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HomeMy WebLinkAboutExhibit 5PROPOSAL PAGE 3 BIDDER'S CONTRACTORS LICENSE (S) - LIST APPROPRIATE LICENSE (5 1. STATE OF FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD: CERIIFI D REGISTERED CONTRACTORS LICENSE No.: G C / 7'Y'-3 EXPIRATION DATE: .PC5 / % G OR QUALIFIED BUSINESS ORGANIZATION LICENSE' No.: EXPIRATION DATE: OR II. MIAMI- DADE COUNTY: CONTRACTORS CERTIFICATE OF COMPETENCY BUSINESS No.: VALID UNTIL e OR STATE CONTRACTORS CERTIFICATE OF REGISTRATION" No.: VALID UNTIL NOTE: • For a Corporation or other Business Organization, required by the State of Florida. '• Florida Licensed Contractors have the option of listing their State Licenses or listing their Certificate of Registration with Miami- Dade County. r / BIDDER'S MUNICIPAL OCCUPATIONAL LICENSE No.: ] `r 3 2/ .��: EXPIRATION DATE: t/3 al o r 7//o BIDDER'S INSURANCE EXPIRATION DATE : Attached hereto is a certified check in the amountof drawn on (name of Bank) or a Bid Bond furnished by //e,"c /c ', rt r' j ram,:( .t1151<�, (Bonding Company) represented by filow,v / (Ps urance Agent) / 'fir/- o�'%�r Dollars ($ sib/ ) for the sum of made payable to: City of Miami, Florida. The full names and addresses of persons and firms interested in the foregoing Bid, as Principals, are as follows: / &ilnernda K. ,3Ari,A 5 9'3 / Sc.) 6 sr _.1, t i tc/, 3 3/.r / SUBMITTED BY: 614.4;r0WASia juice I c o 4 Zvi". (Name of Firrn or Corporation) CPI eaJr. (Address of Firm or Corporation) State Zip Code (Signature) (CORPORATE SEAL) 3or 7C/o- 6S/5 (Teelephone Number) (Title) (Title) PROPOSAL Page 4 Cin of Miami. Florida MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT Please Check One Box Only tspanic [) Female [) Black ( ] Not Applicable If business is not 51% minoriry.`fcmale owned,, affidavit does not apply. If not applicable. notarization is not required. l {Wei, the undersigned agree to the following conditions: I) . that we have read Section 2.25 of the General Terms and meet the fifry-one percent (5l%) ownership and management requirement. for minorityiwomen 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 information have occurred; 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 minoriryr'women business concern as indicated on the. Bidder Application, and that the Cir of Miami, upon a finding to the contrary, may render a..flan's registration with the City null and void and cease to include that firm in its registered list of minority and women -owned businesses; that the City of Miami has a right to diligently verify all information submitted by applicant in his.her Bidder Application to monitor the stares of the Minority/Women Business Enterprise, once registered; 61 that the City of Miami may share a firms registration information concerning its minorirywornen status and its capability with other municipal or state agencies for the sole purpose of accessing the firm to their procurement opppor*unities. unless otherwise specified by the firmin writing. I .(We) certify und er the penalties of perjury that the information contained in anv and all application documents submined to the City of .iarrii.is correct as per Ordinance No, .10062 as amended. Firm Name: + 17d//rO ,cl�i� fl U er-iriG of 6707 (I f signing as a;orpc). fftcer. kindly affix corporate seal) (Name, Title 8 Date) This appl anon must be signed by at least one general partner of a partnership or the proprietor of a sole proprietorship or all partners of ajoint venture, NOTARIZATION COUNTY. SS COUNTY DA Date: �O 43 / 5 That: /5• p AG,A_, pe sonal y appeared before me and acknowledged :he foregoing instru nt as hisrher act and deed. That heshe has produced 41924._,V) as identification. NOTARY PUBLIC: My Commission Expires: �......++..+........ HILDA LOZANO.«.......0 bolas 1101Mil Florida Ntlrry Alan ha a.1...i H... M N... H N..NMYNMN ..i.... ei STATEMENT OF COMPLIANCE WITH ORDINANCE NO. 1002: !:e Bidder certifwus that r.: t:as rend anr, uncle__ Provisions of City of. Miami Or:1inance No. 1(1032, •...: :_ rocr, to the implementation of a First Source Hiring Acreemer... The Bidder will complete end submit the following cues ti^ns as part of the bid proposal. Evaluation of tr.e Bidder s responsiveness to Ordinance No. 10022 will be a consideration in the award of a. contract Violations of this Ordinance may be considered cause fcr annulment of a contract between! the Eidder and the City of *liana. Do `.you expect to create new positions (i.e. laborer, bricklayer, pipe fitter) in your company in the event your company was awarded this bid by the City? NO In the .event your answer to number. 1 is yes, how many:neM' positions would y'u create by virtue of perferrnina this bid:' Please list below the title, irate of nay; summary of .duties, and expected . length or Duration of a1i neu positions which. right he created + by :virtue of : vnuccmpany'.s award. ofthis job.. POSITION/TITLE Rr.TE OF PAY DUTIES EXPECTED Circle one LENGTH OR Hourly/Weekly DURATION 2. (Use additional sheets if necessary) PROPOSAL Page 6 4. Would your firm fully.cooperate with the City of Miami in filling these. positions under the First Source Hiring Ordinance ` of the City, a copy of which is found in the book titled "Standard Contract Documents and Specifications for Public Works Contracts, October 2001 Edition," as revised? YES NO Is your firm ready, willing and. able to execute s First Source Hiring Agreement with the South Florida Employment Training Consortium and to be bound by its terms prior to consideration 'of the bid award by the City Commission? YES Date 200_5 SWORN TO AND SUBSCRIBED. Before me this fs day 0f JGwt,-- 20 05 NO ivi C.�¢J Xervier-J 4. Name of Bidder 591.9/ S. w NamAdress,of Enti Nota y Public, `fit ate of Florida at Large My Commission Expires: fb-CA 0 0 , 20 47 HILDA LOZANO : COMP 000 Swim erts (10O)432•42 4; 111 Florid' Molar/ Assn., Inc NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Florida) ) ss County of Miami Dade) gerAgA L4P 4A- says that: , being first duly sworn. deposes (1) He is • (owne¢, partne officer, representative, or agent) of titvho,atii)Asfe. ,) C'(S Cv'e“-yo the bidder that has submitted the attached bid; • (2) He is : fully informed respecting the preparation' and contents of the attached bid and of all pertinent circumstances respecting such •bid; (3) Such bid is genuine and is not a collusive or sham bid; (4) Neither the said bidder nor any of its officers, partners, owners, agents; representatives, . ertiployees or parties. in interest, including this affiant, has in any way colluded, conspired. or agreed, • directly or indirectly with. any other bidder, firm or person to submit a collusive or sham bid in connection with the contract for which the attached bid has been submitted or to refrain from bidding in connection • with '•such contract, or has in any manner, directly. or indirectly, sought, by agreement or collusion or • communication or conference with any other bidder, firm or, person to fix the price or prices in the attached bid of any other bidder, or to fix' any overhead, profit or cost element of the bid price or the bid price. of any other, bidder, . or to secure through any collusion, conspiracy, connivance • or :unlawful agreement any advantage against the City of. Miami or any person. interested in the proposed contract; • and.. • (5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. Subscribed and sworn to before me This %_ day of u�-- , 2 igee/-/-eLz_ Ae Paeke e Title T-0-41A/Caefj,$� 20 a 9. My commission expires City of Miami. Florida SAMPLE OF AFFIIIMATIVE ACTION POLICY for EQUAL EMPLOYMENT OPPORTUNITY AFFIRMATIVE ACTION/ EQUAL EMPLOYMENT OPPORTUNITY - POLICY STATEMENT It is the policy of (Company Name) to base its hiring and promotions on merit. qualifications and competency and that as personnelpractices 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, One of the management duties of all principals at (company Name) is to ensure that the following personnel practices are being satisfied: . 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. Maintain equitable principles in the recruitment, hiring. training, compensation and promotion of employees. 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. (Company Name) is committed to takeaffirmative action and aggressivelypursue activities that will serve to 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 (Name of assigned principal) at (telephone number) regarding this Affirmative : Action Policy. (SIGNATURE.TITLE)��/ FAILURE TO COMPLETE, SIGN. AND RETURN THIS FORM MAY DISOUALIFY THIS BID. City of Miami PRIMARY OFFICE LOCATION , Affidavit Please type or print clearly. This Affidavit must be completed In full, signed and notarized for local preference consideration. . egal Name ol Firm: 0/1U%/JA Ot,(SrjJ e .C.eru/ce.I �f'O(y) .4..., Entity Type: lane= ire dai o„yl D Parrtersnrp Q sae Provnerorsn,o /1aCorooranon Corporation Doc. No: f gaOOZ/4r967 Dale, wished: 2i19� Occupational License No: ��y32 V 3 Data f Iss4anca: 1 .%7/v. Primary Office Location (Principal estahiptvrentat t'4 bidder/proposer): _ ctCity: ,r Street Address: 5-'7. / S 88 s State: ,/` Mow Tong at this location: 571. N o Slreel Address: f� 237D evry 53 2ao City: State: r� rHow long at this Iocancr: According to the City of Miami's Charter 29-A es amended: 'All contracts...shall be awarded by the commission to no lowest responsible bidder.._ provided. however, that rf the amount ol a bid or proposal submitted by a vendor whose primary office is located in the City of Miami is not more a art,..1t7X N excess ot the lowest otr er responsible bidder or. proposer, such local vendor may be awaraad the contract..' The Intention of this se-ction Is to benefit local bone tide vsndoeopropaeers to promote economic development within the City of Miami. I (we) certify, under penalty of penury, that the primary office lo4aban Of out Ilan nu not been established wr the a purpose al obtaining the advantage granted bona fide tocai vendorslproposers by this sacton. er �[ n e5 ure . / 1 u R r44_, nnl Nam! 'off/"e Tole Authorize Signature Print NarTa Till! (Must be signed by me corporate secretary of a Corporation or one general partner of a partnership or the proprietor ot a sate propneIorship or all partners of a !Dint venture.) STATE OF FLORIDA, COUNTY OF DARE ---- 2ersonafty known to rne. or th Subscribed and Sworn before me at this is a true statement this / day of �200 5 Produced Idenuticauon: ' HILDA LOZANO 3= Notary Publ a at Flonda ��t 1 _ ! ni ri 4--� e A v / 1 d0I ,0 Coma 000saa244 = Erf]Mss ttla2olle ilamisdthru(SODj432.42a4= urn Florida Notary Assn., Inc e Pnnteo Name of Notary Public My Commission Expires Pteese submit with your bid, copies of occupational License, professional and/or trade License to verity local status. The City of Miami.