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HomeMy WebLinkAboutQuestionaire00500. SUPPLEMENT TO BID FORM: QUESTIONNAIRE THIS COMPLETED FORM SHOULD BE SUBMITTED WITH THE BID, HOWEVER, SUBMISSION OF THE FORM OR ANY ADDITIONAL INFORMATION NOT INCLUDED IN THE SUBMITTED FORM AS DETERMINED IN THE SOLE DISCRETION OF THE CITY, MAY BE SUBMITTED WITHIN SEVEN (7) CALENDAR DAYS OF THE CITY'S REQUEST. FAILURE TO SUBMIT THE FORM OR ADDITIONAL INFORMATION UPON REQUEST BY THE CITY SHALL RESULT IN THE REJECTION OF THE BID AS NON -RESPONSIVE. The undersigned authorized representative of the Bidder certifies the truth and accuracy of all statements and the answers contained herein.. I. How many years has your organization been in business while possessing one of the licenses, certifications, or registrations? f Lt yEAgS License/Certification/Registration Name and Number # Years CA C-0G/-- ftAueL Qc.4NA — IA. What business are you in? Commweriom I°' "Ly 2. What is the last project of this nature that you have completed? 1PAt11. (Nsrats.'noAoF Sw1214 R4P 3° GTywrDE — 11200,a00+a-GTyoiFllk NHiAI 5 �o�wA,yc. Cull& RA m.P 1 TF-zi,- CA-DAr) — 4 1, 051.0, boo ‘-t! _1D07-�rsT 3. Have you ever failed to complete any work awarded to you? If so, where and why? A. Give owner names, addresses and telephone numbers, and Surety and project names, for all projects for which you have performed work, where your Surety has intervened to assist in completion of the project, whether or not a claim was made. Nb — 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: hr(.ci' Sul afWG - $�Fl,soR Cmto M. t�t~e1 MtA Mt , "FL 31Ibo (36s)111C--12 oo (name) S$ ‘..4i•essik sr (phone #) 1 (14.4ct oF-le( Q(sow u6 leyB'54WNg. FL331vq Cam) Xs-- giS'S (name) address) (phone #) �.e$ a$A�w,r I►„ti (3a46o -MOO of Cork.. 'S GANAcoal t. QAb ,FL 31)54 (name) (address) (phone #) Bid No. 05-06-095 Page 31 6. List the following information concerning all contracts in progress as of the date of submission of this bid. (In case of co -venture, list the information for all co -venturers.) TOTAL DATE OF % OF NAME OF OWNER & CONTRACT COMPLETION COMPLETION PROJECT PHONE # VALUE PER CONTRACT TO DATE XDA9Mow.I. lot IAMI•'I DFCCUJ9 �� �3 GoM9uA,+a 36-3%s Z -23'4 194oN fl pc, strata/Ad MIAMI— Coy► L]4 4�'' t1Pp,p AEvats box,. Nis- zwi2. �O ; OOo Tab (Continue list on insert sheet, if necessary.) 7. Has a representative of the Bidder completely inspected the proposed project and does the Bidder have a complete plan for its performance? No 8. Will you subcontracty part of this Work? If so, provide the following details for each subcontractor(s) that will perform work in exc,ss of ten percent (10%) of the contract amount. (Attach additional sheets if necessary) Subcontractor Approx. MEI Description of Work Name Percentage Status The foregoing list of Subcontractor(s) may not be amended after award of the Contract without the prior written approval of the Contract Administrator, whose approval shall not be unreasonably withheld. 9. What equipment do you own that is available for the Work? �ur.p e , MAC441P3G Cowe&FTE SA*}) ' LA-T1b ED i>64.cxr Aelit4c4 CoPANA-TlON,' CCR !'c h 10. What equipment will you purchase for the proposed Work? at.a Mn nF_na_naR Page 32 11. What equipment will you rent for the proposed Work? 12. State the name of your proposed project manager and superintendent and give details of his or her qualifications and experience in managing similar work. M Ic,L Qc-AgJa — c G a 6d $ 04 13. State the true, exact, correct and complete name of the partnership, corporation or trade name under which you do business and the address of the place of business. (If a corporation, state the name of the president and secretary. If a partnership, state the names of all partners. If a trade name, state the names of the Individuals who do Usiness under the trade name). 13.1 The correct name of the Bidder is MEF Cs,NSTRuc-nCt 1 l 3Q 13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation). 13.3 The address of principal place of business is 1!,211w 42J Sucre - )GA-1, FL 33r2.4 13.4 The .names of the corporate officers, or partners, or individuals, doing business under a trade name, are as follows: (~(IQK'EL Ai Tom! �%I 7�G /772.eis. Page 33 Rirl Mr n_fF_na5 13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. 13.6. List and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Bidder, its parent or subsidiaries or predecessor organizations during the past five (5) years. include in the description the disposition of each such petition. � 4 13.7. List and describe all successful Performance or Payment Bond claims made to your surety(ies) during the last five (5) years. The list and descriptions should include claims against the bond of the Bidder and its predecessor organization(s). dl) 13.8 List all claims, arbitrations, mediations, civil actions, administrative hearings and lawsuits brought by or against the Bidder or its predecessor organization(s) during the last five (5) years. The list shall include all case names; case, arbitration or hearing identification numbers; the name of the project . over which the dispute arose; a description of the subject matter of the dispute; and the final outcome of the claim. oN� 13.9. List and describe all criminal proceedings or hearings concerning business related offenses in which the Bidder, its principals or officers or predecessor organization(s) were defendants. Has he s principals, ers or predecessor ion(s) been 13.10. suspendedt Bidder, omtbidd g by anycgove government during the Iasttfie (5) years? debarred yes, provide details. 13.11. Under what conditions does the Bidder request Change Orders? Off t o saE N Cori, A Ctzi iCx-A, �I n s err IN 13.12. What is the nature and amount of the three largest change orders submitted by the bidder within the past five years, and their disposition? bQ - Page 35 a a KIn nc_ns.nPA 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 1 of 2) Contractors shall furnish the names, addresses, and telephone numbers of a minimum of five (5) firms or government organizations for which the Contractor has provided services for projects of similar size, scope and complexity over a three (3) year period. 1) Company Name c '1 of +0+1,4 Address ALA Sw 2"°Ale - ryfiseit. Mumotid Ft �7 �. IJORk JbE)Z 2,dOdr0o0.1* Contact Person/Contract Amount t�+� � Telephone No. /Fax No. C ) 1 LG ` 120C 2) Company Name ''SE Q `'a' 14SGaYgg $o la c Si \ Bi3C4Y4C) FL VAR4ouf Q Address VARIES Contact Person/Contract AmountARM# w 0 %U 0NE2 � ��� ��=10 k'r TR, CTS• Telephone No. /Fax No. (30s) Vex5- 89 S 3) Company Name Crilt mF C.if:04.1- ("46W-5 Address Z'SO Afg•o4,w43 ?wE . eca+4LQub tea, F L Contact Person/Contract Amounaiguc_ Lau r /#6D0/000.1—e Telephone No. /Fax No. 400 `IC O - MOO 4) Company Name MiaM1- DADC GOUTY Address 1 A.N./ j.S1Si - 142.0 jvt own 1 cL . Contact Person/Contract AmountTugf.ac 14)Dlt{5 AD utrn_ s,600,,060 4 V auf Telephone No. /Fax No. S) 31, - Z3 12_ _ et Page 36 Rid Kin ng_nR_nP5 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) 5)Company Name 7. J.O' ! , 3)t 1�T :— g�G1A-I • , r hAttC l L U W D �vr.1 L NDO W AA L Address '-�� ilv`., Contact Person/Contract Amount Goy /4110Abte Telephone No. lFax No. C9Szt) 1-304 6) Company Name S Address 90) ti.scE 11-1-1V50 4".M ~/42.S,/ rAb pi..' p Contact Person/Contract Amount 1Rvat CsTE 0oDQ' Telephone No. lFax No, ( s) tiC•15 — 29fl0 7) Company Name Address Contact Person/Contract Amount Telephone No. lFax No. 8) Company Name Address Contact Person/Contract Amount Telephone No. lFax No. Page 37 nn on-„C 00510. OFFICE LOCATION AFFIDAVIT (Page 1 of 2) leted in full, signed and notarized ease MAINTAIN ANor print Iearly. This Affidavit must be OFF OFFICE WITHIN THE CORPORATEpLIMITS OF THE CITY OF MIAMI. IF YOU ONLY IF 'F C7 N S-112..0 cTld ill Legal Name of Firm: Entity Type: (Check One) Partnership Sole Proprietor ' a 100000 0.3 Corporation Document No: Occupational License No: Nov 12. j 39 2 Date Established CrO_, ZOOS Date of Issuance 6 > a ib1= :` -tipi_ + PRESENT Street Address: -R2 )0 Lk) i‘re _ S t"rE LtQ City: State: How long at this location: 1t t i►41411 FL 3 3 t z � u PREVIOUS 1 Street Address: City: State How long at this location: According to Section '18-85 of the City of Miami Code, as amended: The "City Commission may offer to a responsible and responsive local bidder, who maintains an office in the City of Miami, the local pbidder Ity of does snot pexceedbid10t the low percent of d the amount, lowe t the other original submitted yresponsible 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. Page 38 r nm na_nac 00510. E LOCN AFFIDAVIT (Page 2 of 2) Authorized Signature Autio ize Print Name '.',orp,:,r&: jiit;il1 Title Authorized Signature (Must be signed by the corporate secretary of aof oration joint venture. one) general partner of a partnership or the proprietor of a sole proprietorship or ail partners Print Name Title Authorized Signature NOTARIZATION STATE OF FLORIDA, COUNTY OF MIAMI-DADE personally appeared before me "4That: �and acknowledged the foregoing instrument as his/her act and deed. • as identification. That he/she has produced / y NOTARY PUBLIC:: My Commission Expires: ti a z ©0 9 of the License to Please submit with your bid copies of Occupational es the right tof requestia copy trade L1Ce� the te verify local status. The City offiling Miami charter, corporate Income tax filing return and any other documents(s)11o verify the location of firm's office. ��oo � . NOE p :• i/ t. �` ycom iss�GG4',.. ' * Member 'd '7� Page 39 0550 Local, Small, Disadvantaged and MinoritylWomen Business Enterprise Participation Project No.: coµ tl �- /1744" 2.9 Titie:��`twtte atA���E"P� Bidder/Contractor: MET ee z rctiaN, A4 c As previously stated in the Contract Documents, the City encourages the participation of local, small and minority owned businesses. Based on this ongoing effort the City requires that with the submission of the bid, first payment requisition, and at the request of City representative, the Contractor shall submit this report entitled. Failure to submit the report may delay the Issuance of payment to the Contractor, Contractor shall submit an updated report when a subcontractor has been added or changed. The following certified local, small, disadvantaged, minority or women owned firms have been awarded subcontracts for this Project. The legend is to be used in completing the appropriate columns. Name of Firm (Bidder and Subcontractors) I )1 { edia BBE ietre774Nt ocal f BBE Local - _4 BBE Local BBE Local BBE Local BBE Local Types of Firm Bus SBE — Black- (African -American) owned CSBE — Community Small Business Enterprise DBE —Disadvantaged Business Enterprise HBE -- Hispanic Owned Business Local — Local Firm within City of Miami city MBE — Minority Business Enterprise designation None — no special SBE — Small Business Enterprise Enterprise WBE —Woman-Owned Business Business Designation (check all that apply) DBE MBE CSBE or SBE WBE DBE None HBE MBE CSBE or SSE WBE DBE None HBE Certifying Agency (Agencies) List all applicable MiAMP Naas Cobtry MBE CSBE or SBE WBE DBE None HBE MBE CSBE or SBE WBE DBE None HBE MBE CSBE orSBE WBE DBE None HBE MBE ness Enterprise imits ) WBE LEGEND None Certl�i ingEntit es CM - City of Miami Value of Work AsslgnedlA warded $ $ BC - Broward County FOOT — Florida Department of Transportation FG — Federal Government MD - Miami Dade County MDPS — Miami Dade Public Schools Other — please identify Percentage of Total Work or Contract loo %, NOTE: COPIES or t;crrrrrr�ri,rvrra •�� AFFlOAVIr Page 40 n:.d hh., nK.-rin_f1QR