HomeMy WebLinkAboutQualification Statement 24.3. Qualification Statement (Page 1 of 2)
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:
COMPANY OFFICERS:
President 1,PrC (
Secretary
Vice President
Treasurer
% of ownership
% of ownership
% of ownership
% of ownership
+RC
LICENSES:
1. County or Municipal Occupational License No. t 2 4..- I
(attach copy with bid) C.,s—,..--ek_pc.4—..v.,,,
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2. Occupational License Classification 3. Occupational License Expiration Date: 1 3 t 1 c
4. Metro -Dade County Certificate of Competency No,
(attached copy if requested in Bid or RFP)
5. Social Security of Federal I.D. No.
pXPERIENcE:
6. Number of Years your organization has been in business:
t5
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: is
8. Number of Years experience BIDDERJPROPOSER (firm, corporation, propetorship) has had in
operation of the type required by the specifications of the Bid or RFP:
City of Miami Page 29
Bid No. 06-06-006
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 REP with whom you have done business with in the past three (3) years:
AGENCY/FIRM NAME/ADDRESS DA OF JOB DESCRIPTION OF JOB
i4s/4-C Is
L
Cm-1.-......-f‘ . Y.*-—LA01—
CONTACT PERSON: I� PHONE NO.: 'clkS ` r ' 17 /' ÷ 46 Or
AGENCY IRM NA/ADDRESS DA OF JOB DESCRIPTION OF JOB
CONTACT PERSON: 2"w1'q PHONE NO3 S +3 ` t 1 g7
AGENCY/FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
AGENCY/FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FAILURE TO FULLY COMPLETE. AND RETURN THIS FORM MAY DISOUALIFY YOUR BID.
City of Miami Page 30
Bid No. 05.06.006