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Home My WebLink AboutSupplement to Bid Form00500. 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 Name and Number # Years . E- o 13 0 S- (°'te_'t ro-r.7//`Ss► n LG C-0S`o1.G5 t O 1A. What business are you in? 2. What is the last project of this nature that you have completed? (, 310->.z Orc.t 3, . 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 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. wt 05-06-015 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: (name) (address) (phone #) (name) (address) (phone #) (name) (address) (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 (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? ErYes 0 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. M/WBE Description of Work Name Percentage Status The foregoing list 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? 05-06-015 R-30262 Pace 31 10. What equipment will you purchase for the proposed Work? JUc 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. LD y r5 G Kp Pr a �•`. �t w4 %e"' Q. -e---cam 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 -tf o C14-e -e3 S Tn c_ 13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation). COrparc.'%i a/\ 13.3 The address of principal place of business is �C1 iFZ 3.701 05-06-015 Cnn 11, 13.4 The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: ��t✓lio A. r sobc..rt.S 616..4Gco lcc..sJe� 13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. /30 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. Non L 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. 05-06-015 B-30262 -Page 33 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. 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. Juo 13.11. Under what conditions does the Bidder request Change Orders? 5 IZcct v 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? c ctn (.51-;. l- ✓� 05-06-015 R-30262 Page 34 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 five (5) year period. 1) Company Name Address (-/L(L( Su) )v_( ! - Contact PersonlContract Amount G..,..by Q-c y o°/o° 0 Telephone No. /Fax No. Dos -�i ��' - 1 Lss Company Name Address "Y 2- 5,0 ) rLr9- f J Contact Person/Contract Amount .E�,—u' ° U e S• 01 Telephone No. /Fax No. — ZS L— Dx..--`‘ 3) Company Name Address l l (.3 '--- Contact Person/Contract Amount I--.5-3 6-of•,.,u.\ez_ '2. a r� Telephone No. /Fax No. 3 ° 5-- 'i i-1 V5 4) Company Name p&eke C n P)b tit w r) Address Contact Person/Contract Amount C, ( 2 << c-hi \ • 6 Telephone No. /Fax No. 05-06-015 B-30262 Page 35 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) 5) Company Name (- Address ySt- Contact Person/Contract Amount L 6 ° 11-e 3• 7 . L Telephone No. /Fax No. 3 o s= . (C., - 6) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 7) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 8) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 05-06-015 R_An2R2 Page 36 00510. SUPPLEMENT TO BID FORM: 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: Occupational License No: PRESENT Street Address: NIA Date Established Date of Issuance Office Location "(Establishment of the bidder/proposer) 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. 05-06-015 B-30262 Page 37 00510. SUPPLEMENT TO BID FORM: 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 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. 05-06-015 B-30262 Page 38 } 0550 Local, Small, Disadvantaged and Minority/Women Business Enterprise Participation Project No.: - 70 rj•e— 54 f ' `(?�,�Y'" Bidder/Contractor: f‘/I-2 +ro 3 .-. 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 Assigned/ Awarded Percentage of Total Work or Contract r}? I� $ IN BBE ■ CSBE or SBE • DBE ■ HBE • Local ■ MBE • WBE ■ None ❑CSBE or SBE $ ■ BBE ■ 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 ❑ None ■ Local ■ MBE ■ WBE $ ■ BBE ■ CSBE or SBE ■ DBE ■ HBE ■ Local ■ MBE ■ WBE ■ None LEGEND Types of Firm Certifvinq Entities BBE - Black- (African -American) owned Business Enterprise CM - City 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 Govemment Local - Local Firm (within 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 05-06-015 B-30262 Page 39