HomeMy WebLinkAboutBid Response Form 44.0 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
copy for your files. Prices should include all costs, Including transportation to destination. The
City reserves the right to accept or reject all or anyretain a
minimum of 120 days following the time set for opeing of ththisbids� Prices should be firm for a
In the event of errors in extension of totals, the unit prices shallgovern
quoted prices. in determining the
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, items or services specified
the
herein.p
The undersigned hereby certifies that neither the contractual party nor any of its rinci
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 r
section).
(refer to paragraph and
EXCEPTIONS:
Payment Terms: 2% 10 days_ Net 30 clays __
- Delivery or Completion of project will be made within three (3) calendar days afterreceipt
purchase order. of
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, o
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:
NAME OF BIDDER: __
ADDRESS: 0_f.J O GITY
_Tai- TATE/ ___z!P p 75//
PHONE:g0121 � `/12507__--FAX: ___ 7✓ 2 ,1M! ____
.1`? Iimc : EEPER: �//!� , a‘l(%e_�
EMAi
SIGNED
TI LE: /
__Ae_11241,240/4 DATE: _
FAILURE TO CO PLETE SIGN AND RETURN THIS FORM SHALL DIS • UALI Y THIS BID.
City of Miami
Bid No. 05-06-034
Page 2D
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
1 HEREB CERTIFY hat at a99�,��yy�meeting of the Board of Directors of
the law of State -he- a corporation organized of ----_____ , held an the �� o zed and existinger
resolution was dui pa sed and adopted authorizing (Name)_ d f ' +___ a
(Title) ---
and provi ing that his/her execution the o thereof,corporation
to attested bexecute secretary Is ord by ha" „f a$
the official act and deed ofcorporation
the corporation. 1 further certify that said eresolu# resolution bein full force and effect.
r IN WITNESS WHEREOF, l have hereunto -_-. L� .. . �S! 1 v-y.I
20000my
__ __,
Secretary:
Print: rs
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
1 HEREBY -'CERTIFY that at a meeting of the Board of Directors of
the laws of the State of -----, a partnership organized and existing under
resolution was dulyheld on the _day of
(Title) passed and adopted authorizingName ' --- a
that his/her execution thereof,oattested bf the to execute partner,shall be the offiof the l actapartnership and providese
partnership.act and deed of the
I further certify that said partnership agreement remains in full force and effect.
iN WITNESS WHEREOF, I 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 jointt 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
Bid No. 05.06.034
Page 21
Bid Response Form - Certification Statement (Page 3 of 3)
CERTIFICATE OF AUTHO iTY
IF INDIVIDUAL
I HEREBY CERTIFY that, I (Name)_`�`_�
business as (d/b/a) _ _ --------------._ individually and doing
executed and am bound by the terms of the bid to which this attestation is (IfApplicable)have
iN WiTNESS WHEREOF, I have hereunto set my hand this
-----------_--__, ---___ day of
Signed; ________________
Print:
STATE OF
SS;
COUNTY OF
The foregoing instrument was acknowledged before me this _
20 by ____s
day of
produced ^-T" who is personally known to me
oath. `— ____________ as identification and who (did / did not) take an
SIGNATURE OF NOTARY PUBLIC
STATE OF FLORIDA
PRINTED, STAMPED OR TYPED ��-
NAME OF NOTARY PUBLIC
City of Miami
Bid No, 05-06-034
Page 22