HomeMy WebLinkAboutExhibit 10ATTACHMENT B
APPLICATION FOR WRECKER CONTRACT
WITH THE CITY OF MIAMI
1. Business Enterprise Name
2. Business Address
Telephone City Zip
Mailing Address
City Zip
State type of business enterprise (e.g. corporation, association, partnership, organization, joint
venture, trust, foundation, firm, group, society, individual natural person, etc.)
3. NAME ALL OWNERS/PERSONS HAVING AN INTEREST IN THE TOWING AGENCY.
(Attach additional sheets if necessary)
NAME SS#
ADDRESS PHONE
CITY STATE BIRTH DATE
NAME SS#
ADDRESS PHONE
CITY
STATE BIRTH DATE
NAME SS#
ADDRESS PHONE
CITY STATE BIRTH DATE
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NAME SS#
ADDRESS PHONE
CITY STATE BIRTH DATE
4. Has the business enterprise, or any person whose name appears in this application, ever
been convicted of any crime?
If so, list the name, the arrest and conviction record of each person. (Attach additional
sheets if necessary)
5. Does the business enterprise have an officer, director, partner,
or sole proprietor and individual, who has a currently suspended business license revoked by
action of the City within the past five (5) years?
If so, list the individual(s):
6. If a corporation, supply the following:
Corporate Name:
Date Incorporated: State of Charter
What is the fictitious name under which the business will be conducted (if applicable):
8. Has this business ever been suspended, revoked or been the subject of suspension,
revocation or violation of Local, County or State Law?
If so, explain:
9. How many wreckers does the Towing Agency have in each class? (Refer to Exhibit 2 for
Class description)
CLASS A CLASS B
CLASS A (FLATBED) CLASS C
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CLASS B (FLATBED) CLASS D
NOTE: Attach copies of vehicle registration.
10. Has the Towing Agency ever filed for insolvency, reorganization or bankruptcy petition
(Voluntary or involuntary)
If yes, explain:
11. List five (5) references:
NAME
ADDRESS TELEPHONE
12. List any current or prior towing and vehicle storage contracts for governmental
organizations:
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
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Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
13. List any current or prior towing'and vehicle storage contracts for private companies
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
Address:
Contact's Name & Phone #
Agency Name:
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Address:
Contact's Name & Phone #
14. Have any of the owners listed in Item #3 ever had a contract terminated (either as a
primary contractor or sub -contractor) for failure to comply, breach, or default?
If yes, please explain:
15. How long has this Towing Agency been in the towing business?
16. How long has the owner(s) listed in Item 3, been in the towing business? (List by name)
17. Are the payment office and storage facility located at the same site?
18. State the address of the payment office:
19. Provide the address of the storage facility or facilities; indicate the approximate square
footage of the lot at each facility and specify the square footage available for inside
storage:
20. Is the Towing Agency located entirely within the City of Miami limits:
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21. For Category A services, List the Zone(s) you wish to be considered for towing wrecker
service. If more than one, list in order of priority.
22. How many employees will be assigned to this towing contract?
23. What are the qualifications, experience, certification for towing and storage of the persons
assigned to this contract?
24. Who will be supervising the work performed under this contract and what is that person's
experience?
NOTE: IN ORDER TO BE CONSIDERED FOR MORE THAN ONE ZONE, YOU
MUST ALSO HAVE THE ADDITIONAL REQUIRED WRECKERS.
THE APPLICANT COVENANTS AND AGREES AS FOLLOWS:
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The undersigned, after being duly sworn, states that the information contained in this application is
true and correct to the best of his knowledge and belief, and in the event there are any changes,
alterations or additions to the information furnished in this application, he/she shall so notify in
writing to the City of Miami Police Department, or its successor in duties, within five (5) days from
the date of said change, alteration or addition:
Signature of Applicant and Title
Sworn to and subscribed before me this
day of , 2005.
NOTARY PUBLIC
My commission expires:
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