HomeMy WebLinkAboutQualification StatementOFFEROR'S
QUALIFICATION STATEMENT
BID NO. 2006-004
The undersigned certifies under oath the truth and correctness of all statements and of all
answers to questions made hereinafter:
SUBMITTED TO: City of Margate
(Purchasing Manager)
ADDRESS: 5790 Margate Blvd.
Margate, FL 33063
SUBMITTED BY:
NAME: -,ArA 79 FOIII-APX.
ADDRESS:
TELEPHONE NO.
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CIRCLE ONE
Corporation Partnership
Individual Other
FAX NO.
) 1. State the true, exact, correct and complete name of the partnership, corporation, trade or
fictitious name under which you do business and the address of the place of business.
The correct name of the Offeror is: 7Grv&x F-N76, ei)SESAT,y .The address of the
principal place of business is:
2. If Offeror is a corporation, answer the following:
a. Date of Incorporation:
b. State of Incorporation:
c. President's name:
d. Vice President's name:
e. Secretary's name:
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f. Treasurer's name:
g. Name and address of Resident Agent:
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3. If Offeror is an individual or a partnership, answer the following:
a. Date of organization:
b. Name, address and ownership units of all partners:
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c. State whether general or limited partnership:
4. If Offeror is other than an individual, corporation or partnership, describe the
organization and give the name and address of principals:
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5. If Offeror is operating under a fictitious name, submit evidence of compliance
with the Florida Fictitious Name Statute.
How many years has your organization been in business under its present
business name?
a Under what other former names has your organization operated?
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7. Indicate registration, license numbers or certificate numbers for the businesses
or professions which are the subject of this Proposal. Please attach certificate of
competency and/or state registration.
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8. Have you ever failed to complete any work awarded to you? If so, state when,
where and why?
9. List the pertinent experience of the key individuals of your organization (continue
on insert sheet, if necessary).
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10. State the name of the individual who will have personal supervision of the work:
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