HomeMy WebLinkAboutExhibit6Certification 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
fin 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 (I) 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 -
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- MCI - C Laud e Mis i
ADDRESS- 8.53 h+ 1t , l212- )-tune.
PHONE: 3.°5-556-0535 FAX 3o5-Sib-o535
EMAIL: rrO. c:Leta beSotS1-, nit BEEPER:
SIGNED BY: rc. - - e
TITLE: Laeu- &ca._ n e DATE • 4 can r •S a o r�
FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISOUALIFY THIS BID,
Page 2 of 32
Name of Individual:
I}�ai ke— CrI floe 1 ielsoty
Address of Individual:
5 3 l\.w. I42t1
City, State and Zip:
Mailing Address (if different):
La n e
Certifications
3301 sz
Is a copy of your Certificate as a Latent Print Examiner from the International Association of
Identification, attached to this submittal? or No.
25
Do ou agree to submit to and successfully pass, a background investigation conducted by the
Miami Police Department at the City's cost, as part of the qualification process? cn'or No
Do you agree to complete, and successfully pass, a paid Familiarization Program to be provided by
the Miami Police Department at the City's cost, as part of the qualification Process es'or No
aF C
Do you agree adhere to the Fee Schedule for payment of services described in Section 32 Ji'e/or No
'es
Is a copy of your resume, addressing qualitifications and experience, attached to this submittal?
or No
Do you certify that the above information provided, and its corresponding documentation is true
and correct?,9 or No
Do you understand that any false or misleading information, or the omission of information as
required by the City for the purposes of decejpt or deception, shall be grounds for disqualification
from serving services under this contract? Yes' or No
AFC
Please list and acknowledge all addendum/addenda received. List the addendum/addenda number
Page 3 of 32
and date of receipt (i.e. Addendum No. 1, 7/1/07). If no addendum/addenda was/were issued, please
insert N/A.
Are providing proof that you possess knowledge of and can utilize the Automated Fingerprint
Identification System (A.F.I.S.) Computerized System used by the Miami. Police Department? es 7
or No
iP S
Page 4 of 32
International Asso ation for Identification
77i' tiles that
de Nelson
'rjnt Certification Board of the
Identification as a
„`tenf int Examiner
rtrrf��within the power ofrhis issocia/ion to
Mari `
is declared qualified byt;kc Leterit
Intemationa•4NAssiki4tion
Certifi
And i, entitled to al!
86 13 - 02/01 /2012,
ecretarj,to/•1heBoard Certification Number Expiration Dc:r