HomeMy WebLinkAboutQuestionnaire00500. 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.
1. How many years has your organization been in business while possessing one of the
licenses, certifications, or registrations?
License/Certification/Registration Npme and Number
RIVI.9. Enc)i?ev'nct E-i s
L-ro.nt+r0a0 earl rn& -o r ()(o of 3S
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1A. What business are you in? \�GtvI no3 -broi n
2. What is the last project of this nature that you have completed?
a4 rn Seri (yr PI azG
# Years
IZ.
5-
3, Have you ever failed to complete any work awarded to you? If so, where and why?
4. Give owner names, addresses and telephone numbers, and Surety and project names,
for ail 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.
Orange Bowl Parking Lot Repairs —ADA, B-30521 Bid No.: 05-06-117
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5, Give names, addresses and telephone numbers of three individuals, corporations,
agencies, or institutions for which you have performed work:
WL O0 n5 1-taffine 96 1649S NE- Z Ave, 0)(A) z - )I
(name) (address) (phone #)
NMI, Nit\ . I\)orl.inc, t n 7.2 Nw -IL ice` l3( ? - (.02.Z
(name) (address) (phone #)
eia'fi ‘fCXI 0-an+. atv ]-elriculdg 1 z 17 i 5 i3 131 mice f31A-) z3 z - q o 2-1-4(name) (a&dress) (phone #)
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
{lU.f a# - 3tn Uz, 'Zraj4q WC. OCQ 5)
7.557.- 3019- A cs I Gus (A D
4rn Elsz nrema vtd,
prAES &frein-4cAvti
de6UZ
k•trin octet c t 2L D G. cio 45".
(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?
Yes ❑ No
8. Will you subco tract any part of this Work? If so, provide the following details for each
subcontractor(s) that will perform work in excess of ten percent (10%) of the contract
amount. (Attach additional sheets if necessary)
Subcontractor Approx. MIWBE Description of Work
Name Percentage Status
Po
The foregoing fist of Subcontractor(s) may not be amended after award of the Contract
without the prior written approval of the Project Manager, whose approval shall not be
unreasonably withheld.
9. What equipment do you own that is available for the,Work?
o Ca . Nt?oiO ar Ltoehi'rvz C..ec Q SHP
J i , \'}M- , trdr , Pav; lt Q
i-,kfiQf &i A.), W-e.Q �-e.�- .
Orange Bowl Parking Lot Repairs --ADA, B-30521 Bid No.: 05-06-1 17
Page 35
10, What equipment will you purchase for the proposed Work?
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.
2 . �� O , KA_ Yteo ) QQ r? o pr op4
61ps -1-e"6/\+ ,c-cy 1 Ly...01 w-Lik
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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
business under the trade name).
13.1 The correct name of the Bidder is P 1r i Le1UZ J R- / nC
13.2 The business is a (Sole Proprietorship) (Partnership) (
rpir0ai cXl
13.3 The address of principal place of business is
1111 A-ve- tUecjl-eq Fey _?)(Lite3
13.4 The names of the corporate officers, or partners, or individuals doing business
under a trade name, are as follows:
j--t, I L.pet Jai-. FkeS/ef/r f
Orange Bowl Parking Lot Repairs --AAA,13-3052] Bid No.: 05-06-1 17
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s{UCtrtQb Lyn ' VIClt gSiden t
13.5 List all organizations which were predecessors to Bidder or in which the
principals or officers of the Bidder were principals or officers.
NUS.
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.
k.)
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).
Nor.
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.
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.
Orange Bowl Parking Lot Repairs—ADA, B-30521 Bid No.: 05-06-1 17
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13.10. Has the Bidder, its principals, officers or predecessor organization(s) been
debarred or suspended from bidding by any government during the last five (5)
years? If yes, provide details.
30
13.11. Under what conditions does the Bidder request Change Orders?
(ihn.xlt ,conipz., gicirA
0Lon I{ pin rn .
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?
51 GOO ap
Orange Bowl Parking Lot Repairs—ADA, B-30521 Bid No.: 05-06-] 17
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