HomeMy WebLinkAboutQualification Statement 54.3. Qualification Statement (Page lof 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:
Awe rie.40,1
COMPANY OFFICERS:
President a-Ed,L6r6 E
Secretary 042 V R/ Of A/6AM •
COMPANY OWNERSHIPP:/
4 Q•L.'M . MLI✓A�-.
IAl tr
e'ri ,0/7076,4 071Cadori
Vice President
Treasurer ' mJ 42. to
LICENSES:
1.
County or Municipal Occupational License No.
(attach copy with bid)
2. Occupational License Classification
3. Occupational License Expiration Date:
• % of ownership
/9. % of ownership
% of ownership
% of ownership
/ 16 .5p e 4-; 4%/ ZrAdek ii7lizador
'5e.p�em &er 50, 2006 .
4. Metro -Dade County Certificate of Competency No. e. 06/ 2 (30
(attached copy if requested in Bid or RFP) 5. Social Security or Federal I.D. No. 6 - q 2 VI 2 / .
EXPERIENCE:
6. Number of Years your organization has been in business:
7. Number of Years experience BIDDER/PROPOSER (person, principal o firm, owner) has
of the type required by the specifications of the Bid or RFP: 0;4a* •
8. Number of Years experience BIDDER/PROPOSER (firm, corpor tion,_propietgrship) has
of the type required by the specifications of the Bid or RFP:, Q 9CL'i e4 •
0 ed ,
City of Miami
Bid No. 05-06-006
Page 29
had in operation
had in operation
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 DESCRIPTION OF JOB
c LE- 47 -T ,,c 4 b.
CONTACT PERSON: PHONE NO.:
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.:
AGENCY/FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID.
City of Miami Page 30
Bid No. 05-06-006