HomeMy WebLinkAboutQualification Statement4.3. 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: ` i I G C�C� I ' (c? �-)P
COMPANY OFFICERS:
President L1rrt=d c) 0. \.1 Vice President
Secretary ll [ _ Treasurer n {r;
COMPANY OWNERSHIP:
Fr yt I % of ownership
% of ownership
% of ownership
% of ownership
LICENSES:
1. County or Municipal Occupational License No'1 651—?
(attach copy with bid)
2. Occupational License Classification "a61P Lcebr'Vot,,., p It vki:ce,
3. Occupational License Expiration Date: -1 / • jr
4. Metro -Dade County Certificate of Competency No._
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No._
EXPERIENCE:
6. Number of Years your organization has been in business:
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:`
40
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
Bid No. 04-05-123
Page 24
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(3uaJ
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 DATE OF JOB DESCRIPTION OF JOB
l 3o g ti1 (.1.1"11,0-Gb)
CONTACT PERSON:R.e
PHONE NO:
FIRM NAME/ADDRESS DATE OF JOB
al be 1�7{J CL J
DESCRIPTION OF JOB
Tee lrui
CONTACT PERSON: R (.0_ C, ( Jr'
FI NAME/ADDRESS
PHONE NO.: E a5'3 — "-IOC
DATE OF JOB
i ek w,-t F, 3-1t4-4-
DESCRIPTION OF JOB
CONTACT PERSON r � PHONE NO: < -2 �y(o7j $--4
FIRM NAME/ADDRESS DATE OF JOB DESCRIPTION OF JOB
Kt F 1.9P4- 1-ei6wa car 1 ire 3e vU: .
. D S.w (.l a...1 G,..b�_Ir. ,. „o
4n Li;,AA_/ }-L_ti L . irY
rr
CONTACT PERSON: \ &t�llt 0
Int
t c,-- PHONE NO.: ?T„,(910`4-dI41-1,7ka-l1),..1,
FAILURE TO FULLY COMPLETE. AND RETURN THIS FORM MAY DISOUALIFY YOUR BID.
City of Miami Page 25
Bld No. 04-05-123
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