HomeMy WebLinkAboutQualification Statement4.3. Qualification Statement
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:
AAA -TMA ,0nAfell' ION ) �.
COMPANY OFFICERS:
President n✓Amur NoLiv�iv�t
Secretary QUA /bb v4M.7 rz-
COMPANY OWNERSHIP:
E Gut- W Pi!3
Vice President C O
Treasurer 67)602Da / tf-4/W2)E 2—
LICENSES:
I. County or Municipal Occupational License No.
(attach copy with bid)
2. Occupational License Classification
_60 % of ownership
% of ownership
% of ownership
% of ownership
cc 4,7774e
3. Occupational License Expiration Date: cr--30 --2 O 9 &
4. Metro -Dade County Certificate of Competency No. X)O'T A-O/ / /3LE
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I,D. No. 6_f.5 — 066,1631
EXPERIENCE:
b. Number of Years your organization has been in business: TC/\
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: YE4-r2_6
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 Page 26
Bld No. 05-06-046
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
c'Tr Or NMt3/P4i44 2E
NM 9J Ft- '3 3 I b 2-
CONTACT PERSON: 1M b 4V& 0 On/EA!, (3O5) 7g7-6o
DESCRIPTION OF JOB
3t)MMoZ PgNci& wtw7Q GRAM/
%^ditiV6 glogp77C
FIRM NAME/ADDRESS
d r t of 7.41W46.- I /4064- Qom.
fi1 • Gci,w-r 3tvep .
7" 4&t4e j F'L
CONTACT PERSON:
lgQ7 To
it
PHONE NO.: (3 7g7- a o55-
DATE OF JOB DESCRIPTION OF JOB
c(le %a 60 A-*,t£ 4AIP '74giu •
Per
. "MAW ,ee7T 66/10oav
FIRM NAME/ADDRESS
I F3aa VE 7_5 ,WE•
Aim a ) '39 l g 0
CONTACT PERSON: 6'Cc1%
PHONE NO.: (g19) 597-26s
DATE OF JOB DESCRIPTION OF JOB
I q q7 70 vti4M& SP/2,wC.) '„ 2 ca d
POd lerroa✓
PA.CSb7
FIRM NAME/ADDRESS DATE OF JOB
gOyy 6/ay dL ok'
2&67.6- 5W 32 AVE•
IN-4 /4wrr/ / 33 3_1
CONTACT PERSON: AG ex 6Do /GvE Z-,eO fa'
PHONE NO.: (.3'2 972. —WOO X z2 8
DESCRIPTION OF JOB
4'0A- M0.)_ 5,4iwG l0/,im
AvL) �a v71 4 ,v
0l?73 Th y,00; T/aU
lad'`° 7a
PHONE NO.: ( ,5) N' G" '9/D
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID.
City of Miami
Bid No. 05-06-046
Page 27