HomeMy WebLinkAboutQualification Statement 44.3. Qualification Statement (Page 9 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: goer. - 1�\r1G�C C N"YI C�� ` r C Vt S �� ] "1 � ¥(�rcq'
I �
COMPANY OFFICERS:
President
Cr
COY l Vice President_-- G et- (7 ' t'C i;..,€ Ct
Secretary
COMPANY OWNtRSHiP:
.t rcvC\rik'(JC'
:TV; «J i e -
Treasurer . (Q -o TOO 1(
LICENSES:
70 % of ownership
30 % of ownership
% of ownership
% of ownership
1, County or Municipal Occupational License No. B 3 3 "3'7
(attach copy with bid) 33
2. Occupational License Classification Z [ 7 co t., 00- ,A-
3. Occupational License Expiration Date: C q / / le) 0 (:
4. Metro -Dade County Certificate of Competency No. ..C.- 4 Rs 1072
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No. 7' - -311 "- i✓ i
EXPERIENCE:
6. Number of Years your organization has been in business: \ y
PP- --Pj
7. Number of Years experience BIDDER/PROPOSER (person, print pal of fnm, owner) has had in operation
of the type required by the specifications of the Bid or RFP: 1 �/ f' u lr`
8. Number of Years experience BIDDER/PROPOSER (firm, corpora ad in
operation of the type required by the specifications of the Bid or RFP:
City of Miami Page 29
Bid No. 05-06-006
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 RFP with whom you have done business with in the past three (3) years:
AGENCY/FIRM NAME/ADDRESS
DATE OF JOB
i� c 10 > �.'_ r 1 l �v
DESCRIPTION OF JOB
CONTACT PERSON: ., (3tz • f1 V- ' hy i(_ PHONE NO.:
6`05 a,�► c "h, 30�40:M
AGENCY/FIRM NAME/ADDRESS DA1 OF JOB DES
CRIPTION OF JO
._. • , 0 y—^^c�
CO ACT PERSON:A'
AGENCY/FIRM ME/ADDRESS
°15 '2>Z('X) '11)62-,kAn
1F /1_c
PHONE NO.:
DESCRIPTION OF JOB
CONTACT PERSON:_Ta' '� 1/41 `-„; Gti t. rr^
AGENCY/FIRM NAME/ADDRESS
nor) (Lb- �I iVe
PHONE NO.:(3 6) 1 7 7
DATE OF JOB DESCRIPTION OF JOB
Cu r-r
CONTACT PERSON: v U 1--lc t
PHONE NO.( j)47b --j�
FAILURE TO FULLY COMPLETE. AND RETURN THIS FOR.111 MAY DISQUALIFY YOUR BID,
City of Miami
Old No. 05-06400
Page 30