HomeMy WebLinkAboutExhibit 6City of Miami, Florida
Private Investigation Services RFLI 05-06-064
STATEMENT OF QUALIFICATIONS FORM
PRIVATE •INVESTIGATION SERVICES FOR THE CIP
RFLI NO. 05-O6 64
INSTRUCTIONS: Individuals seeking to provide Private Investigation Services on an as
needed, when needed basis, are required to answer all sections of this Attestation, in
addition to providing required information as reflected within RFLI. If any section does not
apply, indicate not applicable ("NA").
FAILURE TO COMPLETE THE FOLLOWING SECTIONS IN THEIR ENTIRETY, AND
FAILURE TO SUBMIT ALL DOCUMENTS, WILL DISQUALIFY YOU FROM
CONSIDERATON IN PROVIDING PRIVATE INVESTIGATION SERVICES TO THE CW.
Name of Firm/individual:
Address of Firm/Individual:
Mailing Address, if different than above:
Information -on Proposer:
A. Provide proof of current certification/license(s) as a Private Investigator in good
standing, from the State of Florida Department of Agriculture and Consumer
Services or any other agency of the State of Florida authorized to issue such
license(s). Proof of licenses as a Private Investigator, of Firm and any assigned
Investigators of firm, and any interested Individual, must be provided with
Response.
YES NO
If yes, individual must submit a current copy of his/her resume certification as a
Private Investigator,
B. Provide its overall qualifications and experience of Proposer. Additionally provide -a
current resume of Proposer and Investigator(s) to be assigned to this Project. The
resume(s) must reflect the following information for at least the past three (3) years:
(1) name(s) of currentlpast employer(s), to include contact name and telephone
number, for -whom private investigation services was performed;- (-2) -the length of
time the Investigator provided said services for that employer(s); and (3) all
experience which reflects the Investigator's familiarization with standard
investigative practices. Include all experience related to law enforcement or work
performed of a similar nature. The CIP reserves the right to contact any and all
references to verify and determine qualifications.
YES
NO
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City of Miami, Florida. !Private lnvestigalion Services RFLI-05.06-064
8. Shall agree to submit to, and •successfully pass, a background investigation at the
CIP's cost, as part of the qualification process.
YES NO
C. Shall submit certificate(s) of insurance evidencing coverage in a form acceptable to
the Department of Risk Management.
YES NO
D. Shall agree to complete, and successfully pass, a paid familiarization -Program to
be provided at the CIP's cost, as part of the qualification process.
YES NO
E. Shall adhere to the Fee Schedule for payment of services described in Section VI1I.
YES NO
Please be advised that any Private Investigator who marks / indicates "No"
to any of the qualification requirements stipulated above shall be disqualified
from consideration as a private Investigator under this RILL
I hereby certify that the above information provided, and its corresponding
documentation, is true and correct. 1 fully understand that any false or misleading'
information, or the omission of information as required by the GIP for the purposes of
deceit or deception, shall be grounds for disqualification from serving as a Private.
Investigator.
The following must be witnessed and notarized by an authorized Notary Public.
Signed:
Date:
Telephone:
Email address:
Print Name:
Fax Number:
Beeper/Cellular number:
10
no, of Miami, Florida
Witnessed by:
Private Investigation Services REV 0546-0164
Print Name:
State of Florida, County of
Subscribed and Sworn before me that this is a true statement this day of
2006. personally known to me, or: produced identification.
Notary Public, State of Florida
Commission Expires (Seal)
Print Name of Notary Public
FAILURE TO COMPLETE AND RETURN THIS FORM SHALL DISQUALIFY INDIVIDUAL FROM
CONSIDERATION AS A PRIVATE INVESTIGATOR UNDER THIS RFLI.
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City of Miami, Florida
Private Investigation Services RFL105-06-064
6.1. RFLI INFORMATION FORM
PRIVATE INVESTIGATION
SERVICES FOR THE CIP
RFLI NO. 05-06-064
I certify that any and all information contained in this Proposal is true; and I further certify that this Proposal
is made without prior understanding, agreement, or connections with any corporation, firm or person
submitting a Proposal for the same materials, supplies, .equipment, or services and is in all respects fair and
without collusion or fraud. I agree to abide by all terms and conditions of the RFLI, and certify that I am
authorized to sign for the proposer. Please print the following and sign your name:
Firm's Name: Telephone:
Principal Business Address: Fax:
E-mail address:
Name:
Mailing Address:- _Title:
Authorized Signature:
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City of Miami, Florida Private Investigation Services RFLI05-06-064
6.2 CERTIFICATE OF AUTHORITY
(IF CORPORATION)
STATE OF
) 'SS:
COUNTY OF
I HEREBY CERTIFY that a meeting of the Board of Directors of the
a corporation existing under the laws of the State of , held on , 20
the following resolution was duly passed and adopted:
"RESOLVED, that, as President of the Corporation, be and is hereby authorized to execute the Proposal dated,
, 20 _ , to the City of Miami and this corporation and that their execution thereof, attested by
the Secretary of the Corporation, and with the Corporate Seal affixed, shall he the official act and deed of this
Corporation."
1 further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF, I have hereuntoset my hand and affixed the official seal of the corporation this
dayof ,20 .
Secretary:
(SEAL)
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSES
13
City of Miami, Florida Private Investigation Services RFLI 0546-064
STATE OF
COUNTY OF
)
) SS:
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
1 HEREBY CERTIFY that a meeting of the Partners of the
organized and existing under the laws of the State of held on
, 20 _ , the following resolution was duly passed and adopted:
"RESOLVED, that, , as of the Partnership, be and is hereby
authorized to execute the Proposal dated, 20 , to the City of Miami and this partnership
and that their execution thereof, attested by the
shall be the official act and deed of this Partnership."
1 further certify that saidresolution is now -in full force and effect.
IN WITNESS WHEREOF, 1 have hereunto set any hand this , day of
20
Secretary:
(SEAL)
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISOUALIFY YOUR RESPONSE.
14
City of Miami, Florida
Private Investigation Services RF1,105.06-064
STATE OF
COUNTY OF
CERTIFICATE OF AUTHORITY
OF JOINT VENTURE)
) SS:
1 HEREBY CERTIFY that a meeting of the Principals of the
organized and existing under the taws of the State of
, held on
, 20 , the following resolution was duly passed and adopted:
"RESOLVED, that, as of the Joint Venture
be and is hereby authorized to execute the Proposal dated, 20 , to the City of Miami
official act and deed of this Joint Venture."
I further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this , day of
,20
Secretary:
(SEAL)
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE.
City of Miami, Florida
Private Investigation Services RFL1 05-06-064
STATE OF
) SS:
COUNTY OF
CERTIFICATE OF AUTHORITY
(if individual)
I HEREBY CERTIFY that as an individual, I
(Name of Individual)
and as a d/b/a (doing business as)
(if applicable)
exist under the laws of the State of
Florida.
"RESOLVED, that, as an individual and/or d/b/a (if applicable), be and is hereby authorized to execute the Proposal
dated, , 20 , to the City of Miami as an individual and/or d/b/a (if applicable) and that
my execution thereof attested by a Notary Public of the State, shall be the official act and deed of this attestation."
I further certify that. said resolution is now in full force and effect.
IN WITNESS WHEREOF, 1 have hereunto set my hand and affixed the official seal of Notary Public this
day of , 20
NOTARY PUBLIC:
Commission No.:
I personally know the individual/do not know the individual (Please Circle)
Driver's License ti
(SEAL)
FAILURE TO COMPLETE. SIGN, AND RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE
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City of Miami, Florida Private Investigation Services RFL105-06-064
6.3. DEBARMENT AND SUSPENSION
Authority and requirement to debar and suspend:
After reasonable notice to an actual or prospective contractual party, and after reasonable opportunity to such
party to be heard, the City Manager, after consultation with the Chief Procurement Officer and the City
Attorney, shall have the authority to debar a contractual party for the causes listed below from consideration
for award of city contracts. The debarment shall be for a period of not fewer than three (3) years. The City
Manager shall also have the authority to suspend a contractor from consideration for award of city contracts if
there is probable cause for debarment. Pending the debarment determination, the authority to debar and
suspend contractors shall be exercised in accordance with regulations which shall be issued by the Chief
Procurement Officer after approval by the City Manager, the City Attorney, and the City Commission.
(b) Causes for debarment or suspension include the following
1. Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public
or private contract or subcontract, or incident to the performance of such contract or subcontract;
(a)
2. Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or
destruction of records, receiving stolen property, or any other offense indicating a lack of business
integrity or business honesty;
3. Conviction under state or federal antitrust statutes arising out of the submission of bids or proposals;
4. Violation of contract provisions, which is regarded by the Chief Procurement Officer to be indicative of
non -responsibility. Such violation may include failure without good cause to perform in accordance
with the terms and conditions of a contract or to perform within the time limits provided in a contract,
provided that failure to perform caused -by -acts -beyond -the control of -•a partyshallnot be considered a
basis for debarment or suspension;
5. Debarment or suspension of the contractual party by any federal, state or other governmental entity;
6. False certification pursuant to paragraph (c) below; or
7. Any other cause judged by the City Manager to be so serious and compelling as to affect the
responsibility of the contractual party performing city contracts.
(c) Certification:
All contracts for goods and services, sales, and leases by the City shall contain a certification that neither the
contractual party nor any of its principal owners or personnel have been convicted of any of the violations set
forth above or debarred or suspended as set forth in paragraph (b) (5).
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 set forth above, or debarred or suspended as set forth in
paragraph (b) (5).
Company name:
Signature:
Date:
FAILURE TO COMPLETE, SIGN, ANDRETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE
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City of Miami, Florida
Private Investigation Services RFL105.06-064
6.4. STATEMENT OF COMPLIANCE WITH ORDINANCE NO. 10032
Proposer certifies that (s) he has read and understood the provisions of City of Miami Ordinance =No.
10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source Miring
Agreement."
Proposer will complete and submit the following questions as part of the RFLI.
Violations of this Ordinance may be considered cause for annulment of a Contract between the
Successful Proposer and the City of Miami.
A. Do you expect to create new positions in your company in the event your company was awarded a
Contract by the City?
Yes No
B. In the event your answer to Question "A" is yes, how many new positions would you create to perform
this work?
C. Please list below the title, rate of pay, summary of duties, number of positions, and expected length or
duration of all new positions which might be created as a result of this award of a Contract.
..........: . EXPEC3C.
RATE:OF PAY NUMBER OF LENGT11R
POSMONTTITLE DUTIES
POSITIONS. DURATIOlq
1)
2)
3)
4)
5)
6)
7)
8)
(Use additional sheets if necessary)
PROPOSER NAME:
SIGNATURE/TITLE:
DATE:
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY PROPOSAL.
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City of Miami, Florida
Private Investigation Services RFL105-06-064
6.5 MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT
Please Check One Box Only: [ ] Hispanic [ ] Female [ ] Black [ ] Not Applicable
If business is not 51 °/,% minority/female owned, this affidavit does not apply. If not applicable, notarization is not required.
1 (We), the undersigned agree to the following conditions:
1) that we meet the fifty-one percent (51%) ownership and management requirement for minority/women registration status
and will abide by all of the policies and regulations governing the City of Miami Minority and Women Business Enterprise
Procedures;
2) that if at any time information submitted by the undersigned applicant in his/her Bidder Application should prove to be
false, inaccurate, or misleading, applicant's name will be struck from the City of Miami's Master Bidder list with no further
consideration given to this applicant;
3) that the City of Miami maintains the right, through award of bid/contract, to revoke the award, should it he found that false,
inaccurate or misleading information or a change in the original information have occurred;
4) to notify the City of Miami within thirty (30) days of any change in the firm's ownership, control, management or status as
an ongoing minority/women business concern as indicated on the Bidder Application, and that the City of Miami, upon a
finding to the contrary, may render a firm's registration with the City null and void and cease to include that firm in its
registered list of minority and women -owned businesses;
5) that the City of Miami has a right 10 diligently verify all information submitted by applicant in his/her Bidder Application
to monitor the status of the Minority/Women Business Enterprise, once registered;
6) that the City of Miami may share a firm's registration information concerning its minority/women status and its capability
with other municipal or state agencies for the sole purpose of accessing the firm to their procurement opportunities, unless
otherwise specified by the firm in writing.
1 (We) certify under the penalties of perjury that the information contained in any and all application documents submitted to the City
of Miami is correct as per Ordinance No. 10062 as amended.
Firm Name:
--{(If signing as -a -corporate officer-, kindly -affix corporate seal) -
(Name, Title & Date)
(Name, Title & Dale)
This application must be signed by at least one general partner of a partnership or the proprietor of a sole proprietorship
or all partners of a joint venture.
NOTARIZATION
STATE OF )
) SS:
COUNTY OF
That:
acknowledged the foregoing instrument as his/her act and deed.
That he/she has produced as identification.
Date:
NOTARY PUBLIC:
personally appeared before me and
My Commission Expires:
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EIP of Miami, Florida
Private Investigation Services RFLI No. 03-{)4-097
6.7. INSURANCE REQUIREMENTS
Commercial General Liability
Limits of Liability
Each Occurrence $500,000
General Aggregate Limit $1,000,000
Personal and Adv. Injury $500,000
Products/Completed Operations $500,000
Error's & Omissions $500,000
Endorsements Required
City of Miami included as an Additional Insured
Business Automobile Liability
Limits of Liability
Bodily Injury and Property Damage Liability
Combined Single Limit
Any Auto
Including Hired, Borrowed or Non -Owned Autos
Any One Accident $300,000
Endorsements Required
City of Miami included as an Additional Insured
-Worker's Compensation -
Limits of Liability
Statutory -State of Florida
Waiver of Subrogation
Employer's Liability
Limits of Liability
$100,000 for bodily injury caused by an accident, each accident
$1-00,000 for bodily injury caused by disease, each empioyee
$500,000 for bodily injury caused by disease, policy Limit
The above policies shall provide the City of Miami with written notice of cancellation or material
change from the insurer not less than (30) days prior to any such cancellation or material change.
Companies authorized to do business in the State of Florida, with the following qualifications, shall issue
all insurance policies required above:
The_c.4.m.pany must be rated no less than "A" as to management, and no less than "Class V".,as to
Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Eesf Company,
Oldwick, New Jersey, or its equivalent. All policies and for certificates of insurance are subject to
review and verification by Risk Management prior to insurance approval.
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