HomeMy WebLinkAboutQualification Statement 64.3. 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:
S'a66 ,4414-fahtioad9,4 c
President /de la /L Vice PresidentAl‘di.,!alp
Secretary v' °`4, L - D ) Treasure
C(}MPANY OWNERSHIP:
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/riivo2i 1 easuG
LICENSES:
1. County or Municipal Occupational License No."
(attach copy with bid)
2. Occupational License Classification
3. Occupational License Expiration Date:
OC
Izs /o (.
/ V % of ownership
% of ownership
% of ownership
% of ownership
S
-Ld-e
4. Metro -Dade County Certificate of Competency No.
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No.
EXPERIENCE:
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6. Number of Years your organization has been in business:
7. Number of Years experience BIDDER/PROPOSER (person, print, ipal of f mr, owner) has had in operation
of the type required by the specifications of the Bid or RFP: iP_.;r 4ZS
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:
City of Miami Page 27
Bid No. 06-06-034
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
04 146/UM alie 5/2-Air
CONTACT PERSON:
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AGENCY/FIRM NAME/ADDRESS
Atizto atie5/1-e;
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CONTACT PERSON:
DATE OF CONTRACT
fro
AG CY/FJRM NAMFJADDRESS DATE OF CONTRACT
4
CONTACT PERSON:S •
AGENCY/FIRM NAME/ADDRESS
CONTACT PERSON:
PHONE NO.: kO S.Z T— Z 2 ( 0
DESCRIPTION OF CONTRACT
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PHONE N
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DESCRIPI1ON OF CONTRACT
Alf Qs d qsAar-
PHONE NO.: C2 L2 72 - 8 / 8IJ
DA OF CONTRACT DESCRIPTION OF CONTRACT
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PHONE NO.: d� 33/- 471 2 .1-
-cG 0
/1/11 c.u. /Y1/ls � 6o �z
FAILURE TO FULLY COMP ,ETE. AND RETURN THIS FORM MAY DISOUALIFY YOUR BID.
City of Miami Page 28
Ski No. 06-08-034