HomeMy WebLinkAboutBid Response Form 34.0 BID RESPONSE FORM
4.1. Certification Statement (Page 1 of 3)
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
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: 1
NAME OF BIDDER: � (/O PVQ-D�S C n n c Kr orjhT .S�iUJ C ¢� hC
ADDRESS:I (5) Sc-S. U3 • l 1CbITY: ► r i rk' STATE:1L ZIP: 3 51 5"7
PHONE: 74`16 - -, °1-1d FAX: .1 % CO
EMAIL: H Q )ct ( b necio) •<O EPER:
SIGNED BY:
TITLE: L,O f DATE: 3 0
FAILURE TO COMPLETE. SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
City of Miami Page 41
Bid No. 04-05-116
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
11 I -IEREB CERTI Y that at a meeting of the Board of Directors of
-l'i'i?Wi4ttiYc LA t& in i)-1 , i,. _LA ( . , a corporation organized and existing under the
laws of the State f jr"/o,2) Of , held on the )'- day of) '1 r -'c-J , b 6 , a resolution
was duly passed and adopted authorizing (Name) H oW-2 c hixy, as
(Title) 00)ne K. 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. p
IN WITNESS WHEREOF, I have hereunto set my hand this II , day of rflr rc �+ ,
200(n .
Secretary;
Print:
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.
I further certify that said partnership agreement remains in full force and effect.
IN WITNESS WHEREOF, 1 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 42
Bid No. 04-05-116
Bid Response Form - Certification Statement (Page 3 of 3)
CERTIFICATE OF AUTHORITY
(IF INDIVIDUAL)
I HEREBY CERTIFY that, I (Name) /I 2 0 4 /)co , individually and doing
business as (d/b/a) Alt� /) mR i --W•di dCbG` 14.E Y (If Applicable) have executed
and am bound by the terms of the bid to which this attestation is attached.
ApeMtdie
IN WITNESS WHEREOF, I have hereunto set my hand this /4( , day of .2 G ,
20Dcr.
STATE OF /.a4//�A )
++ Harold Stewart
`+k Commission t1DD214386
Expires: Jun 24, 2007
Bonded Thin
Atlantic Bonding Co., Inc..
COUNTY OF fl d 4-0-6 )
The foregoing instrument Qwas acknowledged before me this
20 , by ./t�oc-rig" 4_/?r6dar , who +'ti
produced _ , / _ as identification
SIGNATURE OF NOTARY PUBLIC
STATE OF FLORIDA
Ati C �'q c 4 s/9-0-
PRINTED, STAMPED OR TYPED
NAME OF NOTARY PUBLIC
City of Miami Page 43
Bld No. 04-05-116
t
da of M40-6/-( e-),
ally knows o me or who has
n• w o • I• did not) take an oath.