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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. All exceptions to this bid have been documented in the section below (refer to paragraph and section). EXCEPTIONS: AO Vec+ej'A'on 3 / ovr #I 4X y l i�r IQB-/9 F.,/gyp Olte/, •, e+Ctetel/ reet;E r. ILiais. Payment Terms: 2% 10 days Net 30 days,, Delivery or Completion of project will be made within 3 n 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: 2aaA'/G AC/F/d Co,. f.4nry ADDRESS: / 00 o k?f4Cra cow �'r` r LAwR EQCEv t el GA 3 06 YS PHONE: 004) Z y/ -.Kt? ed. //8 FAX: (74 0 3. q- YO EMAIL: kies+ucsekereleyeacA... cart, BEEPER: CC.: (7W) 32-9-,lye TITLE: reitr Ortareft 4 Ave- DATE: c/ / Lo o G SIGNED BY: iehtk IdS. mc.s co K FeILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS RSA, City of Miami Page 22 BId No. 08.06.088 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 REHRIG PACIFIC COMPANY , a corporation organized and existing under the laws of the State of DELAWARE , held on the B day of August , 2 0 0 6 ti• a resolution was duly passed and adopted authorizing (Name) 'KLRK._.LES1ACSEK as (Title) SALES RLP1. :..:.. of the corpd'Ition 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. 20 06 IN WITNESS WHEREOF, I have hereunto set my hand this 8th, day of August r Secretary: Print: "MtIE KISER CERTIFICATEO.F;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, shallbe the offialai act and deed of the partnership. I further certify that said partnership agreement remains in kill force and effect, IN WITNESS WHEREOF, I have hereunto set nrny 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 venturemust sign the bid and submit the appropriate Certificate of Authority (corporate, partnership, or individual). City of Miami Page 23 Bid No. 05-06-098 Bid Response Form - Certification Statement (Page 2 of 3) CERTIFICATE OF AUTHORITY SIF 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 24 Bid No. 06-06-09B 4.2. BID FORM Est. Annual Item No. Description: Quantity: Unit Price: Extended Amount: 1. Litter Container as or equal to 400 $ /ea $ Wausau Tile, Inc. Model #MF3021 meeting the specifications. Manufacturer/Model No. Warranty: No. of calendar days for delivery after receipt of Purchase Order: days 2. Recycling Bin as or equal to 4800 $ 6. 3 ; /ea $ 30, $ 46 . oa Rehrig Pacific Co., Huskylite #RB-18 meeting the specifications. Manufacturer/Model No. lees4/6 ActF,c Warranty: F ✓4 Yee#ArS No. of calendar days for delivery after receipt of Purchase Order: J© days Authorized Signature: Ca. ///1sxyLilt Ara -he Date:/V /2006 FAILURE TO COMPLETE. SIGN AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. City of Miami Old No. 05.06-088 Page 25 41 QualitioatIon Statement INSTATOCTIONS: This questionnaire is to be ibauded with your bL4 De not leSlie 'MY qUeations unaneweted. When cthe ,question does not apply, write the worcgs) "None', Or '"Not ARraable% lipPrdpri* Please print, comPOYIMAnu . 4E01p PAC IC COMPANY CONOWri( grFICEAS: piltddent WILLIAM J. REHRIG Viet Pas:Went. semi)* MURIEL KISER Tmawer JAMES L . DREW, C . F . . COMPANy 9W1s181tA4lEt J B 13,E1-tRIG 0 0 -% of ownership. :of ownership % ofwnerip .% of Ownerabip LICNSES; 1. County or Iviuntoipal DeettpatiOaal License No, (attach ropy with 6i-c1) 2. Occupational License Classification 3, Occupational License Expiretton Date: 4. Metro=Dade County Certificate of -Competency No, (attached copy ifrequested in Bid cpr tiPP) — 5. Social; Secnrity or Federal 1.D. 'No. 9 54 6 0 8 7 9 7 tXPERIENCE: Ntanbor oPrears your organization' los been in buRims: 9 Years . 7, Nuaiber of Yeats -experience 131DDER/PRICROSER. (person., prineipal of firm, owner) has had in operation Of the type requi recl by the specifications of t,he aid or Ilk?: 8. Number of 'Years expktionee BiDriER/PROPOStfk (firtn, OrPOtatiOn, ProPrietOraidP) has had 41 operation of the ow required by the.specifioations of the R,141' cos of Mail Page 26 ,Bld No. O5,011.098 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 three (3) years: FIRM NAME/ADDRESS DATE OF SALE DESCRIPTION OF SALE Anti /Ifonh/ Cava 7ob3 -204- "P over 1 .0,60 )$-is ♦ecyJnja #44/1441000 S /VI t� >nt 'H Ciro... /.. POr1 CONTACT PERSON: 44, it A ccW r1€// PHONE Na: WV - 2 2 Z - 7 75-2 FIRM NAME/ADDRESS DATE OF SALE DESCRIPTION OF SALE cola AAPLe 14✓/401 }/ Cutrt' of P., $eats, cm.t RL over Soo coo R8 / 9 lee cyc/:t, lint i Circy i4.41 ar, CONTACT PERSON: SI SanCity &I go" PHONE NO.: ( 1' 4 Yo - y° (i !) FIRM NAME/ADDRESS C;1y.fAil/, Gra DATE OF SALE DESCRIPTION OF SALE C%rren4' ' ove, yC 000 R S-1$ re cydrr'v►tj Vint iK Lirvv4tiH 6et CONTACT PERSON: J04 C%!rt'1 er't TS PHONE NO.: YO y "- bv9'- 7 . / v FIRM NAME/ADDRESS DATE OF SALE DESCRIPTION OF SALE ;r Qgrq1/4 t1 Oie Zoo Y over So oe o re cyc1 'j 4:or .4 Cjrc..l* I•i on CONTACT PERSON: e e tied/ PHONENO.: (so,)8Z3"7101 FAILURE TO FULLY COMPLETE. AND RETURN TITS FORM MAY DISOUALIFY YOUR BID. Clty of Miami Page 17 Bid No. 06-06-098 4.4. MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT Please Check One Box Only [j "Hispanic I 1 Feitiale i] Black f N-ot Applicable If business isnot 51% ridrioritY/femele owned affidavit does. frOtepply, If trot Applicable, notarization is not required, 1 (We), the undersigned wee: to the following fienatiNS: 1) that we have reed Seeit011 Z1:5 ate Otiteral Tents ad ttlett.the fitlyi-one, percent (51%) owt.terShIP .and luanaseniant requirement tot tnluotitylwornen registration status and will abide by all of the polilvies and tegtilations ittgaettilno the CiV-. otMlarni Minority and Wooten Badness Enterprise Prodedureal 2) that if at any tittle: infant-M*0n SibMitt.db5 theundersigned anplioant in 'hietter Bidder Application should .prove to be false, inaccurate, or misleading, applietinfa name will be struck fromthe. City of Miami's Master Bidder list with no further .consideration given -to this applioant; 3) that the City of Miami maintains the,righti titough award a bid/emu-4o, to revoke the award; "horrid it be found that faiseo inaccurate or ruhileaditig infetinatien ot ohan,ge in the original infornialkn have occurred; 4) to not* ithe City -Ot 1000 itin thittY (a) dais' a ittlY 411arfgo hi! •te firtnla owner4liffi vanagement or *Otto as an bitgeitia ritintritylwolnen 'business concern as indicated 04, the. Bidder' Appaoationi And tbat the City -of lvfierni, ittponi a -fintiin,g to the :.00ntram, may render a Ort&S teegratiOti Witt the City null and void And cease to include that finn in its registered 'list of minority and Women - owned :businesssI. 5;) that the City of Miarni has a right -to diligently verify all inforination submitted by applicant in his/her Bidder Application to monitor the status .of the Ivanority,WOMen DnAttess Enterprise, once registered; 6) that the City olNliami may ,a4are iittfiV registr4tion tuft tonoerning its minority/women ,status. ,and its capability wlth other rannitiol or stave agenoies for fthe sole. purpose oraecessing the "fiat' to their proeurernent•opportunities, urilasS otherwise speeiffed twill() firm in writing. r (WO esol*,;natier the penalties. of perjury suhrtrittedto he City otlidiarte ia correct as .p Firm Name: (if signing co rat CIF , in tte infirmattcat contained in any an all aPPliCatiOn dOetirnettl$ dikranea No. I-00624a amended. COMPANY affix oorporate seal) Mei Mle *Ode) Wattle, Title, -&-Date) JAMES L C.P00., 8-4-2006 This: appileation must he, signed', by it: least, :otte .general pettier of a 'partnership: or the proprietor. Of sole prOptletOrairiporell partners a kiehit ventere, NOTARIZATION COUNTY, SS OA COUNTY OF *ABE. I-09 f1/4,10 611-C-S 5-rxre Ap, R- 4- 0-‘ That: 1 0c - persOnally appeared before rile and acknow.le4e the foregoing instrument as his/her 40t end deed. That he4he has prOclOced 4/1s btr.L.thl k-46-101 as identMeation, ribie,d6, um- NoTARY PUBLIC: C:-.) S41A-- etekad. tommission 141406 Nobly Public • COWIN* q (90 b los Aviles County My'Commission EXpires2 SIGN, AND RETUREn City of Miami Bkl No. 00.06-088 PligjO 28 SAMPLE 0F AFFIENUTIvE ACTION POLIECY for• WEAL EIVII)L0VMENT OPPORTUNITY AFFIRMATIVE ACTION/ EQUAL EMPLOYMENT OPPORTENITY POLTCY STATEMENT It S. the:policy of (Company NaMe) t base Its hiring and.promotions on, A444,. quatMeations and torapetency and that its personnel preaticea wlfl not- he influenced by an apPlicatte$or'ernployees ratei 061or, place of birth, raitgio% natural tois(0, sex; agei,tnatinil status, veter,an sari tattartiaPPeci $4:1111. One of the management duties of all principals at (Oniapeq Naitte) it to ensure 'dist; the following p0e400.01 praofize$.4it tieing satisfle4; 1. Take every necessary :affirmative ,action to Of:NO.4a retain -4utilified employees, regardless of rapt place of birth, religion, national origin; Se.X,. age, rnatitali Itattts, veteran.and handicapped status. Mairitalnequitige principles. in theleotkiient.iiiring, trainiM conmensation and. pro fautiOn of emproyees. 3. Monitor an review perSOnnel practiletA to gut rarbe that equal -opportunities .ate being provIded to di ernpioyeesi Te10041eM,ciftitoe1or plu�e of birth, religion; natiOtattOr*bi,,-$6aLe age, Inadial stetl4F4 Veteran 111101,band(OppetVgatIPIS. (Comply Nal* ig oOMITIlifed *a take afrtrmative action and aggOSSIVely pursue activities that Mil ;serve tO, enable ull employees and applicants opportunities avaitable.throtOOtt-thia orgardcation• .Clearly, the above actions cannot. be aocomplistAd as,tt Seoendary duty for any individual, despite the full Opport of management And so. tMOniter -4311. offiartas (COMOttoy Name) has assigned one of its prineitalSa the! Affirmative Action Director to monitor all !aofivities orNs program. Einployees may contact, Warne of Woad .pritieipal) at (telephone .fintrftr)E regarding tins Attlanative.,ActiOn Pettey. DATE: 8-4-2006 (SIGNATUFOTITL4. AMES L. DREW, C.F.O. FAILURE TO CamAtigy,c MOM AN9 $,ErAN` THISFORIVI MAY DISOUALIFY THIS RID. City Of faanli Pale 19 Bid No. 0640-098 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: Entity Type: (check one box only) j] Partnership (] Sole Proprietorship I] Corporation Corporation Doc, No: Date Established: Occupational License No: Date of Issuance: Office Locatio orthe l idde t ooi beer 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 (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. 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 . [] Produced identification: Notary Public, State of Florida My Commission expires Printed name of Notary Public Please submit with your bid copies of Occupational License, profeulonal and/or trade License to verify local status. The City of Miami also reserves the right to request a copy of tht corporate charter, corporate income tax filing return and any other documents(s) to verify the location of the firm'e office. City of Mlaml Page 30 Bid No. 05-08.098 4.7. STATEMENT OF NO BID NOTE: If you do it 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. 05-06-098 for RECYCLING BINS 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 31 Bid No. 05-06-09B 6.0 BID RESPONSE CHECK LIST This checklist is provided to help you conform to all requirements stipulated in this IFB. Required to be Submitted with Bid 1. Bid Certification form (Form 4.1.) This form must be completed and signed to validate your bid Yes ® No ❑ 2. Bid Form- (Form 4.2.) Yes ®No El form must be completed and signed by bidder 3. Bidder Qualification Statement (Form 4.3.) This form should be completed in Its entirety to verify the capability of Yes ® No ❑ bidder to perform/deliver the services/goods specified in the IFB 4. Mlnority!Women Business Affairs Registration Affidavit, if Yes ®No ❑ 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. 6. Affirmative Action Policy for Equal Employment Opportunity Yes No El(Form 4.6.) 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 Yes ® No ❑ 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 j not more than ten percent (1O%) 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. 7. Statement of No Bid, only If applicable (Form 4.7.) If you do not intend to submit a bid on this commodity or service, Yes ® No ❑ please return this form in the bid 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. • Factory information sheets (specifications, brochures) • Test results of Items bid Yes ® No ❑ • Manufacturer's Installation Instructions • Product warranty • Show Drawings TO BE SUBMITTED AS PART OF YOUR BID RESPONSE. Ctty of Miami Pap 32 Bid No. 05.06.098