HomeMy WebLinkAboutQualification Statement 34.3. Qualification Statement (Page lof 2)
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:
\IG. 4- :Saftc._. Lis
COMPANY OFFICERS:
President - - - IP
Secretary .-At r ; S w e
COMPANY OWNERSHIP:
ire Sa,�\
Vice President �vh S 00. 'r
Treasurer
100 % of ownership
% of ownership
% of ownership
% of ownership
LICENSES:
1. County or Municipal Occupational License No.
(attach copy with bid)
2, Occupational License Classification
3. Occupational License Expiration Date:
4. Metro -Dade County Certificate of Competency No.
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No. —S(4, — y Lk W `'4 G t-if
EXPERIENCE:
6. Number of Years your organization has been in business:
y
7. Number of Years experience BIDDERIPIIkOPOSER (person, principal of firm, owner) has had in operation
of the type required by the specifications of the Bid or RFP: LJ
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: 4
City of Miami Page 27
Bid No. 05-06-034
Cell : �r Cou,A-S ,.,,-;W l/z, y f r
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CONTACT PERSON: o -
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:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT
DESCRIPTION OF CONTRACT
, corm, ke,4 ', t‘`o3 �w,�YI;��o c�� �- uo•h rw��o wttr
1.(0(.6-14-1 ecwlob O & e~1 K....1 h-a_
ac.14V k144 Mb '08-5S
CONTACT PERSON: Lawro. H.. .1tAr y dk
PHONE NO.: Ho = 113 - 8,001
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT..
GE
.
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT
Ci\ d ?roP.e.v.c-¢. Coltinn'\%Sla,
�Co4M11.v..uk..n. C . oh PIQct
ro' : rknc.e. RY o'Zq o 3
PHONE NO.: 2-st\ --1°t3 - q 4A 53
DESCRIPTION OF CONTRACT
V1y Is elrarvilt'. t4o
b cr
CONTACT PERSON: —NO - � 41-ci PHONE NO.: y o k - 114 - k 1 'S O
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
Lake. CO 51,?„r;T 11 Aoy 5����� (WattroC.A4% a— WoM�c-..
2.00I $ou. SA-0. . SA-. coati e,c:tc- Q.•nd ‘-'0,-4,o,sis.,: c 1awi404e
5a"- LA-k-g- L A 1/4-)ix Sy 1 qO bo. e..r..e.
CONTACT PERSON: 10oV-e- \•JoAkere r PHONE NO.: C80 N, —1'43 — Sabfl
/
FAILURE TO FULLY COMPLETE. AND RETURN THIS FORM MAY DISOUALIFY YOUR BID.
City of Miami
Bid No.06-08-034
Paper 28