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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 Mi„arY.l Oo C ciumhdccue&+►one 21 yrs. Llacense— * (31411- 3 1A. What business are you in? c\c cw api(1.5 Las Main oncnce- , Tree_ Spice. LA 2. What is the last project of this nature that you haveJJcompleted? Mi C,M L1 6� Mi am ► P,Jio (i Worms be . AQc-s C cL o f c„v t Pc-r g-s 3. Have you ever failed to complete any work awarded to you? If so, where and why? A 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. NOre 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: City o tiam► P llc Wora. E4 44 S. I. Z't'l Ave. Mromi q_ (305)414-121i (name) taddress) (phone #) 04vn ieac Pa( I ' .4 2(00 tr'. ia. r/1 M►� ► R. l�O (name) es � I (address) (phone #) n 2t s) (0'13- 17ZO Cry lore bolPu�b�� - SeNicrzr 280o S'(n) 12 Ave.., rtf e�� t- (name) (addressY (phone #) (30S )') 3 3 - 00(4 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 Uk S. (tkelt C(3k0) kkO,SSC." 0%'2Oo $ &O Q,r;c a` �t�:��t ( j (-i t� 5g,/8n." O% Loos Q:A Arens tW. �3 S) ,l _1 Si0006. 1220\0 30 (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 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 t \M TQcin Gfark.c4 5 90 .6( ec4rcs-f L.An r-c-k-ors 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 own that is available for the Work? 10. What equipment will you purchase for the proposed Work? \or\c, n:J .1.. n-i MCI nn[f 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. drys �0,mn1.1s \04\6693 Snd- (° S kR% - 2001 Man& e.d munss vvkatirri-enct\c.e_ COn ,('FC-1-S A- OreGn One_ Mt((ton C ofc-S Qe� \\Qc r cr5r. ,�L\ O Caro.\ GC,.ble s, 0,41 c M(mi Reath c Q. 4 ,1 Mivn"1 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 Floc.; de. (-AvJ(1 Se -eV ICe. . 13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation). 13.3 The address of principal place of business is k25°5 S --. , 3 3(is 13.4 The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: r Acres V +, Grnor4la 5) t'rQ s i der\4 el -en 0,, V tAmon-65) Secre.A-ary Bid No. 07-08-008 Page 31 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. N Oc e.- 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. IVQq\c- 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. \\I ore. Riri kin m_nR_nna PROP z7 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. �t7 13.11. Under what conditions does the Bidder request Change Orders? A- s di ceded kr_N (1 o eY\na‘e.5 cs-. 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? NO 1\ R i'1 Aln n7_nR_nnf2 Pam. 11 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 (`t:41 o ' k cv i P k%c OCKc Qet 4444 S •t j 2' - Ay ., - toor % , Address Tnspe Nla'` o Contact Person/Contract Amount y ESi eve Z 2(O OOO.. yr . Telephone No. /Fax No. ()0S) 4U -‘211 (36$) 4((o-t21 2) Company Name C-t of Lora x deS P i06- Je-r'‘lik•c- Address g00 S • . 2 2- Nile. , iM i c*mm i FL Contact Person/Contract Amount Beth&e-a LurVICI As 41 3(40, 000 Telephone No. /Fax No. (30S) 7 3 3 - CAzko. 3) Company Name e t\MfAr4 Bec.a. t'at 1F-S NO% Address a.100 kter d tGn Ave__ , FL. Contact Person/Contract Amount -1--oM(y1 �.�1� t1S,Oo0 Telephone No. /Fax No. 00S) 4,13-1 "t2O L305) 73- 13 S2 4) Company Name k ood r-1 tko MC0 Wrkee4 SOL Address S •\ . `t1 S4 . k t 3'1 e . M c-' fL Contact Person/Contract Amount f1q\-c eta Pcr-ez, 41 3(o,000 .I�r', Telephone No. /Fax No. (110 AS I —' (0 ci a:a , i., n7 110 nno Pa on ;d 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING ((Page 2 of 2) 5) Company Name MOrIPOS�L '1 \ L Address a .:S. 1 &re CD4cXes Contact Person/Contract Amount -:re:Ann Scinuenz�1 # I OOO Telephone No. /Fax No. (3(0 cj R y S 310 Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 8) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. Rid Nri n7_nR_MR Pave 15