HomeMy WebLinkAboutOffice Location Affidavit4.6. OFFICE LOCATION AFFIDAVIT
Please type or print clearly. This Affidavit must be completed In full, signed and notarized ONLY if your office is located within the
corporate limits of the City of Miami.
Legal Name of F irm:
Entity Type: (check one box only) [) Partnership
[] Sole Proprietorship [] Corporation
Corporation Doc. No: Date Established:
Occupational License No: Date of Issuance:
S' y y ' "� % s'rs��� d' �raEsE : si �: s?s
�; �wii.E o �#� .4. d f it 3e (iitrtti lti €iisiir ,E
PRESENT
Street Address:
City:
State: How long at this location:
PREVIOUS
Street Address:
City:
State How long at this location:
According to Ordinance No. 12271 (Section 18-85):
The City Commission may offer to a responsible and responsive local bidder, who maintains a Local Office, the opportunity of accepting a bid at
the low bid amount, if the original bid amount submitted by the local vendor is not more than ten percent (I0%) in excess of the lowest other
responsible and responsive bidder.
The intention of this section is to benefit local bona fide bidders/proposers to promote economic development within the corporate limits
of the City of Miami.
I (we) certify, under penalty of perjury, that the office location of our firm has not been established with the sole purpose of obtaining the
advantage granted bona fide local bidders/proposers by this section.
Authorize Signature
Print Name
Title
Authorize Signature
Print Name
Title
(Must be signed by the corporate secretary of a Corporation or one general partner of a partnership or the proprietor of a sole proprietorship or all
partners of a joint venture.)
STATE OF FLORIDA, COUNTY OF DADE
[) Personally known to me; or
Subscribed and Sworn before me that this is a true statement this day of 199 . O Produced identification:
Notary Public, State of Florida My Commission expires
(aiei11)
Printed name of Notary Public
Please submit with your bid copies of Occupational License, professional and/or trade License to verify local status. The City of Miami
also reserves the right to request a copy of the corporate charter, corporate income tax filing return and any other documents(s) to verify
the location of the firm's office.
City of Miami Page 40
Bid No. 05-06-085
4.7. STATEMENT OF NO BID
NOTE: If you do Loot, intend to submit a bid on this commodity or service, please return this form in the bid
envelope on or before bid opening. Failure to submit a response after three (3) times without a sufficient
justification of "No Bid" will be cause for removal from the vendor/bidder's list.
Office of the City Clerk
3500 Pan American Drive
Miami, FL 33131-5504
We, the undersigned, have declined to submit a bid on your Bid No. 05-06-085 for PURCHASE AND
INSTALLATION OF ABOVEGROUND FUEL TANKS FOR GSA AND MARINE STADIUM MARINA for
the following reasons:
Specifications too "tight", i.e., geared toward one brand or manufacturer only (explain below),
Insufficient time to respond to the Invitation for Bids
We do not offer this product or service.
Our schedule would not permit us to perform.
We are unable to meet specifications.
We are unable to meet bond requirements.
Specifications are unclear (explain below).
We are unable to meet insurance requirements.
Remove us from your bidders' list for this commodity or service.
Other (specify below).
Remarks:
We understand that if this statement is not completed and returned, our company may be deleted from the City of
Miami bidders' list for this commodity or service.
Company Name:
Signature:
Title:
Telephone:
Date:
A completed vendor application should be returned with this form if vendor has not previously submitted an
application and secured a vendor number from the City.
City of Miami Page 41
Bid No. 05.06.085
4.8. STATEMENT OF INTENT TO COMPLY WITH ORDINANCE NO. 10032
Bidder certifies that (s)he has read and understood the provisions of City of Miami Ordinance No. 10032, pertaining
to the implementation of a "First Source Hiring Agreement".
Bidder will complete and submit the following questions as part of the IFB. Evaluation of bidder's responsiveness
to Ordinance No. 10032 may be a consideration in the award of a contract.
Violations of this Ordinance may be considered cause for annulment of a contract between the successful bidder and
the City of Miami.
A. Do you expect to create new positions in your company in the event your company was awarded this contract
Yes IomNo
by the City?
B. In the event your answer to Question "A" is yes, how many new positions would you create to perform this
" work? 4./4-
C. Please list below the title, rate of pay, summary of duties, number cif positions, and expected length or duration
of all new positions which might be created as a result of this award of contract.
1)
2)
3)
4)
5)
6)
7)
8)
(Use additional sheets if necessary)
COMPANY NAME: Ars,. G ` �'�^"' L .c. (h
SIGNATURE/TITLE: oe' DATE: '"a
FAILURE T PLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY THIS BID.
City of Miami Page 42
Bid No. 06-06-086