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HomeMy WebLinkAboutProposal Bid Form (2)00400. PROPOSAL BID FORM: (Pagel of 10) City of Miami, Florida Office of the City Clerk City Hall, 151 Floor 3500 Pan American Drive Miami, Florida 33133-5504 Firm's Name: nor ocka LcoAi i S{x v c-• Submitted on : 2 2 O $ ate 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 all 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 Documents for the Project entitled: Bid No: 07-08-008 Title: CORAL WAY MEDIANS LANDSCAPING CONTRACT, M-0005 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. D.+ 00400. PROPOSAL BID FORM: (Page 2 of 10) 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 retected 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. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * BASE BID A: The sum of item 1 and Item 12 based on a one (1) year completion time Landscaping Maintenance Work $ 120,991," One. it t& (1 cir'eA 41-3e4,-1 o u Sc-r•Nck r11 n e., kvt(Vim c tl i n Written Amount BASE BID B: The sum of items 8 and 9 based on a one (1) year completion time Electrical Work $ 1tA,5©0 °° 42x)or -4n.ous cr,ci 1nu r\a, d d o tLr Written Amount TOTAL BID: The sum of items 1 through 12 based on a one (1) year completion time 416,O do((c-rS Wo ftunc rt4 J4 Sk)c4-61)sc o -k& o cio(tc.r' Written Amount Note to Bidders: The City, at its sole discretion, may award either BASE BID A, BASE BID B, or TOTAL BID, whichever arrangement is best to the City's advantage 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. CNN Rh" n7-08-008 Page 18 00400. PROPOSAL BID FORM: (Page 314 of 10) DIRECTIONS: COMPLETE PART i OR PART 11, 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 01 o g 0 g Addendum No. 2, Dated Addendum No. 3, Dated Addendum No. 4, Dated Part I1: 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; Pace I9 00400. PROPOSAL BID FORM: (Page 5 of 10) (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 the employee'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 5. 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 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 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. Page 20 00400. PROPOSAL BID FORM: (Page 6 of 10) (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 all sub -recipients shall 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. * Note: In these instances, "All" in the Final Rule is expected to be clarified to show that it applies to covered contract/grant transactions over $100,000 (per QMB). 6. Debarment, Suspension and Other Responsibility Matters The Bidder certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency. b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civily charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph 1.b of this certification; and d. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. Where the prospective Bidder is unable to certify to any of the statements in this certification, such Bidder shall submit an explanation to the City of Miami. 00400. PROPOSAL BID FORM: (Page 7 of 10) Attached is a Bid Bond [ ], Cash [ ], Money Order [ ], Unconditional/Irrevocable Letter of Credit [ ], Treasurer's Check [ ], Bank Draft [ ], Cashier's Check [ ], Bid Bond Voucher or Certified Check [ No. Bank of for the sum of Dollars ($ ). The Bidder shall acknowledge this bid and certifies to the above stated in Part III and IV by signing and completing the spaces provided below. Firm's Name: for 1 t ,G,nlrt �'V� kceCe_ Signature: Printed Name/Title: e(ena V t or r\ 3 CAI). Jecre'E"a(1 /AY\JrQ Vcryw4e Pr-s. City/State/Zip: KtaNkk fL 33115 Telephone No.: (30 ) SS3 —231'1 (3 c 1— S9OO Facsimile No.: (3QS> S53 - 2-(3 (P E-Mail Address: r (Or i c%QL n S 2tr.i A 40C.. Conn Social Security No. or Federal I.D.No.: (oS.-03(020(o Dun and Bradstreet No.: (if applicable) If a partnership, names and addresses of partners: 00400. PROPOSAL BID FORM: (Page 8 of 10) CERTIFICATE OF AUTHORITY (IF CORPORATION) I HEREBY CERTIFY that at a meeting of the Board of Directors of FlDrtdo. l.c,,,,., S er.4it , J-+`- . `g-��a corporation organized and existing under the laws of the State of FL held on the ( day of I.>ec b r- , NU,a resolution was duly passed and adopted authorizing (Name) 4Adre-s V i ajyyonie a as (Title) P-.sNden± 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 effect. r IN WITNESS WH REOF, I have hereunto set my hand this (0 , day of NAikry, 20 0 A Secretary: JCS Print: Eferu, Via e..c r * CERTIFICATE OF AUTHORITY (IF PARTNERSHIP) I HEREBY CERTIFY 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 authorizing (Name) as (Title) of the to execute bids on behalf of the partnership and 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, 1 have hereunto set my hand this , day of , 20 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) I 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: 00400. PROPOSAL BID FORM: (Page 9 of 10) NOTARIZATION STATE OF SS: COUNTY OF l\n i Arvii — Da0ut ) The foregoing instrument was acknowledged before me this ' day of F.e oroaf 1 201a, by , who is personally known to me or who has produced EQ.rIA `%I A(1rit1r s as identification and who (did / did not) take an oath. SIGNATURE OF NOTARY P STATE OF FLORIDA Y ;' Elisa Hernandez ., `� 1CoMMISStON #DD753535 PRINTED, STAMPED OR TYPED .`` "••• • 'A`= E(PIRES: FEB. 10, 2012 • NAME OF NOTARY PUBLIC ,°;;: `� 1'VYVW.AARONNOiARY.com 2 3 4 5 6 L ."<i . ,.,. •• 4'. za. ,,f. P CdM ! ' "btt•'�X :..M i::H�x" m. Mowing, weeding, trimming, herbicide spraying, insect spraying, mulching, watering the landscaping as indicated in plan sheet LD-2, and litter/debris pick up, maintenance of 130,000 square feet of median area including all the existing landscaping, on a bi-weekly basis, for the entire length of the median (2.46 miles). Furnishing all labor, materials and equipment necessary for the planting of 1,500 shrub/plant (1-gal) including removal of deceased plant, planting a new one of same species and size, watering, and mulching for a one year period, along the entire length of the median. Furnishing all labor, materials and equipment necessary for the planting of 1,000 shrub/plant (3-gal) including removal of deceased plant, planting a new one of same species and size, watering, and mulching for a one year period, along the entire length of the median. Re -installation of 1,000 linear feet of root guard system at the medians, if needed. 7 8 9 10 11 130,000 Square foot $ 29Sg every two weeks 24 1,500 1,000 1,000 For furnishing all labor, material and equipment necessary for the installation of 500 cubic yards of shredded Spanish Gold mulch — 2" deep, or approved equal. For furnishing all labor, material and equipment necessary for the installation of 100 cubic yards of top soil 50-50 mix, or approved equal. For furnishing all labor, materials and equipment necessary for the installation of 1,500 square feet of St. Augustine (Floratam) Solid Sod, including fine sand, water, etc. Refer to DIVISION 2B. Maintenance of approximately 423 existing light fixtures including all appurtenances, on a monthly basis, for a complete working electrical/ lighting system, Division 2C.. Complete Installation of ten (10) new light fixtures, if needed, as shown in detail Division 2C including all electrical work and installation for a complete working system. Erecting/ staking and bracing 50 fallen trees/palms including all appurtenances on an "as needed" basis at locations citywide, close to the project location. For furnishing 3,060 gallons of Insect Spraying (root drenching) to a total of 153 Banyan trees with CELERO, or Flagship/Meridian, or Marathow Merit or SAFARY product, once a year or as needed for 3,060 the control of FIG WHITEFLY (Singhiella simples) 12 SPECIAL PROVISION = Contingency Allowance 500 100 1,500 423 10 50 Each Each Linear foot Cubic yard Cubic yard Square foot Each Each Each Gallons $ 1 2 1 $ 01`1S o0 $ ISO( OA 12 per month $'SOpw 1 ,� $14- 000!P 3B 000.�' $\\o0O $50,000 Page 25 Bid No. 07-08-008 00500. 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 Mto.Mk (. '-1 � Co' -fa t Dna 2( yfrS. �. tcens It (31(4% 3 1A. What business are you in? Landeco pirtq i Lawn Maimtertcn« , -Tree_ Service 2. What is the last project of this nature that you have completed? Mdkiar\S LL 6T N(arni P(It W�rKS Dept. SPa %k Aeees t�y o 4 Rl G.*`^1 BeaCi PG.( r-S 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. Non 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: City o�= Nkiat'u�'1c')\ mt wor. (441 S.W.S.. 2' Ave..i . Komi , (3c))4Ic�-12i1 (name) (address) (phone #) tk oft wY t PAc� ea �{'p 2t00 M�ridion/-tve. Mia ic,R- (name) (address) (phone #) (00 S) (013 — ./ 2-4 t #- trel G4ke.3 PuizAc_Se„Nic.t.. 280n Stn1 12 Ave_ C.ora C I„, (name) (address}' (phone #) paS) ? 3 3 - DO(o(r, 13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. rt 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). d 1Q1(\� 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. ttOC 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. PaaP �� 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? AS air Cr'e cc b 4-L � 1/4\ e c{ v1/'0.r.o,5 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? Pao, Al 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 141 o &Mi P 11c 1k OC Cc bep . Address 1 ( S.lAS 2_"( iL. t4%'' �{oor Y1/4l\csvAt FG T.nspec•k9-..4enfesi-a- Moreso Contact Person/Contract Amount Eiy CS -re v@.. 2,10‘ 000. ( yr Telephone No. /Fax No. O0S� 4•t(p-t2.Y1 ' (360 4((o-121$ -tnX 2) Company Name 1.k es 1-'u..ou. JerJi«- Address a-wo S• 12 4ir . I�tlrrmi i. Contact PersonlContractAmount gerr1c1-d i.,.upAeKtns 43w,400 G. Telephone No. /Fax No. (30S)"1 3 3 - 00(o(p 3) ta, o M; , gec.c.L P�r s £k r . ea too Oeeridicr, AvL_ ��r�1 i�T��, F.- Contact Person/Contract Amount i ro(`nM\ 41i L-f- #154O00 .' Telephone No. /Fax No. (.'OS)(�,13— )1z0 I CJ3os) (013-13 S2_ 4) Company Name k1 oocc nnto wr rs A SOC . Address S •k 41 S- - . k 3 '1 /%je. . Contact Person/Contract Amount YMc etc Rre z.. 4f 3(0, 000. fr, Telephone No. /Fax No. (i$(,) 5 1 - `l(00 ci Company Name Address Paaa ld 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) 5) Company Name MUripOS4 .S. &les Address Contact Person/Contract Amount --cro\nn S uectzeA) # (g 000 Telephone No. /Fax No. (30s) 911 S 31O 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. cir+ Ain n7_nR_nna PsoP 15 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. Ror cL Lak.ln Se./ V�c� T+r�. Legal Name of Firm: Entity Type: (Check One) Partnership Sole Proprietorship Corporation V (,4301 1i °) Corporation Document No: Date Established 1314'81-3 o9161 e N Date o Issuance Office Location (Establishment of the bidder/proposer): PRESENT Street Address: 2.5 i S S s s(. S-*. City: State: How long at this location: yt-. 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. Dana 16 00510. OFFICE LOCPTION AFFIDAVIT (Page 2 of 2) Authorize Signature £( /\ V J1C c r`1,S Authorized Signature Print Name Print Name Seer 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: EtQ.f1o. Oar and acknowledged the foregoing instrument as his/her act and deed. That he/she has produced parSO ckkty Yjnnvan i-15 MI la NOTARY PUBLIC: personally appeared before me as identification. My Commission Expires: 6. I0) Pc 9��P�•, Elisa Hernandez ?r z COMMISSION #0D753535 Si s EXPIRES: FEB. 10, 2012 ��►�� WWW. ARONNOTARY.com 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. Page 37 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, sma I, 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/A 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 Certifying 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 Government 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 P2QP iri