HomeMy WebLinkAboutBid Submittal Form 2MIAMI-DADE COUNTY BID NO: 4907-1/06-OTR
BID SUBMITTAL FORM
Bid Title: PLAYGROUND AND PARK EQUIPMENT, FURNISH, DELIVER AND/OR INSTALL
By signing this Bid Submittal Form the Bidder certifies that it satisfies all Segal requirements (as an entity) to do business with the County, including all Conflict of interest and
Cudc of Ethics provisions in Section 2-11 of the Miami -Dade County Code. Any County employee or member of his or her immediate family seeking to contract with the County
shall seek a conflict of interest opinion from the Miami -Dade County Ethics Commission prior to submittal of a Bid response or application of any type to contract with the County
by the employee or his or her immediate family and file a copy of that request for opinion and any opinion or waiver from the Board of County Commissioners with the Clerk of
the Board. The affected employee shall file with the Clerk of the Board a statement in a form satisfactory to the Clerk disclosing the employee's interest or the interest of his or her
p p ... intended t i or g p nse, or application.of any type to. contract
immediate
the Cvunt . Also a copyof the requesttract and the nature of the contract at the same time as or before p B
mediate family snthe ro osed canc� .
w y _ . rfora conflict of interest opinion from, the Ethics Commission and pny comes ondsn response,
opinion, or any waiver issued by the Board of.
County Commissioners, must be submitted with the response to the solicitation.
In accordance with Sec. 2-11.1(s) of the County Code as amended, prior to conducting any lobbying regarding this solicitation, the Bidder must file the appropriate form with
the Clerk of the Board statine that a particular lobbyist is authorized to represent the Bidder. Failure to file the appropriate form in relation to each solicitation may be
considered as evidence that the Bidder is not a responsible contractor.
The Bidder confirms that this Bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Bid for the same goods and/or
services and in all respects is without collusion, and that the Bidder will accept any resultant award. Further, the undersigned acknowledges that award of a contract is contingent
upon vendor registration. Failure to register as a vendor within the specified time may result in your firm not being considered for award.
Pursuant to Section 2-8.6, any individual, corporation, partnership, joint venture or other legal entity having an officer, director, or executive who has been convicted of a felony
during the past ten (10) years shalt disclose this information prior to entering into a contract with or receiving funding from the County.
❑ Place a check mark here to affirm compliance with this disclosure requirement.
COUNTY USER ACCESS PROGRAM (UAP): Joint purchase and entity revenue sharing program
For the County's information, the bidder is requested to indicate, at 'A' and 'B' below, its general interest in participating in the Joint Purchase Program of the County User Access
Program (UAP) described in Section 2.21 of this contract solicitation, if that section is present in this solicitation document. Vendor participation in the Joint Purchase portion of
the UAP is voluntary, and the bidder's expression of general interest at 'A' and 'B' below is for the County's information only and shall not be bigdine on the bidder.
A. If awarded this County contract, would you be interest in participating in the Joint Purchase portion of the UAP with respect to other governmental, quasi-govemmental
or not -for -profit entities located within the geographical boundaries of Miami -Dade County?
Yes No
and
B. If awarded this County contract, would you be interested in participating in the Joint Purchase portion of the UAP with respect to other governmental, quasi -
governmental or not -for -profit entities located outside the geographical boundaries of Miami -Dade County?
Yes No
LOCAL PREFERENCE CERTIFICATION: The responding vendor hereby attests, by checking one of the following blocks, that it is 0, or is not 0, a local business. For
the purpose of this certification, a "local business" is a business located within the limits of Miami -Dade County (or Broward County in accordance with the Interlocal Agreement
between the two counties) that conforms with the provisions of Section 1.10 of the General Terms and Conditions of this solicitation and contributes to the economic development
of the community in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities and the support and
increase to the County's tax base. Failure to complete this certification at this time (by checking the appropriate box above) shall render the vendor ineligible for Local
Preference.
Firm Name:
Street Address:
Mailing Address (if different):
Telephone No. Fax No.
Email Address: FEIN No. _I - / / / I l l
Prompt Payment Terms: % days net days
+"By signing this document the bidder agrees to all Terms
(Please see paragraph 1.2 H of General Terms and Conditions) and Conditions of this Solicitation and the resulting Contract"
Signature:
(Signature of authorized agent)
Print Name: Title:
Failure to slap this page shalt renderyvur Bid non -responsive.
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Revised 05-04