Loading...
HomeMy WebLinkAboutBid Response Form 34.0 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 fumish 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: 4 bl —s .cl " & 9 OPP0.vs -►�'NSPv�sc- -� /t L '$1ZrM - di- 8�r� ✓kD. oriT ry� �Tz,t /)%/ cTaeif i Payment Terms: 2% 10 days Net 30 days Delivery will be made within 60 calendar days after receipt of purchase order. We (I) certify that any and all information contained in this bid is true, and we (I) further certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this IFB and certify that I am authorized to sign this bid for the bidder. Please print the following and sign your name: NAME OF BIDDER: ^:7(14/ ° /lr'C�G//Aral Q.'IlrAtO PAD( ADDRESS: I / ' f3 A/ ?9/9//9Lc- .9,9 G' ekr i 33a16 PHONE: 0S._ 3 (.)- - 66 3,?-. FAX: 30 s- 3 6 EMAIL: J A$/P*-rit3cM.P AO 1-.c 0r1r BEEPER: SIGNED BY: TITLE:Sf}mfi 66-4 DATE: L/—C/- )-Do FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISOUALIFY THIS BID. City of Miami Page 38 Bid No. 08-08-040 Bid Response Form - Certification Statement (Page 2 of 3) CERTIFICATE OF AUTHORITY (IF CORPORATION) I HEREBY ERTIFY that at a meeting of the Board of Directors of eY fr-49A- D � �,r, , a corporation organized and existin under the laws of the State of A2,,,g./.4 , held on the day of ,'7 Y , /rlir a resolution was duly ppass�rrd and adopted authorizing (Name) • s .ram d4 iJ as (Title)zKiJJi1 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 thisJiz'17, day of /,i,X/.c , 20P Secrete Print�� 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 20 Partner: Print: ,dayof 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 Bid No. 05-06-040 Bid Response Form - Certification Statement (Page 3 of 3) CERTIFICATE OF AUTHORITY (IF INDIVIDUAL1 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 40 Bid No. 05-06-040 , 4.2. BID FORM 4.2.1 PURCHASE OF TWO (21 VACUUM TRUCKS (VACTOR. MODEL 2115-16) OR APPROVED EQUAL UNIT COST $ x 2 = TOTAL COST $ 4/404 Make and Model (if different from above brand) 4.2.2 OPTIONS: COST OF OPTION Lateral Cleaning Kit $ _ x 2 (two) = TOTAL COST $ OOT3 six (6) strobe $ x 2 (two) = TOTAL COST $ Jet rod camera with LCD $ x 1 (one) = TOTAL COST $ Well Cleaning Device $ x 1 (one) = TOTAL COST $ TOTAL OPTIONS $018/0 Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (it any) Bidde •17,44- �ATr€04 Authorized Signature: (company name) FAILURE TO COMPLETE, SIGN AND RETURN THIS FOR SHALL DISOUAL . N YOUR BID City of Miami Bid No. 06-06-040 Page 41 4.2.3 PURCHASE OF TWO (21 BOBCAT S-1851SKIDSTEE UNIT COST $ LOADER) OR APPROVED EQUA )1 7ji 2 = TOTAL COST $ Make and model (if different from above brand) /fJ 015 cSrO ' / f€? 4.2.4 OPTIONS Tree Shear - TBO3 - 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) Manufacturers warranty parts (years) COST OF OPTION 7 7 5 0+ ~ x 3 (three) TOTAL COST $ 3 So• g o C) x 1 (one) = TOTAL COST $ 6 2 Q, 0/ 7; x 3 (three) = TOTAL COST $. 6473 4� y t y. 615 x 3 (three) = TOTAL COST $ $ S C S 1 (one) = TOTAL COST $ 1 S TOTAL OPTIONS $ 51, c % 7, Q-2 --Xe-0,2 A 1/41P6271-D uArec / See 6-Y92 Celuc: d., i:4 Manufacturers warranty labor (years) ) —sJ65)424// !3r/ 47f56C"',, yG'g2C-'ti6«'4 �''t ' 614.,0 Local Service Facility Address: / / `! / 3 Na., 99 'We N(# L L O A/ e �DL w5 f °� , 3_ C5 / s Exceptions to specifications (if any) Hz---sj' NJ6...6' 60)c4/ /SNP'r_ /MT° ¢/!3c&97vAJioES-/ss,4,7%/4/6iT0SITile SWfLLuoeJ CA/4444'1'7oA.7Ht YK'4tie:cc- Pvvm < Thlr b3"4'15 y''A.vbte-A!Rvvn js/j-g" icx''c'.v76ie S •71//9N6t<E 4srocM4-�9C// 4i/d. 5,L •/%�.vGCc' w4P004+ c_-�tG /� •�i 3,% .3y�.— r Bidder 06C c2/� N 4 Vic` Authorized Signatur (company name) FAILURE TO COMPLETE, SIGN AND RETURN THIS FOR ' SHALL DISO City of Miami Page 42 Bid No. 05-06-040 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 S X1 TOTAL COST $ (B) PORTABLE CONCRETE SILO UNIT COST $ X1 TOTAL COST $ TOTAL (A)+(B) $A ILD 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) Bidde � % �� /4 75 / 110 Authorized Signature: (company name) FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM SHALL DISQUALIFY YOUR BID City of Miami Page 43 Bid No. 05-06-040 4.2.7 PURCHASE OF TWO 12) CHIP DUMP BODY TRUCKS UNIT COST $ X 2 = TOTAL COST $ A 45:fp 4.2.8 OPTIONS: NO OPTIONS Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (if any) Bidde (company name) Authorized Signature: FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM SHALL DISQUALIFY YOUR BID City of Miami Page 44 Bid No. 05-05440 4.2.9 PURCHASE OF TWO (2) MINI -VAC TRUCKS (MODEL VAC-TRON PMD 550 SD OR APPROVED EQUAL) Make and model (if different from above brand) UNIT COSTS X2=TOTAL COST $' Zito 4.2.10 OPTIONS: NO OPTIONS Manufacturers warranty parts (years) Manufacturers warranty labor (years) Local Service Facility Address: Exceptions to specifications (if any) Bidder 8)/(//J 19fi47)t-3 thorized Signature: (company name) FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM SHALL DISQUALIFY YOUR BID City of Miami Page 45 Bid No. 05-06-040 43. 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: ��` C�� dE / 7 74-7i 'a sZ/i700E- COMPANY OFFICERS:OF� President 4.7. /09' /C��rZE�✓ Secretary COMPANY OWNERSHIP: r` / iTz, & A% Vice President 4 t W ✓ v/.'D�` N Treasurerc LICENSES: 1. County or ]Municipal Occupational license No. (attach copy with bid) % of ownership 0245°/n of ownership % of ownership % of ownership 2. Occupational License Classification /9(f� /' i i� /iK�i l'�-' R, f i'%-�� ed),410 .,F,- .ALA i3c}7 72 3. Occupational License Expiration Date: C)VA2cs2- 4. Metro -Dade County Certificate of Competency No. (attached copy if requested in Bid or REP) 5. Social Security F Federal I.D. No. �s- oga - /6/0 EXPERIENCE: 6. Number of Years your organization has been in business: 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: V/ WO -ICJ' S. Number of Years experience BIDDER/PROPOSER (firm, corporatl,'on, proprietorship) has had in operation of the type required by the specifications of the Bid or RFP: 3, City of Miami Page 46 Bid No. 06-06-040 CITY OF HIALEAH GARDENS Business Name: BOBCAT OF METRO DADE INC. 11913 NW 99 AVE HIALEAH GARDENS. FL 33016 Business Type: BOBCAT DEALE LICENSE NO.: BL2828 Delinquency Fee: A 10 percent each month thereafter with total NOTES: NO OUTSIDE STORAG ALL WORK SHALL BE INSIDE B 10001 N.W. 87TH AVENUE - HIALEAH GARDENS, FLORIDA 33016 OCCUPATIONAL LICENSE be imposed rf not renewed by October hand 25;percent �_� DATE: 8/22/2005 Issued To: ELLIOT PRIGOZEN 800 W. AVE 3546 MIAMI, FL 33016 PAID: $ 762.50 percent fee is charged for L I CENSE YEAR 2005 - 2006 LICENSE MUST BE EXHIBITED CONSPICUOUSLY AT YOUR PLACE OF BUSINESS 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 /11 EX() yoloo 6 9,5 4)- /mot. 4.0r) Pi LA [3�r�P��, A 340/0 CONTACT PERSON:d(= L! O j[i4Qre� FIRM NAME/ADDRESS DATE OF PURCHASE c L, A.�; c. "C- co c 5 L 331149032- CONTACT PERSON: FIRM NAME/ADDRESS DATE OF PURCHASE V r r 04 -R--5 0 4/ 4 4. 5G,Pi i 3,4006 v)r).-'S/ Yj2 <-1/4, - ree4- Mtncylt t-L ;33to7 CONTACT PERSON: L / / Gtt2 L `? A - Z S- DESCRIPTION OF EQUIPMENT / 7 S ski.. SleZ.12 L041a)6 l •ci s x-r-t C (.2•51,04: PHONE NO.:3L - .4' 59 -ka g' Co DESCRIPTION OF EQUIPMENT S- 3 n to Sk/ srz -c-p2 c Tc�Zi2L.c��� PHONE NO.:, 5-S2 57a) DESCRIPTION OF EQUIPMENT r- 3 ra 0 77?frh /4 , i v}-c// i4- 5 ~- c3 S o 5//, 5 7ZZ 2 C 04,0 -.y 5�z�t7S/C�n S " FIRM NAME/ADDRESS DATE OF PIJRCI1ASE (JU / re-il '6-y'JH mc%b/tv2j /_2- c 5 [)C) :a.(t) _ U 4-r ee .1-- , �l�a rn i --t. ,3 3{ S y e .'50 CONTACT PERSON: L 3&-QT 6 42 e/l1 PI IONS NO.: , "j 5 - tsb c, DESCRIPTION OF EQI.11PM?Nf PHONE NO.:305--- -� ?O7 FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISOUALIFY YOUR BID. City of Miami Bid No. 06-08-040 Page 47 Firm Name: (I f signing 4.4. MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDA Please Cheek One Box Only [ ] Hispanic [ ] Female [ ] Black [j4Not 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 th 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. er, kindly affix corporate seal) rate o Date) (Name, Title & Date) This applies to ust 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. COUNTY, SS COUNTY OF ADEJ That: U11'U jf(AS e acknowledged the foregoing i That he/she has produced NOTARIZATION Date: tument as his/her act and deed. :1/eiS o;Cease NOTARY PUBLIC: My Commission Expires: ,1 goo 6 personally appeared before fication. 9007 me and MERCEDES M. SAI AZAR MY COMMISSION # DO 1908334 EXPIRES: Minh 6, 2007 swim Th,u t a m UUndnw7Nen FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISOUALIFY THIS BID. City of Miami Bid No. 05-06-040 Page 48 AFFIRMATIVE ACTION/ EQUAL EMPLOYMENT OPPORTUNITY — POLICY STATEMENT It is the policy of Bobcat of Metro Dade 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 Bobcat of Metro Dade 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. Bobcat of Metro Dade 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 fulrsupport of management. And so, to monitor our efforts, Bobcat of Metro Dade has assigned one of its principals as the Affirmative Action Director to monitor all activities of this program. Employees may contact Douglas E. Jansen at 305-362-6632 regarding this Affirmative Action Policy. DATE: April 3, 2006 (Signature/Title G—y President FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY THIS BID 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: Corporation 1)oc. No: Al di/ Entity Type: (check one box only) p Partnership [] Sole Proprietorship [] Corporation Da 7 stablished: 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 l low long at this location: According to Ordinance No. 12271 (Section 18-85): The City Commission may offer to a rrsponsible and responsive local bidder, who maintains a Local Office, the opportunity of accepting a bid at the low bid amount, if the original bid amountsubmitted by the local vendor is not more than ten percent (10%) 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. 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 O1 FLORIDA, COUNTY OF DADE Subscribed and Swam before me that this is a true statement this __day of Notary Public, Stale of Florida Printed name of Notary Public My Commission expires [1 Personally known tome; or 199 . [1 Produced identification: 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 10 request a copy of the corporate charter, corporate income lax filing return and any other documents(1) to verify the location of the frm's office. City of Miami Page 60 Bid No. 00-08-040 4.8. STATEMENT OF INTENT TO COMPLY WITH ORDINANCE NO. 10032 .0s: • • 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 11.B. 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 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 01' PAY NUMBER OF LLNGTII OR POSIT_IONITITL1 Hourly/Weekly .__ DJTTI]S PO.�SITIONS DURATION 1) 2) 3) 4) 5) 6) 7) 8) (Use additional sheets if necessary) COMPANY NAME: City of Miami Bid No. 05-08440 IGN, AND RETURN THIS FORM MAY DISOUALIFY THIS BID. Page 52 5.0 BID RESPONSE CHECK LIST This checklist is provided to help you conform to all requirements stipulated in this IFB. \1. Bid Certification Form (Form 4.1.) This form must be completed and signed to validate your bid • 2. Bid Form- (Form 4.2.) This form must be completed and signed by bidder J 3. 5. Bidder Qualification Statement (Form 4.3.) This form should be completed in its entirety to verify the capability of bidder to perform/deliver the services/goods specified in the IFB MinoritylWomen Business Affairs Registration Affidavit, if applicable (Form 4.4.) Must be completed only if one or more of the owners in the business enterprise is at least 51% owned by a Black, Hispanic or Female. Affirmative Action Policy for Equal Employment Opportunity (Form 4.5.) Should be completed by Bidder. 6. Office Location Affidavit, if applicable (Form 4.6.) Section 18-85 of City Ordinance No. 12271, states that the City Commission may offer to a responsible and responsive 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 (10%) in excess of the lowest other responsible and responsive bidder. (Must be signed and notarized by the local bidder, only for use in attesting office location). The City reserves the right to verify local status. Statement of No Bid, only if applicable (Form 4.7.) If you do not intend to submit a bid on this commodity or service, please return this form in the hid envelope on or before bid opening. If the "Statement of No Bid' form is not completed and returned, your company may be deleted from the City of Miami bidder's list for this commodity or service. 8. Statement of Compliance with Ordinance 10032 (Form 4.8.) This form must be completed and signed by bidder 9. Copy of Occupational License To be submitted by bidder with bid. ,10. Copy of Equipment Warranty Certificates To be submitted by bidder with bid. 11. Parts, Operators and Service Manuals To be submitted by bidder with bid. Ce5A"fE . ;'i s / 12. Pricelists for Additional Attachments/Components/Accessories To be submitted by bidder with bid. Required to be Submitted with Bid Yes ® No 0 Yes ® No ❑ Yes ® No ❑ Yes ®No ❑ Yes ®No❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ❑ Yes ®No❑ Yes No ❑ Yes ® No El Yes ® No ❑ TO BE SUBMITTED AS PART OF YOUR BID RESPONSE. City of Miami Page 53 Bid No. 06-06-040