HomeMy WebLinkAboutBid Response Form4.17. The protected and insulated AST systems design shall have been in use for a minimum of eighteen
(18) years. The manufacturer must stipulate no reportable AST containment system failure in 28,000
units produced.
4.18. The protected and insulated AST systems shall have two (2) bolts for connecting grounding
conductors for lightning protection in accordance with NFPA 780.
4.0 BID RESPONSE FORM
4.1. Certification Statement (Page 1 of 3)
Please quote on this form(s) net prices for the item(s) listed. Return signed original and retain a
copy for your files. Prices should include all costs, including transportation to destination. The
City reserves the right to accept or reject all or any part of this bid. Prices should be firm for a
minimum of 120 days following the time set for opening of the bids.
In the event of errors in extension cif totals, the unit prices shall govern in determining the
quoted prices.
We (I) certify that we have read your Invitation for Bids, completed the necessary documents,
and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified
herein.
The undersigned hereby certifies that neither the contractual party nor any of its principal
owners or personnel have been convicted of any of the violations, or debarred or suspended as
set in section 18-107 or Ordinance No. 12271.
All exceptions to this bid have been documented in the section below (refer to paragraph and
section).
EXCEPTIONS: /A,A%
Payment Terms: 2% 10 days_ Net 30 days ✓�
Delivery or Completion of each project will be made within 45 calendar days after receipt of
purchase order.
We (I) certify that any and all information contained in this bid is true; and we (I) further certify
that this bid is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a bid for the same materials, supplies, equipment, or
service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all
terms and conditions of this IFB and certify that I am authorized to sign this bid for the bidder.
Please print the following and sign your name:
NAME OF BIDDER: T erdtx,CEu.vr ' %�cI,✓, ref G S"t •t.u/cam /MC
ADDRESS: /371,7 ,5
tAi /S-Z 11. CITY 444(' STATE 7i4--ZIP 33177
PHONE: 3 aS 4 44, - 5966 FAX: -50s-" a 6 7 3'
� Cc-LL
dJ
EMAIL: !) to/Ca hat. Saj21, .+tier BEEPER; 3c'S 986 a 39 '
City of Miami Page 30
Sid No. 06.06-086
SIGNED BY:
TITLE:
ZZ)zw--t----
194e5i Pour DATE: .g d)j C
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
City of Miami Page 31
Bid No. 06-06-086
Bid Response Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
n I HEREBY CERTIFY that at a meeting of the Board of Directors of
t" rlLat, Tedrot,cacti ,u.ae. , a corporation organized and existing under
the laws of the State of ` - -1. b-4- , held on the day of TIC a
resolutionAwas duly passed and adopted authorizing (Name) p. . z_ 4TS J as
(Title) V4 c. ! t3CvT" of the corporation to execute bids on behalf of the corporation
and providing that his/her execution thereof, attested by the secretary of the corporation, shall
be the official act and deed of the corporation. I further certify that said resolution remains
in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this ix) , day of
20 .
Secretary:
Print:
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
I HEREBY CERTIFY that at a meeting of the Board of Directors of
i//4- a partnership organized and existing under
the laws of the State of , held on the ,day of , a
resolution was duly passed and adopted authorizing (Name) as
(Title) of the to execute bids on behalf of the partnership and provides
that his/her execution thereof, attested by a partner, shall be the official act and deed of the
partnership.
I further certify that said partnership agreement remains in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this , day of
20
Partner:
Print:
CERTIFICATE OF AUTHORITY
Al (IF JOINT VENTURE)
Joint venturers must submit a joint venture agreement indicating that the person signing this bid
is authorized to sign bid documents on behalf of the joint venture. If there is no joint venture
agreement each member of the joint venture must sign the bid and submit the appropriate
Certificate of Authority (corporate, partnership, or individual).
City of Miami Page 32
Bid No. 06-06.085
Bid Response Form - Certification Statement (Page 3 of 3)
CERTIFICATE OF AUTHORITY
(IF INDIVIDUAL)
I HEREBY CERTIFY that, I (Name) 4,74 , individually and doing
business as (d/b/a) (If Applicable) have
executed and am bound by the terms of the bid to which this attestation is attached.
IN WITNESS WHEREOF, I have hereunto set my hand this day of
20
Signed:
Print:
STATE OF
SS:
COUNTY OF )
The foregoing instrument was acknowledged before me this day of ,
20 , by , who is personally known to me or who has
produced as identification and who (did / did not) take an
oath.
SIGNATURE OF NOTARY PUBLIC
STATE OF FLORIDA
PRINTED, STAMPED OR TYPED
NAME OF NOTARY PUBLIC
City of Miami Page 33
Sid No. 06-06.08S
4.2. BID FORM
4.2.1. Furnishing and installation of a 15,000 Gallon Aboveground Gasoline Tank
at GSA in accordance with Bid Specifications, at the below listed price:
Item
No.
Description:
1. Furnishing and Installation of 15,000 Gallon
Aboveground Gasoline Tank with included items
as per Bid Specifications
U/M
Lump Sum
Completed
Project Price
$ Ion, WO.° o
if no Subcontractors are to be used, insert the word "Self" in the spaces under "Name of Subcontractor'.
Subcontractor's County -Municipal
Type of Work Name of Subcontractor Occupational License Number
et-
1. LE(-lji t c *L 6L. ..Go./, S i7E--GICd 6—C Q0E0, 2
2. c.t..1'e %3ia.coca 9A1 7.
3,
Manufacturers warranty parts (years) 1A4)fG-- j 9ex- S 7.0 t't- ctp /
Manufacturers warranty labor (years) -• t+t (L%
Delivery time (maximum 45 Days) If less, please indicate here: r" � ,,,,�.
Twenty-four (24) hour response time after call for service is required.
Exceptions to specifications (if any)
yg&.
PCL ZJ `- ( "Ti tA.A. r vt3 i h) i ', $
City of Miami Page 34
Bid No. 06-06-085
4.2.2. Furnishing and installation of a 2,000 Gallon Aboveground Gasoline Tank
at Marine Stadium Marina, in accordance with Bid Specifications, at the below
listed price:
Item Completed
No. Description: U/M Project Price
1. Furnishing and Installation of 2,000 Gallon
Aboveground Gasoline Tank with included items
as per Bid Specifications
Lump Sum
If no Subcontractors are to be used, insert the word "Self" in the spaces under "Name of Subcontractor".
Type of Work
1. • Ge t-+ 444-
2.
3.
Subcontractor's County -Municipal
Name of Subcontractor Occupational License Number
4c47 J� di "Lr�' eC 4a'92...
c-'. 44. (5'1 0c c oyF47
Manufacturers warranty parts (years) 7.�--�1G �jca yR /c- egr ea-- r1GJLJ f i y,-
Manufacturers warranty labor (years)_ 0 ifs-rr. 5
Delivery time (maximum 45 Days) If less, please indicate here: ,?eD
Twenty-four (24) hour response time after call for service is required
Exceptions to specifications (if any)
7 T(:— 7E-Ai0e0
Bidder:gEa-OLEZu . :Tie/AO 441 $u` uthori d Signature:
(Company Name)
Print Name:.JO I '-) .L 0.)i4-7515A"---
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
City of Niteroi Page 35
Bid No. 05-06-085
4.3. Qualification Statement (Page 1 of 2)
INSTRUCTIONS:
This questionnaire is to be included with your bid. Do not leave any questions unanswered. When the question
does riot apply, write the word(s) "None", or "Not Applicable", as appropriate. Please print.
COMPANY NAME: PeT..oLE%&z J C 1 " 041.. 5c,u, e-t
COMPANY
�-OFFICERS: .
President i,1Q Inn) C� . ),ATSVice President
Secretary ' AV O, f �•v,'�� Treasurer �.JQ 4 .) D..
COMPANY OrWNERSHIP:
a4IAA)
LICENSES:
Q % of ownership
% of ownership
% of ownership
% of ownership
1. County or Municipal Occupational License No. VA -VC C o 'r) ZEd 0 6'ct S' )
(attach copy with bid)
2. Occupational License Classification 5erz0.4 .M CZ- 114. + C41
3. Occupational License Expiration Date:
4. Metro -Dade County Certificate of Competency No. 5T.4 4..4.7:4-.441 »t c _"14 ta..51S- 7.7
(attached copy if requested in Bid or RFP)
5. Social Security or Federal I.D. No. 4' ,0 7- Q(9- c"46
EXPERIENCE:
6. Number of Years your organization has been in business: 15 y 6-44- 5
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: 1 C ' 4-/t S A - a
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: ' ' 'y 4 4-)
City of Miami Page 36
Bid No.05-06-086
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 five (5) years:
AGENCY/FIRM NAME/ADDRESS DATE OF PROJECT DESCRIPTION OF PROJECT
EA,Aui„ &4 9 AA! 4.44. 1 13 '. Lb-Cr- AA ‘4r i4a.D
ice"
CONTACT PERSON: "„A.' 1.7-0,4.6
A[.40c' 14 C.e.i,45�4
AGENCY/FIRM NAME/ADDRESS
ili1) € itod (j.4 ti 41 i— 06
Lvt3. — Mti
PHONE NO3o;3 -7T Z Z- 8
LL•
DATE OF PROJECT DESCRIPTION OF PROJECT
RCA 04.ra— Z• 64- "" Gi-cLaL cJ s r
CONTACT PERSON: TO L'f .-"-Sei461r
AGENCY/FIRM NAME/ADDRESS
5, 69 �"� aliki l,M if0
`�� J/�
CONTACT PERSON: Africa 4.6/9,4,,0
PHONE NO,: 30-- 72 z.-)'
DATE OF PROJECT DESCRIPTION OF PROJECT
PHONE NO
AGENCY/FIRM NAME/ADDRESS DATE OF PROJECT DESCRIPTION OF PROJECT
/Uli ►w 1 Zizeorriet.� JL.t. t '- 5 ` .4.4 fc. & -
LA -sr- !a y 5 (Z e 1 o v cca s-s'
o
CONTACT PERSON: t ( (l IElf .a{- S`
PHONE NO.: 305" 5T? C tlG'
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID.
City of Miami Page 37
Bid No. 06.06.085