HomeMy WebLinkAboutQualification Statement 54.3. 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: (1Gt+b e.s Ste--, ►n Cr
COMPANY OFFICERS:
President` i vv a rie-11-4
rt;
Secretary r1;X(,e_ (A/kJ 5
COMPANY OWNERSHIP:
Vice President &IQ-44c—
C.)
l
Treasurer \I ^ 1
LICENSES:
I e % of ownership
l % of ownership
% of ownership
% of ownership
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. --4- I (10 ( P 8,
EXPERIENCE;
6, Number of Years your organization has been in business:
7. Number of Years experience BIDDER/PROPOSER (person, principal of firm, owner) has had in operation
of the type required by the specifications of the Bid or RFP:
8. Number of Years experience BIDDER/PROPOSER (firm, corporation, pro jetorship) has had in
operation of the type required by the specifications of the Bid or RFP:
City of Miami Page 27
Bid No. 05-06-034
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
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CONTACT PERSON:
PHONE NO,:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
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CONTACT PERSON:
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PHONE NO.:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
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CONTACT PERSON: PHONE NO.:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
CONTACT PERSON: PHONE NO.:
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID,
City of Miami Page 28
Bid No. 05-06-034