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HomeMy WebLinkAboutExhibit1200500. 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 alt 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? j4 YEA�,S License/Certification/Registration Name and Number CSC _ 0 6 / 5'Oti- - t'4 L, L Oc.a 1.14 1A. What business are you in? Cm-xfT7wc-T7oD4§7'Ly #'Yeears What is the last project of this nature that you have completed? 'emli Ivsnat..tAnoAoF gdiPifs &T t.,tQE 4I,20o,boa +2s-0-ryoFAkaif4F�6, s iv w �e.t K fir3A "- oArT CADA) -- 4 I, Dsi', to o F1)6T- •94T] 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. !VIA 5. Give names, addresses and telephone numbers of three individuals, corporations, agencies, or institutions for which you have performed work: y 4 stJ 2A4c, - 8" FloaR Criof MtAM! MtA.M1, fl 331?J0 �3oS�4�6- 120p (name) %8 w mca ress) $ , (phone #) G1u.rac,t 13 rscayuE KEYB/scaYtis, fc.33/yy (name) 2Bs Ar.4addressE) (phone #) of Cor4t. GA6t.E'S Can2.4c Ab as, FL 33)34 C36 460 -S'DOb (name) (address) (phone #) Page 31 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 :DL►Stat toALF. MIAhit- 'AAPECower./ Co Mt *i Cs 3s-C-335-23QZ 194,stott V c. pc, StDEumK Miami—gmy* Cow.lty IYIPIL4VElFAIT S 301'-Nis—Z34L 11g01000 -T o;(, 440. (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? Yes 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 (1O%) of the contract amount. (Attach additional sheets if necessary) Subcontractor Approx. MNVBE Description of Work Name Percentage Status 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? 131-4)1.4- tokActerni C,oNc.2 9;14 } 7)6 color j A__41J-106 C.0r N,1-T1014, Cc ic,.1ETc 10. What equipment will you purchase for the proposed Work? Page 32 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. (NAMA — CG C -- D6j 5 04 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. Of 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 MEF CoNs-nzwe tom, ZNc 13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation). coF.?o Ra rio iJ 13.3 The address of principal place of.business is �82A t 4,2-AvE .- Sctift C410• )-t14+41, F'L 3.5 13.4 The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: rajT rn5 1HISZC • /77Z.EXI-S. Pape 33 13.5 List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. t4 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. itk • 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). NoAc 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. Nome 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, Page 34 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. IV�I`l ' 13.11. Under what conditions does the Bidder request Change Orders? �1ta tmESE6bi CDNDl7TOALs oft fTE— S A)trt 1).l 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? Page 35 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 CIT1 of 'MIA t Address ` q 544 "Alt - }(ask Mcpx441, R. Contact Person/Contract Amount -Zest -lc lAkASDaE(►AVM 2,0O4OOC).- VA Riate Telephone No. /Fax No. CS) 4L4o — (2bd +�F VI 114SE 8 cowYge Address '82 ) . Mcitsnttis ST1<ey Br3G4Y14&1 Contact Person/Contract AmountAzKAivfo %Vvzc2 DUe1C.4,coo,w; Yawns Company Name Telephone No. /Fax No. C3bT) lecS- St}5 Company Name CM"! F- C ,e,,L C:24.42, (Ks Address Z:80 1141,4% 4 i C-ca a- C-4arb t *s, F L Contact Person/Contract Amount uluc_ I4c l ( 4D0,4t0. Telephone No. /Fax No. (�(45) 46 O " 5a0o 4) Company Name MIAMI -DAPCCour�.+7-y Address iS3 �Uia! .i5 -(- 1 `f zo KA A $I'. Contact PersonlContract AmountR4 Lac W Dxj:1 P..)Vtr7Z. 4;600,060: Telephone No. (Fax No. s) 2392 V4R1 end TRH Page 36 00502. SUPPLEMENT TO BID FORM: CUSTOMER REFERENCE LISTING (Page 2 of 2) Company Name 'I .��Q,�. 11s{'r4ti — Address -MIND�3 CotttVIVit,Ct L LVD 1 ex� Z.on►DE Ate J Contact Person/Contract Amount WAV M McCoy (4 /ps ioQ •-=' Telephone No.'/Fax No. C9S9t) 9'G, 1'30O Company Name s Address 901 r9o,3cf�,E ditto cog/4 c,G},T.t 6t, �. Contact Person/Contract Amount �1A►ate,J CsTEL M / $S,/DCAM Telephone No. /Fax No. (bS) 9(15.— 2900 7) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. 8) Company Name Address Contact Person/Contract Amount Telephone No. /Fax No. Paee 37 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. M"E r C©sTP.0 cTt O Al Legal Name of Firm: Entity Type: (Check One) Partnership Sole Proprietor 92 Dco004003 Corporation Document No: 1.51303'E,— 002 Occupational License No: Nov ! 2, 1992 Date Established Oct. , ZOOS Date of Issuance Office.Locaf on=(fstabfislament of the`` ideedproposg) l PRESENT Street Address: � N eir2 A r„ S cr - ti-o City: t t 4 PREVIOUS r Street Address: State: L 351Z4 How long at this location: 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. Page 38 005 i0. �!F , E LOC •N AFFIDAVIT (Page 2 of 2) Autho ze et LL L Authorized Signature Print Name Print Name :E 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 NOTARY PUBLIC: as identification. My Commission Expires: Ad'. G Zn(79 Please submit with your bid copies of Occupational License, professional and/or trade License to verify kcal 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. `,`ott111uN11trr,/ NOEP,,f ••GD * : �� 4 embpS/41, '•�� ca a' , AovijJ . * 47; 1Ilio111\1f t Q00 Page34 0550 Local, Small, Disadvantaged and Minority/Women Business Enterprise Participation Project No.:B-9 -11-' dr Title: C twlar r3EQlAc-04 i' Bidder/Contractor: MEF C'ou fYLUc-rlokt` 1.1 c ram- TP44SE 29 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 Firrn (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 ljt�f i► + e4SN37 41)c-j7ePJ BBE C DBE HBE iut�tM' 1 C —$ ON of MAPIr IOC) 42, / f�SBEorSB> �` �� >> c c MBE WBE None BBE CSBE or SBE r DBE HBE• $ Local MBE WBE None BBE CSBE or SBE DBE HOE $ 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 F1RMS SHALL ATTACH THE LOCAL OFFICE AFFIDAVIT