HomeMy WebLinkAboutExhibit 46.0. RESPONSE DOCUMENT FORMS
6.1. Certification Statement
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 solicitation have been documented in the section below (refer to paragraph
and section).
EXCEPTIONS:
We (I) certify that any and all information contained in this response is true; and we (I) further
certify that this response is made without prior understanding, agreement, or connection with
any corporation, firm, or person submitting a response 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 solicitation and certify that I am authorized to sign for
the bidder/proposer. Please print the following and sign your name:
NAME OF BIDDER/PROPOSER:
ADDRESS: CITY: STATE:
PHONE: FAX:
EMAIL:
AUTHORIZED SIGNATURE:
NAME:
TITLE: DATE:
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISOUALIFY THIS
RESPONSE.
City of Miami Page 28
RFQ No. 05-06-114
Response Document 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
, a corporation 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 corporation to execute bids/proposals 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 , day of
20
Secretary:
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/proposals 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
(1F JOINT VENTURE)
Joint venturers must submit a joint venture agreement indicating that the person signing this
bid/proposal is authorized to sign bid/proposal documents on behalf of the joint venture. If there
is no joint venture agreement each member of the joint venture must sign the bid/proposal and
submit the appropriate Certificate of Authority {corporate, partnership, or individual).
City of Miami Page 29
RFQ No. 05.05-114
Response Document Form - Certification Statement (Page 2 of 3)
CERTIFICATE OF AUTHORITY
fIF INDIVIDUAL
1 HEREBY CERTIFY that, 1 (Name) , individually and doing
business as (d/b/a) (If Applicable) have
executed and am bound by the terms of the bid/proposal 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 30
RFQ No. 05-06-114
6.3. Qualification Statement
INSTRUCTIONS:
This questionnaire is to be included with your response. 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:
COMPANY OFFICERS:
President Vice President
Secretary Treasurer
COMPANY OWNERSHIP:
LICENSES:
1. County or Municipal Occupational License No.
(attach copy with response)
2. Occupational License Classification
3. Occupational License Expiration Date:
4. Metro -Dade County Certificate of Competency No.
(attached copy if requested in this solicitation)
5. Social Security or Federal 1.D. No.
% of ownership
% of ownership
% of ownership
% of ownership
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 solicitation:
8. Number of Years experience BIDDER/PROPOSER (firm, corporation, proprietorship) has had in
operation of the type required by the specifications of the solicitation:
City of Miami Page 31
RFC) No. 06-06-114
Response Document 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 solicitation with whom you have done business with in the past three (3) years:
FIRM NAME/ADDRESS
DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FIRM NAME/ADDRESS
DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FIRM NAME/ADDRESS
DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FIRM NAME/ADDRESS
DATE OF JOB DESCRIPTION OF JOB
CONTACT PERSON: PHONE NO.:
FAILURE TO FULLY COMPLETE, AND RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE.
City of Miami Page 32
RFQ No. 05-06414
6.5. 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) [] Partnership
[� Sole Proprietorship [] Corporation
Corporation Doc. No:
Date Established: Occupational License No:
Date of Issuance:
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/proposer, who maintains a Local Office, the opportunity of
accepting a bid/proposal at the low bid/proposal amount, if the original bid/proposal amount submitted by the local vendor is not more than ten
percent HOW in excess of the lowest other responsible and responsive bidder/proposer.
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 fine 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
(Corro!"i.Ric GF.y{ii) 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 Swom before me that this is a true statement this day of 199 . [] Produced identification:
Notary Public, State of Florida My Commission expires
(Seal)
Printed name of Notary Public
Please submit with your response copies of Occupational License, professional and/or trade License to verify local status. The City of
Miami also reserves the right to request a copy of the corporate charter, corporate income tax filing return and any other documents(s)
to verify the location of the flrm's office.
City of Miami Page 33
RFQ No. 05-06-114
6.6. STATEMENT OF INTENT TO COMPLY WITH ORDINANCE NO. 10032
Bidder/proposer certifies that (s)he has read and understood the provisions of City of Miami Ordinance No. I0032,
pertaining to the implementation of a "First Source Hiring Agreement".
Bidder/Proposer will complete and submit the following questions as part of the response. Evaluation of
bidder's/proposer'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/proposer 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.
1)
2)
3)
4)
5)
6)
7)
8)
(Use additional sheets if necessary)
COMPANY NAME:
SIGNATURE/TITLE: • DATE:
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISOUALIFY THIS RESPONSE.
City of Miami Page 34
RFQ No. 05-06.114
6.7. DEBARMENT AND SUSPENSION
CITY OF MIAMI CODE SEC. 18-56.4
(a) Authority and requirement to debar and suspend:
After reasonable notice to an actual or prospective contractual party, and after reasonable opportunity to such
party to be heard, the City Manager, after consultation with the Chief Procurement Officer and the City
Attorney, shall have the authority to debar a contractual party for the causes listed below from consideration
for award of city contracts. The debarment shall be for a period of' not fewer than three (3) years. The City
Manager shall also have the authority to suspend a contractor from consideration for award of city contracts
if there is probable cause for debarment. Pending the debarment determination, the authority to debar and
suspend contractors shall be exercised in accordance with regulations which shall be issued by the Chief
Procurement Officer after approval by the City Manager, the City Attorney, and the City Commission.
(b) Causes for debarment or suspension include the following:
1. Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public
or private contract or subcontract, or incident to the performance of such contract or subcontract;
2. Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or
destruction of records, receiving stolen property, or any other offense indicating a lack of business
integrity or business honesty;
3. Conviction under state or federal antitrust statutes arising out of the submission of bids or proposals;
4. Violation of contract provisions, which is regarded by the Chief Procurement Officer to be indicative
of nonresponsibility. Such violation may include failure without good cause to perform in accordance
with the terms and conditions of a contract or to perform within the time limits provided in a contract,
provided that failure to perform caused by acts beyond the control of a party shall not be considered a
basis for debarment or suspension;
5. Debarment or suspension of the contractual party by any federal, state or other governmental entity;
6. False certification pursuant to paragraph (c) below; or
7. Any other cause judged by the City Manager to be so serious and compelling as to affect the
responsibility of the contractual party performing city contracts.
(c) Certification:
All contracts for goods and services, sales, and leases by the City shall contain a certification that neither the
contractual party nor any of its principal owners or personnel have been convicted of any of the violations set
forth above or debarred or suspended as set forth in paragraph (b) (5).
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 set forth above, or debarred or suspended as set forth
in paragraph (b) (5).
Company name:
Signature:
Date:
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE
City of Miami Page 36
RFQ No. 05•06-114
6.8. STATEMENT OF NO RESPONSE
NOTE: If you do laz intend to submit a response on this commodity or service, please return this form on or before
the submission date. Failure to submit a response after three (3) times without a sufficient justification of
"No Response" will be cause for removal from the Supplier list.
Office of the City Clerk
3500 Pan American Drive
Miami, FL 33131-5504
We, the undersigned, have declined to submit a response on your RFQ No. 05-06-114 for MVIUNICII"AL BOND
UNDERWRITING SERVICES for the following reasons:
Specifications too "tight", i.e., geared toward one brand or manufacturer only (explain below).
Insufficient time to respond to the Request for Qualifications
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 suppliers' 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/proposers' 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 36
RFQ No. 06-06-114