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HomeMy WebLinkAboutBid Response Form 24.0 BID RESPONSE FORM 4.1. Certification Statement 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 of 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. RI# -exceptions to this bid have been documented in the section below (refer to paragraph and section). EXCEPTIONS: DELIVERY TIME WILL BE 60 DAYS A. R. 0. C . ON BOTH THE VAC -CON' S AND VAC-TRON1S BID FOR SECTIONS 3.1 AND 3.5 RESPECTIVELY. Payment Terms: 2% 10 days Net 30 days X Delivery will be made within 60 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: SSES, INC. dba SOUTHERN SEWER EQUIPMENT SALES ADDRESS: 3409 INDUSTRIAL 27th STREET, FT PIERCE, FL 34946 PHONE: (800) 782-4134 FAX: (772) 595-9171 EMAIL: info@southernsewer.com SIGNED BY: TITLE: GENERAL MANAGER DATE: APRIL 3, 2006 FAILURE TO COMPLETE, SIGN. AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. City of Miami Page 38 Bid No, 08.06-040 Bid Response Form - Certification Statement (Page 2 of 3) CERTIFICATE OF AUTHORITY (IF CORPORATION) I HEREBY CERTIFY that at a meeting of the Board of Directors of SSES, INC. , a corporation organized and existing under the laws of the State of FLORIDA , held on the 3r dday of MAY , 2004 , a resolution was duly passed and adopted authorizing (Name)MIKE WOOD as (Title) GENERAL MANAGER 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 3rd , day of ARIL 2006 . Secretary:j./ s i /t. .>- Print „li �,- 1• i1 (� `� CERTIFICATE OF AUTHORITY (IF PARTNERSHIP) I HEREBY CERTIFY that at a meeting of the Board of Directors of , 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 (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 39 Bld No. Oa O6-04O Bid Response Form - Certification Statement (Page 3 of 3) CERTIFICATE OF AUTHORITY (IF INDIVIDUAL), I HEREBY CERTIFY that, I (Name). , 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 4fl BId No, 05.06-040 4.2. BID FORM 4.2.1 PURCHASE OF TWO (2) VACUUM TRUCKS (VACTOR, MODEL 2115-16) OR APPROVED EQUAL UNIT COST $284, 925.0Q2 A TOTAL COST $ 569,850 .00 Make and Model (if different from above brand) NEW VAC —CON VPD3616LHAEN/1500 MOUNTED ON A NEW INTERNATIONAL 7600 SFA 6x4 4.2.2 OPTIONS: COST OF OPTION Lateral Cleaning Kit $ ADDENDUM 1 x 2 (two) = TOTAL COST $ N/A DOT3 six (6) strobe $ 2,660.00 x 2 (two) = TOTAL COST $ 5, 320.00 Jet rod camera with LCD $ 18, 353.0Q x 1 (one) = TOTAL COST $18, 353.00 Well Cleaning Device $ 4, 660.00 x 1 (one) = TOTAL COST $4, on TOTAL OPTIONS $ 28, 333.00 Manufacturers warranty parts (years) 1 Manufacturers warranty labor (years) 1 Local Service Facility Address: AT YOUR FACILITY VIA MOBILE SERVICES TECHNICIANS OR 3409 INDUSTRIAL 27t:h STREET, FT PIERCE, FL Exceptions to specifications (if any) DELIVERY TIME WILL BE 60 DAYS A.R.O.C. dba EQUIPMENT SALES ---- Bidder SSES, INC. SOUTHERN SEWER Authorized Signature: (company name) FAILURE TO COMPLETE. SIGN AND RETURN THIS FORM SHALL DISOUALIFY YOUR BID �lf City of Miami Page 41 Bid No. 05-06-040 AVAILABLE OPTIONS PRICE LIST CITY OF M IAM I BID # 05-06-040 (Section 4.2.2) AVAILABLE OPTIONS: Dual Engine Design ilo Single Engine 827 Roots PD Blower Wireless Pendant Control 3' x 8" Clear Vacuum Tube 5' x 8" Aluminum Vacuum Tube 6' x 8" Aluminum Vacuum Tube 8" Aluminum Vacuum Tube Quick Clamp Triangle Road Kit First Aid Kit Fire Extinguisher 5 Lb. Rotating Chain Scraper Root Cutter Kit 6", 8", 10" Nozzle Rack Vacuum Enhancer Assembly Electromagnet for Outrigger Leg 50 GPM @ 3000 PSI Water Pump ilo 80GPM @ 2000PSI High Dump Debris Tank D.O.T. Arrowboard 575 GPM Pump Off System Gravity Drain System Industrial Door Design Lazy Susan Pipe Rack ilo Hydraulic Folding Pipe Rack Hydraulic Swage Kit Manhole Guard 3 Stage Compressor Vacuum System (Dual Engine Design) DEDUCTIONS: Single Axle Unit (9 yard debris tank/1000 gallon water capacity) 12 Yard Debris Tank ilo 16 Yard 6' Telescopic Boom ilo 10' Telescopic Boom 1300 Gallon Water Capacity ilo 1500 Gallons TH 7400 Chassis with 310HP HT570 Engine/Allison 3000 RDS Delete GPS System 60GPM @ 2000PSI Water System 9,612.00 3,299.00 3,376.00 417.00 205.00 232.00 28.00 70.00 70.00 113.00 1,650.00 85.00 3,537.00 3,537.00 N/C 13, 781.00 3,690.00 9,247.00 1,413.00 3,939.00 N/C 2,181.00 169.00 2,631.00 ( 15,329.00) (8,975.00) (1,500.00) (2,848.00) (12,400.00) (3,000.00) (2,500.00) 4.2.3 EIiRCHASE OF TWO (2) BOBCAT S-185 (SKID -STEER LOADER OR APPROVED EQUAL UNIT COST $ N�A X 2 = TOTAL COST $ Make and model (if different from above brand) 4.2.4 OPTIONS COST OF OPTION Tree Shear - TB03 - Hydraulic Rotation (High Flow) with a 5.5" bore cylinder 24 diameter Rock Auger Bit (Bit Only) 48 Angle Broom Grapple Bucket Stump Grinder (SG60) x 3 (three) = TOTAL COST $ x 1 (one) = TOTAL COST $ x 3 (three) = TOTAL COST $ x3 (three) = TOTAL COST$ x 1 (one) = TOTAL COST $ TOTAL OPTIONS $ Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (if any) Bidder Authorized Signature: (company name) FAILURE TO COMPLETE..SIGN AND RETURN THIS FORM SHALL DISQUALIFY YOUR BID City of Miami BId No. 05-06-040 Page 42 4.2.5 PURCHASE OF ONE MOBILE CONCRETE MIXER (MODEL ZIMMERMAN) OR APPROVED EQUAL AND ONE PORTABLE CONCRETE Silo (A) MOBILE CONCRETE MIXER UNIT COST $ N/A XI TOTAL COST $ (B) PORTABLE CONCRETE SILO UNIT COST $_ XI TOTAL COST $ TOTAL (A)+(B) $ Make and model (if different from above brand) 4.2.6 OPTIONS: NO OPTIONS Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (if any) Bidder Authorized Signature: (company name) FAILURE TO COMPLETEJIGN AND RETURN THIS FORM SHALL DISOUALIFY YOUR BID City of Miami Page 43 BId No. 06-06-040 4.2.7 PURCHASE OF TWO (21 CHIP DyMP BODY TRUCKS UNIT COST $ N/A X 2 = TOTAL COST $ 4.2.8 OPTIONS: NO OPTIONS Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (if any) Bidder Authorized Signature: (company name) FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM SHALL DISOUALIFY YOUR BID City of Miami Page 44 Bid No. 06-06-040 4.2.9 PURCHASE OF TWO (2) MINI -VAC TRUCKS (MODEL VAC-TRON PMD 650 SD OR APPROVED EQUAL) Make and model (if different from above brand) VAC-TRON MODEL PMD550SD MOUNTED ON A NEW FORD F650 UNIT COST 688,986.00X2=TOTAL COST$177,972.00 4.2.10 OPTIONS: NO OPTIONS (VAC- ON) Manufacturers warranty parts (years) 1 YEAR LIMITED PARTS WARRANTY (AS PER SPECIFICATIONS) (VAC-TRON) Manufacturers warranty labor (years) 6 MONTH LIMITED LABOR WARRANTY (AS PER SPECIFICATIONS ) Local Service Facility Address: AT YOUR FACILITY VIA 3409 INDUSTRIAL 27th Exceptions to specifications (if any) CHASSIS QUOTED IS AND ALLISON 2500 IDS 'TRANSMISSION MOBILE SERVICE TECHNICIANS OR STREET, FT PIERCE, FL F-650 WITH CUMMINS DIESEL ENGINE SSES INC. dba SOUTHERN SEWER EQUIPMENT SALES f y Bidder , Authorized Signature: (company name) FAILURE TO COMPLETE. SIGN AND RETURN THIS FORM SHALL DISOUALIFY YOUR BID OPTIONS: 6.0 FORD POWERSTROKE ENGINE---N/C HYDRAULIC BOOM ILO ELECTRIC BOOM---$2,400.00 City of Miami Bid No, 05-06-040 Page 45 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 not apply, write the word(s) "None", or "Not Applicable", as appropriate. Please print. COMPANY NAME: SSES, INC. dba SOUTEIERN SEWER EQUIPMENT SALES COMPANY OFFICERS: President SHERRY DENMON Secretary SHERRY DENMON COMPANY OWNERSHIP: SHERRY DENMON FEf ,TX fFNMINN Vice President FELIX DENMON Treasurer FELIX DENMON 51 % of ownership 49 % of ownership % of ownership % of ownership LICENSES: 1. County or Municipal Occupational License No. 5999-00970142 (attach copy with bid) 2, Occupational License Classification 5999_. SALES OF EQUIPMENT FOR CLEANING & SERVICES 3. Occupational License Expiration Date: SEPTEMBER 30, 2006 4. Metro -Dade County Certificate of Competency No. N/A (attached copy if requested in Bid or RFP) 5. Social Security or Federal I.D. No. 65-0267110 EXPERIENCE: 6. Number of Years your organization has been in business: 15 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: 15 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: 15 City of Miami Page 48 Bid No. 05-08-040 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 equipment sold, that BIDDER/PROPOSER has delivered and/ serviced 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: FIRM NAME/ADDRESS DATE OF PURCHASE FLORIDA POWER & LIGHT 2005 VAC IRON 158 MACA IEUR CAUSEWAY MIAMI, FL 33139 DESCRIPTION OF EQUIPMENT PMD850SDT CONTACT PERSON: MIKE DENO FIRM NAME/ADDRESS CITY OF BOYNTON BEACH 222 N.E. 9th AVENUE BOYNTON BEACH, FL 3.435 CONTACT PERSON: TIM CALHOUN PHONENO.:(3Q5) 228-5233 DATE OF PURCHASE DESCRIPTION OF EQUIPMENT 2003 VAC TRON PMD500DTE FIRM NAME/ADDRESS DATE OF PURCHASE INDIAN RIVER COUNTY 180 S.W. 27t:h AVENUE SRO RFACH, FT. 37968 CONTACT PERSON: EMORY BAILES PHONENO,: (561) 742-6215 DESCRIPTION OF EQUIPMENT 2005 VAC TRON FM15OSDT FIRM NAME/ADDRESS DATE OF PURCHASE PALM BEACH CTY1 WATER UTIL. 2004 3700 BELVEDERE RD, BLDG rE" WEST PALM BEACH, FL 33406 CONTACT PERSON: JIMMY HARTMAN PHONENO.:(772) 770-5266 DESCRIPTION OF EQUIPMENT VAC TRON PMD80OSDT PHONE NO.:(561) 493-6209 FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID. City at Miami Page 47 Bid No. 05-06-040 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 equipment sold, that BIDDER/PROPOSER has delivered and/ serviced 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: FIRM NAME/ADDRESS MIAMI DADE WASD 3700 DOUGLAS ROAD MIAMI, FL 33146 DATE OF PURCHASE DESCRIPTION OF EQUIPMENT 2005 ORDERED 21 VAC -COW S CONTACT PERSON: BILL RICHMOND FIRM NAME/ADDRESS CITY OF HOMESTEAD PHONE NO.:(786) 552-8052 DATE OF PURCHASE DESCRIPTION OF EQUIPMENT 2004 VAC -CON SEWER CLEANERS 675 N. FLAGLER AVENUE HOMFSTFATI, FT , 3'3n 3n CONTACT PERSON: ROBERT LANDEN FIRM NAME/ADDRESS FLORIDA UTILITIES PHONE NO.:(305) 247-1801 DATE OF PURCHASE DESCRIPTION OF EQUIPMENT 2005 VAC -CON SEWER CLEANERS 8569 N.W. 68th STREET MTAMT, FT, 33166 CONTACT PERSON: HECTOR PAREDES FIRM NAME/ADDRESS DATE OF PURCHASE PALM BEACH COUNTY WATER UTIL. 2005 810Q EQRREST HILL BLVD WFST PALM BFACH, FT , '3 3416 CONTACT PERSON: JIMMY HARTMAN PHONE NO.: (305) 597-4010 DESCRIPTION OF EQUIPMENT VAC CON SEWER CLEANERS PHONENo.:(561) 493-6209 FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISOUALIFY YOUR BID. City of Miami Bld No. 05-06-040 Page 47 4.4. MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT Please Check One Box Only [ ] Hispanic [ jFemale [ 1 Black [ } Not Applicable If business is not 51% minority/female owned , affidavit does not apply. If not applicable, notarization is not required. I (We), the undersigned agree to the following conditions: 1) that we have read Section 2.25 of the General Terms and meet the fifty-one percent (51%) ownership and management requirement for minority/women registration status and will abide by all of the policies and regulations governing the City of Miami Minority and Women Business Enterprise Procedures; 2) that if at any time information submitted by the undersigned applicant in his/her Bidder Application should prove to be false, inaccurate, or misleading, applicant's name will be struck from the City of Miami's Master Bidder list with no further consideration given to this applicant; 3) that the City of Miami maintains the right, through award of bid/contract, to revoke the award, should it be found that false, inaccurate or misleading information or a change in the original information have occurred; 4) to notify the City of Miami within thirty (30) days of any change in the firm's ownership, control, management or status as an ongoing minority/women business concern as indicated on the Bidder Application, and that the City of Miami, upon a finding to the contrary, may render a firm's registration with the City null and void and cease to include that firm in its registered list of minority and women -owned businesses; 5) that the City of' Miami has a right to diligently verify all information submitted by applicant in his/her Bidder Application to monitor the status of the Minority/Women Business Enterprise, once registered; 6) that the City of Miami may share a firm's registration information concerning its minority/women status and its capability with other municipal or state agencies for the sole purpose of accessing the firm to their procurement opportunities, unless otherwise specified by the firm in writing. I (We) certify under the penalties of perjury that the information contained in any and all application documents submitted to the City of Miami is correct as per Ordinance No. 10062 as amended. , / Firm Name: SSES, INC. dba SOUTHERN SEWER EQUIPMENT SALES /C..r -k.-- "74-12: k1-,-_-,"'- (If signing as a corporate officer, kindly affix corporate seal) SHERRY DENMON/ PRESIDENT APRIL 3, 2006 FELIX DENMON/ VICE-PRESIDENT APRIL 3, 2006 (Name, Title & Date) (Name, Title & Date) This application must be signed by at least one general partner of a partnership or the proprietor of a sole proprietorship or all partners of a joint venture. NOTARIZATION COUNTY, SS COUNT,QF SARI LUCTE `'' Date:APRIL 3, 2006 �kk" That: ie.(1. C.tt"-1FC1CPCI personally appeared before me and acknowledged the fore oing instrument as his/her act and deed. That he/she has produced' .) (L.`i `yor1(i I !i K ("ell._L�i t as identifica i [ a z''' n. �- Y� �— - - � NOTARY PUBLIC: di.._-i.�..• rly� SAFII A. SHRADER , ,� MY COMMISSION # OD 523008 My Commission Expires: / �... e.- -C) too, ffXP1RES: Maroh 17, 2010 1'a°0's"Naritllai ,+ iretattfrePl'l SIGN. AND RETURN THIS FORM MAY DISQUALIFY THIS BID. City of Miami BId No. O546-040 Page 45 4.5. SAMPLE OF AFFIRMATIVE ACTION POLICY for EQUAL EMPLOYMENT OPPORTUNITY AFFIRMATIVE ACTION/ EQUAL EMPLOYMENT OPPORTUNITY - POLICY STATEMENT It is the policy of (Company Name) to base its hiring and promotions on merit, qualifications and competency and that its personnel practices will not be influenced by an applicant's or employee's race, color, place of birth, religion, national origin, sex, age, marital status, veteran and handicapped status. One of the management duties of all principals at (Company Name) is to ensure that the following personnel practices are being satisfied: 1. Take every necessary affirmative action to attract and retain qualified employees, regardless of race, color, place of birth, religion, national origin, sex, age, marital status, veteran and handicapped status. 2. Maintain equitable principles in the recruitment, hiring, training, compensation and promotion of employees. 3. Monitor and review personnel practices to guarantee that equal opportunities are being provided to all employees, regardless of race, color, place of birth, religion, national origin, sex, age, marital status, veteran and handicapped status. (Company Name) is committed to take affirmative action and aggressively pursue activities that will serve to enable all employees and applicants opportunities available throughout this organization. Clearly, the above actions cannot be accomplished as a secondary duty for any individual, despite the full support of management. And so, to monitor our efforts, (Company Name) has assigned one of its principals as the Affirmative Action Director to monitor all activities of this program. Employees may contact (Name of assigned principal) at (telephone number) regarding this Affirmative Action Policy. DATE: APRIL 3, 2006 (SIGNATURE/TI LE): l.� GENERAL MANAGER FAILURE TO COMPLETE. SIGN, AND RETURN THIS FORM MAY DISQUALIFY THIS BID. City of Miami Sid No. 08.08.040 Page 49 4.6. 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 Firm: N/A Corporation Doc, No: Entity Type: (check one box only) [] Partnership [) Sole Proprietorship p Corporation Date Established: Occupational License No: Date of Issuance: Office Location of the bidder/proposer: 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 (10141 in gticess 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 or the City of Miami. 1 (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 [t Personally known to me; or Subscribed and Swam before me that this is a true statement this _ day of 199 . [l Produced identification: Notary Public, State of Florida My Commission expires Printed name of Notary Public Please submit with your bid copies of Occupational License, professional and/or trade License to verily local status. The City of Mianti also reserves the right to request a copy of the corporate charter, corporate Income tax tiling return and any other documents(s) to verily the location of the firm's office. City of Miami Page 60 BId No. 06.06.040 4,7. STATEMENT OF NO BID NOTE: If you do Lipl 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. 05-06-040 for PURCHASE OF VACUUM TRUCKS. SKID STEER LOADERS. MOBILE CONCRETE MIXER. CONCRETE SILO. CHIP DUMP BODY TRUCKS AND MINI VACUUM TRUCKS FOR PUBLIC WORKS 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: N/A 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 61 BId No. 06.06.040 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 by the City? Yes X No B. In the event your answer to Question "A" is yes, how many new positions would you create to perform this work? C. Please list below the title, rate of pay, summary of duties, number of positions, and expected length or duration of all new positions which might be created as a result of this award of contract. EXPECTED RATE OF PAY NUMBER OF LENGTH OR POSITION/TITLE Houllv/Weekly DUTIES: POSITIONS DURATION 1)N/A 2) 3) 4) 5) 6) 7) 8) (Use additional sheets if necessary.) COMPANY NAME: SSES, INC. dba SOUTHERN ,SEWER EQUIPMENT SALES GTIENA(ER,ALFR SIGNATURE/TITLE: DATE: APRIL 3, 2006 FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY THIS BID. City of Miami Page 52 Bid No. 05-06-040