HomeMy WebLinkAboutQualification StatementFROM :DSS INC FAX NO. :3056396024
Aug. 22 2006 02:03PM P2
4.3. Qualification Statement (Page lof 2)
INSTRUC'l'!UNS:
This guwtio.nnaim is to be inclndcd with your bid. Do not leave any questions unanswered. When the yucstion
does not apply, write the word(s) "None", or "Not Applicable", as appropriate. Please print.
' COMPAAl1!lAlk: A°t S``„# $11 1 ) C.
• C'OM.rAN'r' op-fe CER.S:
Prosident Ir1 ", EQ 5 Ve)
Secretary
COMPANY OWNERSHIP:
C 10.). o5s
Tercy-ci EL Eason
LfeLNSES:
2.
Vice: President
Treasurer
Unatn.ry nr Municipal Occupational ,License No.
(attach copy with bid) Q ��1
Occupational License Clussifcatiotn ra 1 3 /1 ► �v � (LA, -
."'� �N��� ^4 7-101?
1 % orowncrship
39 "/° of ownership
% ul uwncrship
% of ownership
5q 113S— 0 , 56/1 /34—g
3, Occupational License Expiration 1.)++te:, .,...,..4 .1,1.3,CL) t7 /O
4, Metro -Dade County Ccrtllic+itn of Cutrapctcncy Nu.
(attached copy if reguesled in Bic' or lthl')
l Gee
tiut:inl Security or Federal LC), No. a D 3 t0 6 q J 39
EXPERIENCE,
6. Number of Years your organirutinn has been in business:
16 OA Is.) A ....\\AA,
'1. Number or Years experience B1DL)ER/PROPOSER (paeryun, principal of firm, owner) has had In
operation of the type: required by the, specifications of the .Did nt RFP: 77, 7'A L QQ # i€S ALL Elute pE .5
i;. Number of Ycers experience 1.t11)I)I+ItJPROYOSCR (firm, curpnration, propriotorehip) has had in
operation of the typo required by the specifications of the Ltld or RFP:. Lt. .o,rr4tt
City or Miami Pn90 12
Bid No, a6•e8-O36
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 13 id or RFP with whom you have done business with in the past three (3) years:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
- C. At'4 i �01, Vona Po / 43/3 42 G 8
CONTACT PERSON:
PHONE NO.:
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
11 0 q OF r .ems u: p .+ rrole
CONTACT PERSON:S�7 ..h /,t/ /AFL
AGENCY/FIRM NAME/ADDRESS
DATE OF CONTRACT
CONTACYt PERSON: �4)7 A K
PHONE NO.: 30S - odg I - 798?
DESCRIPTION OF CONTRACT
wirrifei
PHONE NO.:.39,S- 47.3- 70DC
x..3t',pJ
AGENCY/FIRM NAME/ADDRESS DATE OF CONTRACT DESCRIPTION OF CONTRACT
c,/ CA . St V. Zao G SO hl sz try 4./p
CONTACT PERSON: a5:6A) / 44,4/-L-s'
PHONE NO, 23'7^ 793-99 s"7
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR BID.
City of Miami Page 43
Bid No. 05-06-035
FROM :DSS INC
FAX NO. :3056396024 Aug. 22 2006 02:03PM P3
4.4. MINORITY/WOMEN BUSINESS AFFAIRS R ,OIS'I'RATION AFFIDA'V1' '
Please Check One Box Only [ ] Hispanic.' 70emale (1 ])lack [ 1 Not Applicable
If business is not 51%minority/tem.►le owned , affidavit does not apply. Until applicable. notarization is not requited,
I (Wc), the; undersigned agree to the following conditions:
1) that we have read Section 2,7.5 of the Oonorul 'forms and meet the fifty -ono percent (51") ownership and
manngernent requirement for minority/women rcg,istrntion status and will abide. by all of the policies and
regulations governing the City of Miaini Minority and Women Business Enterprise Procedures;
2) that if. at any time information stthmitted by the undersigned applicant i.n his/her Bidder Application should
prnvr ..to tte..fnl5c. inaccurate, .or rnislccufing,. ap.plrcattr.'s name .will. be.. ntrook_.frnrrti. Rio. City of Miamis
Master Bidder list with no further consid.cration given to this applicnnt;
3) that the City of Miami rttnintnins the right, through award of bid/contract, to revoke the award, should it be
found that false, inaccurate or misleading information or n change in the original information have occurred;
4) to notify rhu City of Miami within thirty (30) days of any change in the lirrn's ownership, control,
management or status As an ongoing minority/women business concern as indicated on the Bidder
Application. nod 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 rinority and women -owned
businesses;
5) that the City IA: Miami has a right to diligently verify all information submitted by applicnnt in his/her
Didder Application to monitor the status of the Minority/Women Business Priti rprii e, once registered;
5) that the Cittrf Miurni niuy share a frtn'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
procurenterttsopportuni.tics, unless nthcrwi.v, specified by the firm in writing.
I t(We) certify unelrr the pcnnliies of parjrtry that the information contained in any acid all application documents
submitted to the City nt' Miami is correct as per Ordinance No. 10(162 ns mrnen.ded.
• Finn Jame: � �TT�'�.i .r. S I fir .
Mkt! as x carp -rate -led)
itic & Date
P g�z Goo 0 0
. 1 — Nnme Title &. Date)
plication mu. t1he Signed by at least one general partner of i partnership or the proprietor of a sole
proprietorship or all painters of a.joint venni;e.
COUNTY, SS
COI 1NT Y or DA D.E
▪ That: grf, .i�54�
Acknowledged the foregoing insttutnent as his/her act and deed.
• That hcAhe has produccd!C ' 4 7O M5
NUTAIIi(ZATION
Darr: _- 2/%2LY6
t' raonally appeared.
as iderrtificat
NOTARY PI331,1C. Ce¢X.s! DI CT
My Comm ir,4inn Pxpircs• ii//i/PO/0
MAMA TQ COMPE.i''rI , S.] :N_, AND RETURN THIS FORM MAY DISQUALIFY THIS BID.
before me and
City or Mlnml
i•3ia No 06-05.035
Pape44
FROM :DSS INC
FAX NO. :3056396024 Aug. 22 2006 02:04PM P4
4.5_ SAMPLE Or AFFTnMATXVC ACTION POLICY for EQUAL EMPLOYMENT
OPPORTUNITY
AFFIRMATIVE ACTION/
EQUAI JIGMPLOYMENT OPPORTUNITY - POI, ICY STATEMENT
It is the policy of (Con►pany Name) lu base its /tiring and promotions on tncrft, qualifications and competency and
that its ptxsannel practices will nor be .influenced by nn Applicant's or employee's race, color, place of birth, religion,
national origin, ytsx, agc, marital status, veteran and handicapped .statn�. S � 1 , r
1)O'Aa. S
vi
tame of the management duties of all principals at (Company Nome) is to ensure th`1t the following personnel
practices are being satisfied
1 Take every necessaly affirmative action to attract and retain qualified employees, regardless of race, color,
place of biltlt, religion, national origin, sex, agc, ,mils r1Il status, veteran and handicapped status.
2. Maintain etluitirhle principles in thc recruitment, hiring, training, cnrnpcnsntion and promotion of employees.
3. Monitor and rovicw personnel predate$ to guarantee that equal opportunities are beim!, provided to all
employees, regardless of race, color, plants of birth, religion, national origin, sex, age, %mitlsl si:tlus, veteran
and handicapped AMC.
Dr-vt •- 5 -s 1 y ,�n..c-
(Cotnpany Name) is c mmitttld to trine affirmative action and aggressively pursue activities that will serve to enable
all employees and applicants opportunities available throughnrit this organization,
Clearly, the above actions caliw t he accomplished as a secondary duty far any individunl, despite the full support of
management. And so, to momar our efforts, (Company Name) 110 aSSiglied one of its principals us thc Affirmative
Action Director to monitor all activities of this program.
Employees may contact (Name of assigned principal) at (telephone number) rugarding this Affirmative Action
Pnlicy.
• (SIGNAl'UIZUITITL..J
FA1L1)RE TO COMPLETE, SEGN, AND RETURN THIS FORM MAY DISCO lAI.1FY Ilia DID.
City of Miami Page d6
Bid No. 06•06•036
4.6. OFFICE LOCATION AFFIDAVIT
Please type or print clearly. This Affidavit must be completed in Tull, signed and notariz d ONLY if , our office is located within the
corporate limits of the City of Miami.
Legal Name of Finn:
Corporation .Doc. No: Date Established:
PRESENT
Street Address:
Entity Type: (check one box only) [] Partnership
[] Sole Proprietorship [] % • oration
Occupational License No: Date of Issuance:
•= O€fice i:oc tlpn tilcth rittdcteriD oppsr:
City:
PREVIOUS
Street Address:
State: .klow fang at this location:
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 bidde who maintains u Local Office, the opportunity of accepting a bid at
the low bid amount, if the original bid amount submitted by the local v dor is not mote than ten percent (16%) in exrest of the lowest other
responsible and responsive bidder,
The intention of this section is to benefit foe s�l ba? r e bidder roposcrs to promote economic development within the corporate limits
of the City of Miami.
I (we) certify, under penalty of perjury, that `office loc ion of our firm has not been established with the sole purpose of obtaining the
advantage granted bona fide local bidders r by thi action.
•a!
Authorize Signature
Print Name
'ride
Authorize Signature
Print Name
Title
(Must be signed by the corpo„to 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 FLO DA, COUNTY OF DADE
[] Personally known to me: or
Subscribed and Sw' before me that this is a true statement this day or 199 . [l Produced identification:
Notary : blic, State of Florida My Commission expires
Prin ed name of Notary Public,
Please submit with your hid copies of Occupational License, professional andlor trade License to verify local status. The City of Miami
also reserves the right to request n 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
Bid No. 06 06.435
Page 46
4.7. STATEMENT OF NO BID
NOTE: If you do not intend to submit a bid on this commodity or service, please return this form in the ► d envelope
on or before bid opening. Failure to submit a response after three (3) times without a suffici 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 06-035 fo MERGENCY VEHICLE
E9t'_lIPMENT-CITYWIDE for the following reasons:
Specifications too "tight", i.e., geared toward one brand or manufturer 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 (xplai below).
We are unable to meet insur nce r irements.
Remove us from your bidder lis his co • modity or service.
Other (specify below).
Remarks:
We understand that if thi tatement is not completed and returned, our company may be deleted from the City of
Miami bidders' list for is 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
Bid No. 05-06-035
Page 47
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 1FB. 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 a 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.
XPECTID
RATE OF` PAS ' NCIMBE OF L N ' [ kI OR
1)
2)_
3)
A)
5)
6)
7)
8)
e additional sheets if necessary)
COMPANY NAME: b41JA J A 47 y
SIGNATURE/TITLE:
1 ES DATE: g' 2 a^ 2
FAILURE TO COMPLETE, SIGN, ANI) RETURN THIS FORM MAY DISQUALIFY THIS BID.
5.0 BID RESPONSE CHECK LIST
City of Miami
Sid No. 05.06.035
Page 48