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Bid Response Form 6
4.0 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 govem 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 V Delivery or Completion of project will be made within three (3) calendar days after receipt of purchase order. 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: NAME OF BIDDER: ,D2 akirrkieLe444.4.,�'-��'�' ,l U , ADDRESS:74 l 7' cue r CITY /Y// ATE I1 ZIP3 ZO PHONE: 10 5/ 9 '_ 4/7 9 FAX: 040 / ©4/7? EMAIL:5UP bk 1 • T-4/C BEEPER: Aid C-p. 23-- / .23 SIGNED BY: '`"g" 4.5/1.114*teloile4.DATE: 41 T 1 04 TITLE: FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. City of Mani Page 20 Bld No. 06-06-034 Bid Response Form - Certification Statement (Page 2 of 3) CERTIFICATE OF AUTHORITY (IF CORPORATION) 1 HEREBY . CERTIFY that. at a meeting of the Board of Directors of J / & m a -Ttv el a corporation organized and existing unde r the lawthe State of 0l r164, held on the day of � a resolution wa dui p ssed and adopted authorizing (Name►¢::- /0 as (Tiflelp PS 04004012, of the corporation to execute bids on behalf of the corporation and providing th his/her execution thereof, attested by the secretary of the corporation, shall be the official act and deed of the corporation. I further certify thatsaid resolution remains in full force and effect. IN WITNESS WHEREOF, I have hereunto set 104411101181140bscriktiOthireaaees Secretary: r ....r. ' A#, nture I Nr,.{ Po Hc-State of Flona Print: ,���► , '� r Prim, lyre or Stamp liam i at Nottry Public J L Prigntilly WWI :ail Mel Of CERTIFICATE OF AUIPICROPitd 'iriiintltloiatlbna j i)L (IF PARTNERSHIP) TYRO oridenNricaatlnn 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 hls/her execution thereof, attested by a partner, shall be the official act and deed of the partnership. HEREBY CERTIFY that at a 1 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: ITS 41 let 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 21 Bid No. 06-06-034