HomeMy WebLinkAboutQualification Statement 44.3. 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:
COMPANY OFFICERS:
President (1 d
Vice President ' Y ® rtf2._
Secretary 5 !i L Treasurer1S
1-1-0/6hei
COMPANY OWN RSHIP:
J.-W(5
LICENSES:
/ 06 % of ownership
of ownership
% of ownership
of ownership
l . County or Municipal Occupational License No. 1 Y (A
(attach copy with bid)
2. Occupational License Classification
3. Occupational License Expiration Date: J V !'
4. Metro -Dade County Certificate of Competency No. NM
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No. 2 2+'6 46 76,
EXPERIENCE:
6. Number of Years your organization has been in business: 31�
WAAL
7. Number of Years experience BIDDER/PROPOSER (person, prin ye of firm, o
of the type required by the specifications of the Bid or RFP:
ner) has had in operation
8. Number of Years experience BIDDER/PROPOSER (firm, corporatio9n�, proprietorship) has had in
operation of the type required by the specifications of the Bid or RFP: 3tQ
C.
City of Miami
Bid No. 05-06-034
Page 27
DATE OF CONTRACT DESCRIPTION OF CONTRACT
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PHONE NO.: 5a 5-- 0 oC 7— 9 50e
DATE OF CONTRACT DESCRIPTION OF CONTRACT
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CONTACT PER ON: 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 Sid 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
AO 11 .t . 41 rreelihi 3Ita ;a (h4'rof. ot,A (�Hla Sri PAkt.) A,
31 N. 5 ,-'l •#.5. tP.Crdrsr VA, Ed./ oNICT
C��I RA.Ct
Z k5017— 7R
CONTACT PERSON: S N: S 1 crick- ( L PHONE NO.: W o o c7 5 531-1
AGENCY/FIRM NAME/ADDRESS
CONTACT PERSON Pt g1-0 0it-o- (3- a Ie L
AGENCY/FIRM NAME/ADDRESS
PHONE NO.: 026-3' r 75- I f f 7
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
•1
CONTA V PERSON:
g q MO3DAQLA A4 ( A- e¢,r,
P r� Crefi a ANA G.oi'SR1hG1-
37 11- 0 5(DO
Ni ar v R o sseLt.,r
PHONE NO.: (0 ! 5. 3 65 -1l0 00 X /23
FAILURE TO FULLY COMPLETELAND RETURN THIS FORM MAY DISQUALIFY YOUR BID.
City of Miami Page 28
Bid No. 05-06-034