Yes ®No❑
Yes ®6
Yes ® No C]
TO BE SUBMITTED AS PART OF YOUR BID RESPONSE.
Page 33