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 NONRESPONSIVE.
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 Name and Number # Years
M iaM N4c-. OccUPa-Vvnc License I314 V 3 — 3 21
IA. What business are you in? LU tr KAAir4ef,crN LGVALC-c-e f`' Te, Serer,
2. What is the last project of this nature that you have completed?
u .S Nqd.ks , 0Ak1 o� M Pbulic. Wore-s DT\--.
3. Have you ever failed to complete any work awarded to you? If so, where and why?
N D.
4. Give owner names, addresses and telephone numbers, and Surety and project names, for all 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.
-0ne�
5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions
for which you have performed work:
0;4, o.- W'\ DJ30 \ores p-k..., 444 s �, 2 4 ( Mi ",, El— (yos)q�� —1��
(name) (address) (phone #)"
0.,-,, t„ 1G.rYu Beadn Po.r s `)ept Z(00 iNer�dir,.r, A Mk Bch, L. (cs)673-7"120
(name) (address) (phone #)'
L o ` 0-zral C--knn1c 5 t' tc ervice, )800_S.13. 1Z Ave �tc.. eL (303)-233-00(0(,
(name) (address) (phone #)
Bid No. 136-07-007 Page 38
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
e_ o M►c; ;
O.S. NlediunS (34S 416--12t1 4S$,300."' 03 `3I 61 (OO
0_ Mi4 f3ck
4 Neon (30S) 13-11245 49S,00O. V2...`9-oW 2S
A-ik 04er 3 ohs are_ ma* n--6- rnon 1 nick
(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 •erformance?
No
8. Will you subcontract 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. MMVBE Description of Work
Name Percentage Status
Ni I Pc
The foregoing list of Subcontractor(s) may not be amended after award of the Contract without the prior
written approval of the Contract Administrator, whose approval shall not be unreasonably withheld.
9. What equipment do you own that is available for the Work?
S Qe Pk- c-c.voz d LA s *`
10. What equipment will you purchase for the proposed Work?
Yl L)
Bid No. 06-07-007 Page 39
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.
Acdr€s V 1 o r ry c-J i a ndsc tc.s— Si nce j°i S o
Ecorn \ x (o — 20 04 , Marle je A croon cls n rkai nTanar\ce.
C6(\ o-C*S �0 1\r-Q yY\-oc,e. ---V\c-e-N nne on dotlass
?Cr- y2CS r C, 1)� e - G& o\ s , a rki o - 1 "� � C.SVtI & a.r e l.th
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 rname).
13.1 The correct name of the Bidder is F(O r is a- Se r J; ce -4✓LL .
13.2 The business is a (Sole Proprietorship) (Partnership) Corporation .
13.3 The address of principal place of business is
(ZS°iS S.1^J. S{o �� M'iarvik 3317S
13.4 The names of the corporate officers, or partners, or individuals doing business under a trade
name, are as follows:
nare_s V iGnnor\A-e s Presdrt
C1e/-14 V 4Gmon
SeCr��F.r�
Bid No. 06-07-007 Page 40
13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of
the Bidder were principals or officers.
Nr.9_
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.
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).
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.
Nocit,
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.
[�oner
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.
Ro
Bid No. 0647-007 Page 41
13.11. Under what conditions does the Bidder request Change Orders?
_AS k ceo)e_c*
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?
N �
Bid No. 06-07-007
Page 42
00502. SUPPLEMENT TO BID FORM:
CUSTOMER REFERENCE LISTING (Page 1 of 2)
Contractors shall furnish the names, addresses, and telephone numbers of a minimum of five (5) firms or
government organizations for which the Contractor has provided services for projects of similar size, scope and
complexity over a three (3) year period. Pull( l��
1) Company Name tA1 o M't &fru , 1"u.bi( c. VVor D_ee�.
Address 4 4'4 S.t,J 2_" Avc ' -' -Noor, MjaPe, i
Contact Person/Contract Amount Eli CS eve 2_ ,° 81, 3OO 00
Telephone No. /Fax No. Ph 430S) (4I(0 - (211 j : (30 S) 414, - 121 Y
2) Company Name 0 `t"i 0k- aor1 (r}o-Wes PAI(Cc. Sesv. bee.
Address 2$OC) S,\, 12 llve., k_or'ti , Ft.
Contact Person/Contract Amount e-erolacci Luto.r-vs ' 13(0,000.
("41
(3°S)'33-.00C0C
Telephone No. /Fax No.
3) Company Name l..l ..l gtUrnl eeG 1 Par` ic& Ve*,
Address 2-i00 Me r',dic1 /lve<.1 Mic4mi Bec,a-, Et -
Contact Person/Contract Amount Torrrrn (,ri5\A- 1 #1S,Uoo.°°
Telephone No. /Fax No. C3°s� (o'j 3 -112_o } (3 o ") (4,13_9 3') 2_
4) Company Name IN 0c &bur 1 k-k4meo�ar1 erg .ssoC..
Address S .VJ . 41 Sk- . 132 /'I Ve, • M (c ,
Contact Person/Contract Amount �e�k4 Pe-r'e- - L 43 (a 000 .°°
Telephone No. /Fax No. (11 1 a S CobsS
Sid No. 06-07-007 Page 43
00502. SUPPLEMENT TO BID FORM:
CUSTOMER REFERENCE LISTING (Page 2 of 2)
5) Company Name M aripc P(aZA
Address U .5 . 0-0rc)4 Gab1�
Contact Person/Contract Amount Toinrt SCY1denzel f 8 000.3°
Telephone No. /Fax No. (oS) $ - S 3 10
6) Company Name
Address
Contact Person/Contract Amount
Telephone No. IFax No.
7) Company Name
Address
Contact Person/Contract Amount
Telephone No. /Fax No.
Company Name
Address
Contact PersonlContract Amount
Telephone No. /Fax No.
Bid No. 06-07-007 Page 44
00510. OFFICE LOCATION AFFIDAVIT (Page 1 of 2)
Please type or print clearly. This Affidavit must be completed in full, signed and notarized ONLY IF YOU
MAINTAIN AN OFFICE WITHIN THE CORPORATE LIMITS OF THE CITY OF MIAMI.
Legal Name of Firm:
Entity Type: (Check One) Partnership Sole Proprietorship Corporation
Corporation Document No:
Date Established
Occupational License No:
PRESENT
Street Address:
Date of Issuance
Office Location. (Establishment of the bidder/or000sei?jt
City:
State: How long at this location:
PREVIOUS
Street Address:
City:
State How long at this location:
According to Section 18-85 of the City of Miami Code, as amended:
The "City Commission may offer to a responsible and responsive local bidder, who maintains an office in the City
of Miami, the opportunity of accepting a bid at the low bid amount, if the original bid amount submitted by the local
bidder does not exceed 110 percent 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.
Bid No. 06-07-007
Page 45
0051i0. OFFICE LOCATION AFFIDAVIT (Page 2 of 2)
Authorize Signature Authorized Signature
Print Name Print Name
Title Title
Authorized Signature Authorized Signature
(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.)
NOTARIZATION
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
That: personally appeared before me and
acknowledged the foregoing instrument as his/her act and deed.
That he/she has produced as identification.
NOTARY PUBLIC:
My Commission Expires:
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 to request a copy of the corporate charter,
corporate income tax filing return and any other documents(s) to verify the location of the firm's office.
Bid No. 06-07-007 Page 46
0550 Local, Small, Disadvantaged and Minority/Women
Business Enterprise Participation
Project No.: Title:
Bidder/Contractor:
As previously stated in the Contract Documents, the City encourages the participation of local, small and minority owned businesses. Based
on this ongoing effort the City requires that with the submission of the bid, first payment requisition, and at the request of City representative,
the Contractor shall submit this report entitled. Failure to submit the report may delay the issuance of payment to the Contractor. Contractor
shall submit an updated report when a subcontractor has been added or changed.
The following certified local, small, disadvantaged, minority or women owned firms have been awarded subcontracts for this Project. The legend
Is to be used in completing the appropriate columns.
Name of Firm (Bidder and
Subcontractors)
Business Designation
(check all that apply)
Certifying Agency
(Agencies)
List all applicable
Value of
Work
AsslgnedlA
warded
Percentage
of Total
Work or
Contract
BBE
CSBE or SBE
DBE
HBE
$
Local
MBE
WBE
None
BBE
CSBE or SBE
DBE
HBE
Local
MBE
WBE
None
BBE
CSBE or SBE
DBE
HBE
$
Local
MBE
WBE
None
BBE
CSBE or SBE
DBE
HBE
$
Local
MBE
WBE
None
BBE
CSBE or SBE
DBE
HBE
$
Local
MBE
WBE
None
BBE '
CSBE or SBE
DBE '
HBE
$
Local
MBE
WBE
None
LEGEND
Types of Firm
Certifvina Entities
BBE — Black- (African -American) owned Business Enterprise
CM - Cif of Miami
CSBE — Community Small Business
BC - Broward County
DBE — Disadvantaged Business Enterprise
FDOT — Florida Department of Transportation
HBE — Hispanic Owned Business Enterprise
FG — Federal Government
Local — Local Firmswithin City of Miami city limits)
MD - Miami Dade County
MBE — Minority Business Enterprise
MDPS — Miami Dade Public Schools
None — no special designation
Other — please identify
SBE — Small Business Enterprise
WBE — Woman -Owned Business Enterprise
NOTE: COPIES OF CERTIFICATIONS MUST BE ATTACHED. LOCAL FIRMS SHALL ATTACH THE LOCAL OFFICE
AFFIDAVIT
Bid No. 06-07-007
Page 47