HomeMy WebLinkAboutBid Response Form4.0 BID RESPONSE FORM
EDY
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 any part of this bid. Prices should be firm
for a minimum of 120 days following the time set for opening of the bids.
In the event of errors in extension of totals, the unit prices shall govern in determining the
quoted prices.
We (I) certify that we have read your Invitation for Bids, completed the necessary documents,
and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified
herein.
The undersigned hereby certifies that neither the contractual party nor any of its principal
owners or personnel 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 days
Delivery or Completion of project will be made within caserldar days after receipt of
purchase order. ! C�. 1 i ,r(i) .z o i .;' ._ � '`j >> f 1 1 � �; f
tuts Li �.,t (C.vtp is fz .. (h /kLr ,L- `t-1.i�7 �.�_, "tiCl/%of
We (I) certify that any and all information contained in this bid is true; and we (I) further certify
that this bid is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a bid for the same materials, supplies, equipment, or
service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all
terms and conditions of this IFB and certify that I am authorized to sign this bid for the bidder.
Please print the following and sign your name:
NAME OF BIDDER: �`I l X\& C=
ADDRESS: t-4..1.45I R(;;'T :' L`- ) Li..6 L n + '1
2)Ci.e! E F L 3 ,)
PHONE: (cl 44-) '1 c`�� - L.5 .fiA.4- L FAX: (ci L_ �� �� E . Ll
EMAIL: LLpc c. i j & (-L! sip ; . r-- BEEPER: 1'1)
SIGNED BY: �': -'= (. t
TITLE: �` � t ( ,a � �� .� � DATE: Cale
FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
City of Miami Page 24
Bid No. 06-06-027
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
I HEREBY CERTIFY that at a meeting of the Board of Directors of
t I nor:Li e Wue .DA , a corporation organized and existing under
the laws of the State of l- it 'r; .La_. , held on the ts, day of , 4/6 , a
resolution was duly passed and adopted authorizing (Name) Z0(2. (. -ILA as
(Title) ti i ( P e silt fill- 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, 1 have hereunto set my hand this =" day of i eh i:tr7t.
200t .
Secretary: Lfi C(1-e-
Print: Hi.i<f: rc e:t lb Li c(. i
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
I HEREBY CERTIFY that at a meeting of the Board of Directors of
�, a partnership organized and existing under
the laws of the State of , held on the day of , a
resolution was duly passed and adopted authorizing (Name) as
(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.
1 further certify that said partnership agreement remains in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this , day of
20
Partner:
Print:
CERTIFICATE OF AUTHORITY
(IF JOINT VENTURE)
Joint venturers must submit a joint venture agreement indicating that the person signing this bid
is authorized to sign bid documents on behalf of the joint venture. If there is no joint 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 Page 25
Bid No. 05-06-027
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF INDIVIDUAL)
I HEREBY CERTIFY that, I (Name) , individually and doing
business as (d/b/a) (If Applicable) have
executed and am bound by the terms of the bid to which this attestation is attached.
IN WITNESS WHEREOF, I have hereunto set
20_
Signed:..__..
Print:
STATE OF I-- t0; _i t:(s. )
) SS:
COUNTY OF TN-6A, ,t4.c� )
The foregoing `instrument was acknowledged before me
20 0 ir, , by i-444-1-c 'i d I- . tilt c ;'1 r. d : 'i ho
produced \ i as iden
oath. F
' 1
SIGNATURE OF N TARY PUBLIC
STATE OF FLORIDA
PRINTED, STAMPED OR TYPED
NAME OF NOTARY PUBLIC
City of Miami
Bid No. 05-06-027
ific
my hand this , day of
this day of
is personally known to me —or who has
a ion and who (dial dia not) take an
Page 26
4.2. BID FORM
item No.
Description: Lump Sum Amount:
cc
1. Furnishing all labor, parts, materials, and equipment $
necessary for the full renovation of the Swimming Pool
Facility at the Miami Rowing Club, as per Bid Specifications
New surface material: i_ /"/ 0j L. i ( - f i tz if
Detailed Warranty #Inform don: � I r/ln) r" 1`4 �.i4�-�''.W, _ : t( - J 1 Li (-4,,L 4:-`4:7:' l;7-�•7x:.� �'!�
IL' /71,� 1/1/)i.rVELi1aei'C.4 .. ill L1.%_e f-57 yeGUL I i.,,,i ..,i% -
Gas heater manufacturer/model no.: &' i41; i; ; Ae... (1, .S . ? 4t10c''4/
Detailed Warranty Information: ,= (,r LL./GL t' r vv'(
If no Subcontractors are to be used, insert the word "Self" in the spaces under "Name of Subcontractor".
Subcontractor's
County -Municipal
Name of Occupational
Type of Work Subcontractor License Number
1.
2. )
3.
Failure to disclose subcontractors at time of bid may deem your bid non -responsive.
Bidder:L�� Authorized Signature: --
FAILURE TO COMPLETE. SIGN AND RETURN ANI) RETURN THIS FORM SHALL DISOUALIFY THIS BID.
City of Miami Page 27
Bid No. 05-06-027
i�.
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: Ct i fin Cu.!' C' .
COMPANY OFFICERS:
President l+i' -i 4 Lk_ L . yl i.,.j ,'� ,I LT-T Vice President z CI( (� - J ) 1
Secretary i f (! Alt- Treasurer .; t f(... ,) Li-); 1. ,L,
COMPANY OWNERSHIP:
LICENSES:
1_ County or Municipal Occupational License No.
(attach copy with bid)
% of ownership
% of ownership
% of ownership
% of ownership
. ( (_`,'�
2. Occupational License Classification Pc: • c' (1 '`' f i ; a _er- t Rye_
3. Occupational License Expiration Date: .1. ) : (t / () ('
4. Metro -Dade County Certificate of Competency No.
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No."` ' �' 11�
EXPERIENCE:
6. Number of Years your organization has been in business: '( 'R (-1 J'S
7. Number of Years experience BIDDER/PROPOSER (person, principal of firm, owner) has had in operation
of the type required by the specifications of the Bid or RFP: , t lf f r' i'
8. Number of Years experience BIDDER/PROPOSER (firm, corporation, proprietorship) has had in operation
of the type required by the specifications of the Bid or RFP:
City of Miami Page 28
Bid No. 85-08-027
' :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
1-Am Pe it i?,z. e. 614 tv
-CiA) //fit f)& J
g
CONTACT PERSON: t.--:61.1./Ie Pfi-4.17;
j
FIRM NAME/ADDRESS
• ( k
ij./J(s 24).4.. )4 bevc,
't)
Yfl,47)f Ir 72> /
CONTACT PERSON: L 6 s
DATE OF JOB
ct/24: e
(
DATE OF JOB
DESCRIPTION OF JOB
C,1,( y
PHONE NO.: ( — -3
DESCRIPTION OF JOB
PHONE NO.:
FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
C r7• 44-1A.,o
/1444.
4
EU; 5 4- tj?#-) ti t. 66 76. • - -4.0
T 2/4 1*-4.64;72
CONTACT PERSON: in
FIRM NAME/ADDRESS
t" Oirsy- iicest
/•')C, 67 4/16/ ttir-
DATE OF JOB
V2c•erc
coo
?, /4/20c'it
CONTACT PERSON: (eile
PHONE NO.:0 L)---(/1) trt
DESCRIPTION OF JOB ( .?:.; cx..)..,;.• ',..:.,,,-z.,:, rc,../S)
•,)
( ..,;')ii.-- l;:-= ./). 4?,,)e-.,49-,-,•,.,,,.., /.2ie., ,i.. .....e... -
(:(.;:i• it/ L.f.,-: ,e, e'.....)r-,,.. i rz,,q,-,-.? /V,,,--e•27---
13/Yts, ._r.:-
( i• ,y11 4',-)
PHONE NO.: Y-5-9 c/k4.../ — Li/
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISOUALIFY YOUR BID.
946)t3i
-3 ,7:1-) 4:e_ I X1
Ai ,7".
City of Miami
Bid No. 05-06-027
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Page 29
4.5. SAMPLE OF AFFIRMATIVE ACTION POLICY for EQUAL EMPLOYMENT
OPPORTUNITY
AFFIRMATIVE ACTION/
EQUAL EMPLOYMENT OPPORTUNITY - POLICY STATEMENT
GI.L.i �: }l%4 I d-)064.
It is the policy of (Company Name) to base its hiring and promotions on merit, qualifications and competency and
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.
I,LL'iZf Tie POCI_5r
One of the management duties of all principals at (Company Name) is to ensure that the following personnel
practices are being satisfied:
I. Take every necessary affirmative action to attract and retain qualified employees, regardless of race, color,
place of l?irth, religion, national origin, sex, age, marital status, veteran and handicapped status.
2. Maintain equitable principles in the recruitment, hiring, training, compensation and promotion of employees.
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'LLTI ( n li.t pc`c L S ,
(Company Name) is committed to take affirmative action and aggressively pursue activities that will serve to enable
all employees and applicants opportunities available throughout this organization.
Clearly, the above actions cannot be accompli vas a seconIary dufor any individual, despite the full support of
management. And so, to monitor our efforts, �Lompa'rt"an e') Fits assigned one of its principals as the Affirmative
Action Director to monitor all activities of this program.
Employees may contact (Name of assigned prmcipal) at (telephone number) regarding this Affirmative Action
Policy.
DATE:
2•
(SIGNATURE/TITLE): �--
FAILURE TO COMPLETE, SIGN. AND RETURN THIS FORM MAY DISQUALIFY THIS BID.
City of Miami Page 31
Bid No. 05-06-027
4.6. OFFICE LOCATION AFFIDAVIT
Please type or print clearly. This Affidavit must be completed in full, signed and notarized ONLY if your office is located within the
corporate limits of the City of Miami.
Legal Name of Firm:
Entity Type: (check one box only) [] Partnership
[] Sole Proprietorship )(Corporation
Corppration Doc. No:
Office Lo
PRESENT
Street Address:
Date Established:
tioit of'tt►idder/p0ptlsel':`.
Occupational License No: Date of Issuance;
1 - O 'tl �, L.,.. = j/e.
-
City: ` h , State: FL -
How long at this location: T 5 4. -e u
PREVIOUS
Street Address: t, " L l.(-' .lLt (.1 't ri �1'1
City:
State
How long at this location:
According to Ordinance No. 12271 (Section 18-85):
The City Commission may offer to a responsible and responsive local bidder, who maintains a Local Office, the opportunity of accepting a bid at
the low bid amount, if the original bid amount submitted by the local vendor is not morn than ten percent (1 O%) in excess of the lowest other
responsible and responsive bidder.
The Intention of this section is to benefit local bona tide bidders/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 his not been established with the sole purpose of obtaining the
advantage granted bona fide local bidders/proposers by this section.
Authorize Signature
iJr-•r{Lii(:_ If c1.
ijrint Name
1
•
Authorize Signature
Ii Print Name/
Title
(Must be signed by the corporate secretary of a Corporation or one general partner of a partnership or the proprietor of a sole proprietorship or all
partners of a joint venture.)
STATE OF FLORIDA, COUNTY OF-DADE
Subscribed : Sworn befor
Notary Publi
sin true state
Printed name of Notary Public
nt this C �f
'i. tr ,
day of :'/?,:'t ,(M.,! 199 . (1 Produced identification:
SCOTT A. FRIEDERS
np
MY COMMISSION # DD302413
Nt`" XP RES: April 13, 2008
3il03.NarARY FI.Nowy Mow AMoo. CA
[l Personally known to me; or
Please submit with your bid copies of Occupational License, professional and/or trade License to verify local status. The City of Miami
also reserves the right to request a copy of the corporate charter, corporate income tax filing return and any other documents(s) to
verify the location of the firm's office.
City of Miami
Bid No. 05-06-027
Page 32
4.8. STATEMENT OF INTENT TO COMPLY WITH ORDINANCE NO. 10032
Bidder certifies that (s)he has read and understood the provisions of City of Miami Ordinance No. 10032, pertaining
to the implementation of a "First Source Hiring Agreement".
Bidder will complete and submit the following questions as part of the IFB. Evaluation of bidder's responsiveness to
Ordinance No. 10032 may be a consideration in the award of a contract.
Violations of this Ordinance may be considered cause for annulment of a contract between the successful bidder and
the City of Miami.
A. Do you expect to create new positions in your company in the event your company was awarded this contract by
the City?
Yes X. No
B. In the event your answer to Question "A" is yes, how many new positions would you create to perform this
work? i1 I C.
C. Please list below the title, rate of pay, summary of duties, number of positions, and expected length or duration
of all new positions which might be created as a result of this award of contract.
EXPECTED
NUMBER OF LENGT•
H OR
1)
2)
3)
4)
5)
6)
7)
8)
(Use additional sheets if necessary)
COMPANY NAME: L i +141 Ca E7
SIGNATURE/TITLE: C_ __- �- e C'Lc.--
Er i 1r-
DATE: f
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY THIS BID.
City of Miami Page 34
Bid No. 05-06-027