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HomeMy WebLinkAboutBid Form00400. PROPOSAL BID FORM: (Page 1of 9) Firm's Name: Loire.WAsie- ce/'/t') 6.04/0,:c. Submitted on : / 2.4 /47 Date City of Miami, Florida Office of the City Clerk City Hall, 1st Floor 3500 Pan American Drive Miami, Florida 33133-5504 The undersigned, as Bidder, hereby declares that the only persons interested in this bid as principal are named herein and that no person other than herein mentioned has any interest in this bid or in the Contract to be entered into; that this bid is made without connection with any other person, firm, or parties making a bid; and that it is, in all respects, made fairly and in good faith without collusion or fraud. The Bidder further declares that it has examined the site of the Work and informed itself fully of all conditions pertaining to the place where the Work is to be done; that it has examined the Contract Documents and all addenda thereto furnished before the opening of the bids, as acknowledged below; and that it has satisfied itself about the Work to be performed; and that it has submitted the required Bid Guaranty; and all other required information with the bid; and that this bid is submitted voluntarily and willingly. The Bidder agrees, if this bid is accepted, to contract with the City, a State of Florida municipal corporation, pursuant to the terms and conditions of the Contract Documents and to furnish ail necessary materials, equipment, machinery, tools, apparatus, means of transportation, and all labor necessary to construct and complete within the time limits specified the Work covered by the Contract Docurnents for the Project entitled: Bid No: 06-07-041 Title: Slab Cover Trench Cleaning Project, M-0001 The Bidder also agrees to furnish the required Performance Bond and Payment Bond or alternative form of security, if permitted by the City, each for not Tess than the total bid price plus alternates, if any, and to furnish the required Certificate(s) of Insurance. The undersigned further agrees that the bid guaranty accompanying the bid shall be forfeited if Bidder fails to execute said Contract, or fails to furnish the required Performance Bond and Payment Bond or fails to furnish the required Certificate(s) of Insurance within fifteen (15) calendar days after being notified of the award of the Contract. In the event of arithmetical errors, the Bidder agrees that these errors are errors which may be corrected by the City. In the event of a discrepancy between the price bid in figures and the price bid in words, the price in words shall govern. Bidder agrees that any unit price listed in the bid is to be multiplied by the stated quantity requirements in order to arrive at the total. In case of an error in the extension of prices, the numerical unit price will govern. Bid No. • 06-07-041 Page 16 00400. PROPOSAL BID FORM: (Page 2 of 9) Note: Bidders are bidding on a total bid cost basis for the purpose of determining the lowest responsive and responsible bidder. However, Bidders will be paid based on the line item breakdown, contained in the Bid Form, with payments based on actual work performed. Bidders must submit bid prices for all items. Failure to bid on all items will result in the bid being rejected as non -responsive. The City will award a Contract to the lowest responsive responsible Bidder based on any of the Combined Bid Price stated below. Refer to Section 01000 — Supplemental Conditions. Our items and lump sum bid prices include the total cost for the work specified in this bid, consisting of furnishing all materials, labor, equipment, supervision, mobilization, overhead & profit required, in accordance with the Bid Specifications. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * TOTAL BID: The sum of item 1 and Item 2 based on a one (1) year completion time. Slab Cover Trench Maintenance Work ' )ref *1(4 se,r, 44,44 $ J ireo, --- Written Amount ****************************************W********** * * * * * * * * * * * * * * * * * Note to Bidders: The City reserves the right to reject any and all bids. The one year completion time shall be the total time for whichever bid arrangement is awarded by the City. And the City may opt to renew (OTR) the Contract for four (4) additional one (1) year term pending on the availability of funding and the contractor's performance. Bid No. 06-07-041 Page 17 00400. PROPOSAL BID FORM: (Page 3/4 of 9) DIRECTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES, AND PART III. Part I: Listed below are the dates of issue for each Addendum received in connection with this Bid: Addendum No. 1, Dated Addendum No. 2, Dated Addendum No. 3, Dated Addendum No. 4, Dated Part II: I/ No addendum was received in connection with this Bid. Part III; Certifications The Bidder, by virtue of signing the Bid Form, affirms that the Bidder is aware of the following, and shall comply with all the stated requirements. 1. Affirmative Action Plan Successful bidder(s) shall establish an Affirmative Action Plan or an Affirmative Action Policy pursuant to Ordinance #10062 as amended. Effective date of implementation must be indicated on the policy: and 2. First Source Hiring Bidder certifies that (s)he has read and understood the provisions of City of Miami Ordinance No. 10032, pertaining to the implementation of a "First Source Hiring Agreement". Evaluation of bidder'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 and the City of Miami; and 3. Non -Collusion Bidder certifies that the only persons interested in this Bid are named herein; that no other person has any interest in this Bid or in the Contract to which this Bid pertains; that this Bid is made without connection or arrangement with any other person; and 4. Drug Free Workplace The undersigned Bidder hereby certifies that it will provide a drug -free workplace program by: (1) Publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Bidder's workplace, and specifying the actions that will be taken against employees for violations of such prohibition; Bid No. 06-07-041 Page 18 00400. PROPOSAL BID FORM: (Page 5 of 9) (2) Establishing a continuing drug -free awareness program to inform its employees about: (i) The dangers of drug abuse in the workplace; (ii) The Bidder's policy of maintaining a drug -free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace (3) Giving all employees engaged in performance of the Contract a copy of the statement required by subparagraph (1); (4) Notifying all employees, in writing, of the statement required by subparagraph (1), that as a condition of employment on a covered Contract, the employee shall: (i) Abide by the terms of the statement and (ii) Notify the employer in writing of theemployee's conviction under a criminal drug statute for a violation occurring in the workplace no later than five (5) calendar days after such conviction; (5) Notifying the City in writing within ten (10) calendar days after receiving notice under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination;` or (ii) Requiring such employee to participate satisfactorily in a drug - abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and (7) Making a good faith effort to maintain a drug -free workplace program through implementation of subparagraphs(1) through (6); and Lobbying The undersigned certifies to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid, or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer oremployee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. Bid No. 06-07-041 Page 19 00400. PROPOSAL BID FORM: (Page 6 of 9) (2)If any funds other than Federal appropriated funds have been paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report. Lobbying," in accordance with its instructions. (3) This undersigned shall require that the language of this certification be included in the award documents for "All" sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that ail sub -recipients shalt certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a pre -requisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. In these instances, "All" in the Final Rule is expected to be clarified to show that it applies to covered contract/grant transactions over $100,000 (per QMB). Debarment, Suspension and Other Responsibility Matters The Bidder certifies to the best of its knowledge and belief, that it and its principals: Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency. b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining; attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civily charged by a government entity (Federal, State,` or local) with commission of any of the offenses enumerated in paragraph 1.b of this certification; and Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. Where the prospective Bidder is unable to certify to any of the statements in this certification, such Bidder shall submit an explanation to the City of Miami. Bid No. 06-07-041 Page 20 00400. PROPOSAL BID FORM: (Page 7 of 9) Attached is a Bid Bond Cash [ J, Money Order [ J, Unconditional/Irrevocable Letter of Credit [ ], Treasurer's Check [ j, Bank Draft [ ], Cashier's Check [ J, Bid Bond Voucher [ J or Certified Check [ J No. Bank of for the sum of Dollars ($ ). The Bidder shall acknowledge this bid and certifies to the above stated in Part 11I and IV by signing and completing the spaces provided below. Firm's Name: t 1ch.-o G1)As Ic. 5r,-u«<J 6,07, Signature: �1 Printed Name/Title: C Jr,.. arad 6,444 , C .0.0, City/State/Zip: iia,ki rc/ 33/$12 Telephone No.: `3c' 637'.66'1 Facsimile No.: eSGf - Cg7 14‘-r E-Mail Address: eddy 4a .Q Social Security No. or Federal .. .. I . D . N o.: 67: OF 2-90 y0 Dun and Bradstreet No.: G (/1/ 7 (if applicable) If a partnership, names and addresses of partners: Bid No. 06-07-041 Page 2! 00400. PROPOSAL BID FORM: (Pape 8 of 9) CERTIFICATE OF AUTHORITY (IF CORPORATION) I IjEREBY pERTIFY that at a meeting of ` the Board of Directors of o ro WAS ?pc., a corporation organized and existing under the laws of the State of F44 held on the day of ?p 07 , a resolution was duly passed and adopted authorizing (Name) as (Title) d ,/ C. O. d. of the corporation to execute bids 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 Wit. IN Secretary: Print: ftAro,4 REOF, I have hereunto set my hand this P7, day of Pe«r, 6ir 20 07. CERTIFICATE OF AUTHORITY HEREBY CERTIFY (IF PARTNERSHIP) 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 as (Title) of the to execute bids on behalf of 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 authorizing (Name) the partnership and Partner. Print: CERTIFICATE OF AUTHORITY (IF JOINT VENTURE) Joint venturers must submit a joint venture agreement _indicating that the person signing this bid is authorized to sign bid documents on behalf of the joint venture. If there is no joint venture agreement each member of the joint venture must sign the bid and submit the appropriate Certificate of Authority (corporate, partnership, or individual). CERTIFICATE OF AUTHORITY (IF INDIVIDUAL) HEREBY CERTIFY that, I (Name) , individually and doing business as (d/b/a) (If Applicable) have executed and am bound by the terms of the bid to which this attestation is attached. IN WITNESS WHEREOF, I have hereunto set my hand this , day of , 20 Signed: Print: Bio No. 06-07-041 Page 22 00400. PROPOSAL BID FORM: (Page 9 of 9) STATE OF Flrl A NOTARIZATION ) SS: COUNTY OF /'//' i // 44 The foregoing instrument was acknowledged before me thiscl/ day of L 1 0G)7, by Afs /ph A. 6, , who : is-per"onally know -iv to me or who has produced as identification and who (did / did not) take an oath. SIGNATURE OF NOTARY PUBLIC STATE 0 atfc Notary Public State of Florida - Maria -Elena Martin w My Commission DD733783 Bid No. 06-07-041 Page 23 Line No. 1 00402 Slab Cover Trench Cleaning Project, M-0001 Page 1 of 1 Pay Item Description SLAB COVER TRENCH CLEANING = Price for furnishing all labor, equipment and machinery necessary for a thorough cleaning of 2000 linear feet of cover trench, cover ditch or slab cover trench as indicated in Section 01000- Supplemental Conditions, of these specifications. This item price must include the following: removal of all sediments including roots, silt, floatables, compacted soils, concrete material, wood leaves, clay, any other debris, etc. using Hydro jetter with a minimum of 380 gpm, 2,400 psi. The selected contractor will use a highly specialized machine to cut and remove all types of root systems growing inside the cover ditch and used of labor crew inside the ditch if it has to be cut by hand. The crew must be OSHA certified to operate in confine spaces and the divers must meet OSHA and Association of Diving Contractors (ADC) certification standards. In addition, CCTV and sonar survey will be conducted as part of the final cleaning inspection. The debris may be tested by an environmental engineering testing company prior to be disposed at a Miami -Dade County waste facility. The cost for this test shall be included in the contract price and no additional compensation shall be allowed. The cost of a floating water meter and water use shall be included in this item price. Contractor shall make all provisions to obtain his own water supply. The waste water from the jetting operation shall be filtered (< 29 NTU) before being discharged into a storm sewer system. SPECIAL PROVISION = Contingency Allowance Units 2,000 Item Quantit Linear foot Item Cost Total Cost Units *Item Cost $/6',9f per foot of $ J �7 GD.� trench $20,000 Bid No. 06-07-041 Page 24 00410. BID BOND FORM (Page 1 of 3) State of Florida ) County of Dade) SS City of Miami ) Envirowaste Services KNOWN ALL PERSONS BY THESE PRESENTS, that Group, Inc. as Principal, Hartford Fire Insurance Company as Surety, are held and firmly Five Percent of bound unto The City of Miami, in the penal sum of Amoun Bid Dollars ($ ***5%**** ) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the accompanying bid, dated December 27th , 20 07, for: Slab Cover Trench Cleaning Project, M-0001 - Bid No. 06-07-041. NOW THEREFORE: (a) If the principal shall not withdraw said bid within ninety (90) days after date of opening the same, and shall within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the City, in accordance with the bid as accepted, and give bond with good and sufficient Surety or Sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or, (b) In the event if the withdrawal of said bid within the period specified, or the failure to enter into such contract and give such bond within the time specified, if the principal shall pay the City the difference between the amount specified in said bid and the amount for which the City may procure the required work and supplies, if the latter amount be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. Bid No. 06-07-041 Page 25 00410. BID BOND FORM (Page 2 of 3) IN WITNESS WHEREOF, the above bound parties have executed this instrument under their several seals, this 27th day of Derember , A. D., 200A, 7 the name and corporate seal of each party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. WITNESS: (If Sole Ownership, Partnership, or Joint Venture, two (2) Witnesses are required. If Corporal n, Secretary only will, st and ftffix seal.) Affx Seal SEE POWER OF ATTORNEY ATTACHED Surety Secretary PRINCIPAL: Envirowaste Services Group, Inc. (Name of (Signature of authorized officer) (Title) 9911 NW 19 Street (Business Address) Miami, FI 3.31 tit City State Surety: (Corporate Surety) Zip _ipany Affix Seal Si. ature of Authorized Officer) Michael Bonet, Attorney in Fact & Licensed Florida Resident Agent (Title) 400 International Parkway, Suite 425 (Business Address) Heathrow. FL 32746 City State Zip Rrnum & Rrrn n of Flnricla, Tnc (Name of Local Insurance Agency) 8000 Governors Square Blvd., Suite 400 Miami Lakes, Address FL 33016 305-364-7815 Telephone Number Bid No. 06-07-041 Page 26 00410. BID BOND FORM (Page 3 of 3) CERTIFICATE AS TO CORPORATE PRINCIPAL i, RA 4 /-4. 6,4/4A _ certify that I am the Secretary of the Corporation narried as Principal in the within bond; that L— r" ua 64i4A of said corporation; that I know his signature, and the signature hereto is genuine; and that said bond was duly signed, sealed and attested for and in behalf of said rati9 t' authority of its governing body. (Corporate Seal) STATE OF FLORIDA ) COUNTY OF DADE ) SS City OF MIAMI ) Before me, a Notary Public duly commissioned, and qualified, personally appeared Mirhnei Bonet to me well known, who being by me first duly sworn upon oath, says that he/she is the attorney -in -fact, for the Hartford Eire Ins. Co. and that he/she has been authorized by Hartford Fire Ins. Co .to execute the foregoing bond on behalf of the Contractor named therein in favor of The City of Miami, Florida. Subscribed and sworn to before me this 27th day ofDecembArD., 20 07 . INSTRUCTIONS: Bid Bonds must be accompanied by Notary e o a Power of Attorney, in compliance with Instructions to Bidders u lic, State Florida at Large My Commission Expires: 3 f c2 /I coo 004 Notary Public State of Florida Mercedes Garcia My Commission DD628434 OF n." Expires 03/21 /2011 Bid No. 06-07-041 Page 27 00500. SUPPLEMENT TO SID 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 umber # Years Co /TA-4 C4ceds`• ti Cc,4, �� �,al�. C G c / s07Y17 3 ,v(,R.. % PAL c.c. (r crr,“ t// 3 `7106 1A. What business are you in? Sewer u 4,ji. C/Ba'„,�, 2. What is the last project of this nature that you have completed? JZev 4c) 7Z Se-r: q..i /co - d'( s ?. t�� .,: d",ec C-rP 6 T //A /Z GAGJN!iaJ S c % 74`,e,<J..-f 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. 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: (4.4q 5.3 z,4 Av.- 3t30 4' /R03,4 44 z Lj v(,1.4;4.: 30r- (7/6-/2cfr) (name) (address) , (phone #) ,tit mg 1ST" l"Fl�r 3 ?. /(" //:N% /2 (-0, (address) ,4 wed(s f 4're AJ- (name) eArro 6/rnj Si (name) ar-3751/73 . (phone #) 1;.(1.A c°.4 Co(bo/ flit`..- L f,�! 7i -$37-�c57 14"d»dress) (phone #) 6012 r /}.".4 l�Iwa ..f S " Bid No. 06-07-041 Page 28 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 ail co -venturers.) TOTAL DATE OF % OF NAME OF OWNER & CONTRACT COMPLETION COMPLETION PROJECT PHONE # VALUE �(,' PER CONTRACT70 DATE $-Jb3 w�-1 �r q'76- Z c sV 4)4 f 74" 6 5D`ZS�6 C4 34r- 51/4-/20 gi,c2PX lair 67Z. 6-167/7 I( < < 4:/.5Z)A l/1• 67/ I ETDJ /To( 91'Y-77( Y3a -°zoa/c 91/46P 20 (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? 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 (Qj Name / Percentage / Status &fn4d /el afro f,e4 e.et (0(7/7 60,1714- ,c/a)/34F ) t lX1- G?nd 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 ownthat is available for the Work? z S�cuG/ Cc.),1.1;4,4 Tld,0 A V % 411 d( 4ruic /-ed- 6-?a,-,/ej ?<We/C. Li, 10. What equipment will you purchase for the proposed Work? Bid No. 06-07-041 Page 29 11. WA equipment will you rent for the proposed Work? .et 740 e 71-u-0 A704 4 4 � 4C-� TWo re c/,A / 1-i /T !/' i/' t_o„ % /"t/! C,4/�Ci 117 I lAhl. 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. 4::luard0 AL4" ,a a sh. is ye 4..S ..,I , o�,��,- aid' go er4 i4. o -(fe, L.; U/.:-c 4/AS R „„c„.„.U/!t/ Rue a /I cplii4 444, 1- e-1ib�/[ a 1(' 2 2 ie'wer C AAS "'ArAye) O)Cr ?Zvh:C/Co•.s,7, cvJbR% 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 v�:�a ct�,as Sc�w«i Goa . 13.2 The business is a (S le Proprietorship) (Partnership) (Corporation). , 13.3 The address of principal place of business is 2R'// ,t cv 3 � sT-/�.a�;� ,/ 3/5 13.4 The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: i6f/Mdso //14e/ ISA,i �Gr �lr�o Foie 6 A/4i 4, t6A,14 Bid No. 06-07-041 Page 30 13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. 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. AivN` . 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). Ala,r)( 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. ,(Jo.�< • 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. Pow,/ Bid No. 06 07-041 Page 31 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. 13.11. Under what conditions does the{Bidder request Change Orders? w4 Lva�A 'fi.., C�,vc jc,eS U,as Lt./p.1 Shoe..¢. o t Ctiv/L SW/Po WAS `1AS vv -eur/' a C4At* c-dte,( j44 ; I. �,s,pry.✓ 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?/ U 4J 1 y '1 Wa �adT et uyc wc4rI 4.4'71 .5,/, %-,e-14, Two PO l c'vcll`/.nc• '‘ id n :4 Ce,- e.; � Qc Sr.21, So r wtic ice4A, FsI744. )0;4,0 ..c. : Sid No. 06-07-041 Page 32 Telephone No. /Fax No. 7fe6 ZS'6 Z6 ZS 2) Company Name 6 1/ € (/ /a..i Address 1/0 Sc.J Z 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. 1) Company Name ,&7;.4 /2,rU Le:I.', /7 Address lI I ,u w / /6' ,, _ /0 A.; //i4..) Contact Person/Contract Amount -'- rcJ et 44fi""Ai S7 2 4 9// /2 6zgs-z6, c Contact Person/Contract Amount /= /' t. Telephone No. /Fax No. 56r- y76-/Zcv 3) Company Name / D1 Address (773 'CC 2ors-t" 33/?I Contact Person/Contract Amount Hc.s�. 2.44,B,; ' ys2:).F Telephone No. /Fax No. T- 6S5'-7/, 3 c,r- Cam? 4) Company Name F,o-r 64%/ Address /y«S 5c0 /116 Contact Person/Contract Amount /41431"/ 6K / *~' 7, // a Telephone No. /Fax No. 50s- 256-6'3'30 Bid No. 06-07-041 Page 33 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) 5) Company Name Address Contact Person/Contract Amount f3n-t 4 'j' J 4*/rat /4:0 Telephone No. /Fax No, f5-`/- 7147- Y3' 76'a Company Name l ow./ e-(s Address / S7ae ,ow C 7R,Pc- '33// / Contact Person/Contract Amount ekeadik 6s ' . /r //,_ Telephone No. /Fax No. 30r 3‘y C✓49 i 5 or- Ste``-� . 5-// 7) Company Name U igc{�� 012 Po gym/ & gOo > v /SZ 'r 5 57s 7 Address Contact Person/Contract Amount co Telephone No. /Fax No. 3o)"—Z-57 - /Z3`/ 6 3or."2-5 1--/Zf'o 8) Company Name `lirf//yc , / Y Address / I$S/ S, ©;,r,< gc.,Y, 33 r r`. Contact Person/Contract Amount Goer 4 ,t. Telephone No. /Fax No. -30f' ri<6 Bid No. 06-07-041 Page 34 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: Date of Issuance Office Location (Establishment of the bidder/oroposerj PRESENT Street Address: 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. 06-07-041 Page 35 00510. 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. 06-07-041 Page 36 0550 Local, Small, Disadvantaged and MinorityNVomen Business Enterprise Participation Project No.: 66 b y/ Title: $/.'6 Co:.e�re-ca e/QG�,. Bidder/Contractor: LI cais4- Se cam% G�oNo. Z-- 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, sma I, disadvantaged, minority or women owned firms have been awarded subcontracts for this Project The legend is to be used in compfeting the appropriate columns. Name of Firm (Bidder and Subcontractors) Business Designation (check all that apply) Certifying Agency (Agencies) Ust all applicable Value of Work Assigned/A warded Percentage of Total Work or Contract ci,,;,, .JQs� s;e.��cci 6,a:.,, .�'e. BBE CSBE or SBE DBE HBE $ MO ;ro / Local MBE WBE None BBE CSBE or SBE DBE HBE $ Local MBE WBE None BBE CSBE or SBE OBE 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 Certifying Entities BBE — Black- (African -American) owned Business Enterprise CM - City of Miami CSBE — Community Small Business BC - Broward County DBE — Disadvantaged Business Enterprise FOOT — 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 ATTACH AFFIDAVIT Bid No. 06-07-041 Page 37