HomeMy WebLinkAboutCertification Statement 2Certification Statement
Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and
retain a copy for your files. Prices should include all costs, including transportation to destination.
The City reserves the right to accept or reject all or any part of this submission. Prices should be
firm for a minimum of 120 days following the time set for closing of the submissions.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted
prices.
We (1) certify that we have read your solicitation, completed the necessary documents, and propose
to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein.
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 submission have been documented in the section below (refer to paragraph
and section).
EXCEPTIONS • N /A
We (I) certify that any and all information contained in this submission is true; and we (I) further
certify that this submission is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a submission 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 this submission for the
submitter. Please print the following and sign your name:
SUPPLIER NAME• Sanson. Kline. Jacomino & Company, LLP
ADDRESS: 782 NW LeJeune Road, Suite 650, Miami, Florida 33126
PHONE: (305) 442-2470
FAX. (305) 442-2850
EMAIL: rtan@skjnet.com BEEPER• N /A
SIGNED BY•
Richie Tandoc_
TITLE: Partner DATE: 8/3/2007
FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISOUALIFY THIS BID.
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Certifications
Legal Name of Firm:
Sanson, Kline, Jacomino & Company, LLP
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
Partnership
Year Established:
1978
Office Location: City of Miami, Miami -Dade County, or Other
City of Miami
Occupational License Number:
127617-0002
Occupational License Issuing Agency:
City of Miami, Florida
Occupational License Expiration Date:
September 30, 2007
Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance
No. 10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source
Hiring Agreement.": (Yes or No)
Yes
Do you expect to create new positions in your company in the event your company was awarded a
Contract by the City? (Yes or No)
No
In the event your answer to question above is yes, how many new positions would you create to
perform this work?
N/A
Please list 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 a Contract.
N/A
Minority/Women Business Affairs Registration Status: Hispanic, Female, Black or None,
Hispanic
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Will Subcontractor(s) be used? (Yes or No)
Does the City of Miami Living Wage Ordinance apply to this formal solicitation? ( See Section
1.40 of the General Terms and Condtions) (Yes or No)
Service Total Contract Amount( which includes base term and renewal options):
Is this service contract a citywide contract? (Yes or No)
If the above answer is no, please indicate the name of the city (end user) department that your
contract will serve:
Provide brief description of the project or service to be provided
I/We hereby state compliance with the City of Miami Living Wage Ordinance, Section 18-556
through Section 18-559 as summarized in Section 1.40 of the General Terms and Condtions? (Yes
or No)
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