HomeMy WebLinkAboutExhibit 4SUPPLEMENT TO BID FORM:
QUESTIONNAIRE
This Completed Form Must Be Submitted With The Bid, The City May, At Its Sole
Discretion Require That The Bidder Submit Additional Information. Not Included in The
Submitted Form. Such Information Must 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.
Additional Pages May Be Used Following The Same Format And Numbering.
By submitting its Bid the Bidder certifies the truth and accuracy of all information contained
herein.
A. Business Information
1. How many years has your company been in business under its current name and
ownership?
a. Professional Licenses/Certifications (include name and number)* Issuance Date
('include active certifications of small or disadvantage business & name of certifying entity)
b. Date company licensed by Dept. Of Professional Regulation:
c. Qualified Business License: 0 Yes ❑ No If Yes, Date Issued:
c. What is your primary business?
(This answer should be specific. For example; paving, drainage, schools, interior renovations, etc.)
d. Name of Qualifier, license number, and relationship to company:
2. Name and Licenses of any prior companies
Name of Company License No.
Issuance Date
3. Type of Company:
0 Corporation C3"S" CorporationDLLCOSole ProprietorshipOOther:
(specify)
4. Company Ownership
a. identify ail owners of the company
Name
Title % of ownership
b . Is any owner identified above an owner in another company? ❑ Yes ❑ No
If yes, identify the name of the owner, other company names, and % ownership
-5—___Employee Information
Total No. of Employees: Number of Managerial/Admin. Employees:
Number of Trades Personnel and total number per classification:
(Apprentices must be listed separately for each classification)
6. Has any owner or employee of the company ever been convicted of a federal offense or
moral turpitude: If yes, please explain:
7. Insurance & Bond information
a. Insurance Carrier name & address:
b. Insurance Contact Name, telephone, & e-mail:
c. Insurance Experience Modification Rating (EMR):
(if no EMR rating please explain why)
d. Number of insurance Claims paid out in last 5 years & value:
e. Bond Carrier name & address:
f. Bond Carrier Contact Name, telephone, 8, e-mail:
g. Number of Bond Claims paid out in last 5 years & value:
8. Have any claims lawsuits been file against your company in the past 5 years, If yes,
identify all where your company has either settle or an adverse judgment has been
issued against your company. Identify the year basis for the claim or judgment &
settlement unless the value of the settlement is covered by a written confidentiality
agreement.
9. To the best of your knowledge is your company or any officers of your company
currently under investigation by any law enforcement agency or public entity. If yes,
provide details:
10. Has your company been assessed liquidated damages or defaulted on a project in the
past five (5) years? ❑ Yes ❑ No (If yes, provide an attachment that provides an
explanation of the project and an explanation.
11. Has your company been cited for any OSHA violations in the past five (5) years. If yes,
please provide an attachment including all details on each citation,
12. Provide an attachment listing all of the equipment, with a value of $5,000 or greater,
owned by your company.
B. Project Management & Subcontract Details
1. Project Manager for this Project:
a. Name:
b. Years with Company:
c Licenses/Certifications:
d. Last 3 projects with the company including role, scope of work, & value of project:
2. Subcontractors:
Name Trade % of Work License No. Certification*
(*active certifications of small or disadvantage business & name of certifying entity)
3. Scope of actual construction work to be performed by your company and the
corresponding percentage of the work: (This does not include such items as insurance * bonds, dumpsters,
trailers, and other similar non -construction work items)
C. Current and Prior Experience:
1. Current Experience including projects currently under construction, recently awarded, or
pending award (Provide an attachment to this questionnaire that lists all such projects,
including the owner's name, title and value of project, scope of work, projected or actual
start date, projected completion date, and number of company trades personnel
assigned to the project)
2. Prior Projects of a similar size, scope and complexity (Provide an attachment to this
questionnaire that complies with the minimum number of projects identified by the bid
solicitation. Information provided must include the owner's name , address and contract
person, including telephone & e-mail, title of project, location of project, scope, initial
value and .final cost of the project, projected and final timeframes for completion in
calendar days and the number of company trades personnel that were assigned to the
project. If there is a difference between the initial and final cost or initial and actual
timeframe provide details on the differences exist.
SUPPLEMENT TO BID FORM:
CUSTOMER REFERENCE LISTING (Page 1 of 1)
Bidders may furnish the names, addresses, and telephone numbers of firms or government
organizations for which the Contractor has provided services in addition to the minimum five (5)
projects of a similar size, scope, and complexity.
1)
2)
Company Name
Address
Contact Person/Contract Amount
Telephone No. /Fax No.
Company Name
Address
Contact Person/Contract Amount
Telephone No. /Fax No.
3) Company Name
Address
Contact Person/Contract Amount
Telephone No. /Fax No.
4) Company Name
Address
Contact Person/Contract Amount
Telephone No. /Fax No.
SUPPLEMENT TO BID FORM:
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:
PRESENT
Street Address:
Date of Issuance
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/Bidders 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/Bidders by this section.
SUPPLEMENT TO BID.FORM:
OFFICE LOCATION AFFIDAVIT (Page 2 of 2)
Authorize Signature Authorized Signature
Print Name Print Name
(Corporate Seal; 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 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.
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, small, 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)
Awarded
Percentage
of Total
Work or
Contract
❑ CSBE or SBE
❑ DBE
[MBE
$
■ BBE
❑ MBE
❑ WBE
❑ None
■ Local
❑ DBE
❑HBE
$
• BBE
• CSBE or SBE
❑ MBE
❑ WBE
❑ None
• Local
0 DBE
❑HBE
$
■ BBE
• CSBE or SBE
❑ Local
0 MBE
0 None
• WBE
❑ BBE
0 CSBE or SBE
$
• DBE
■ HBE
0 MBE
■ Local
■ WBE
• None
• BBE
• CSBE or SBE
■ DBE
❑HBE_-_
$
❑ Local
0 MBE
❑ WBE
■ None
❑ BBE
0 DBE
OHBE
$
■ CSBE or SBE
❑ Local
0 MBE
0 WBE
0 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 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 ATTACHED. LOCAL FIRMS SHALL ATTACH THE
LOCAL OFFICE AFFIDAVIT
Section 6- Contract Execution Form
THIS Contract (contract number) made this day of in the year 2008
by and between THE CITY OF MIAMI, FLORIDA, hereinafter called the "CITY," and (name of
Contractor)
IN WITNESS WHEREOF, the parties have executed this Agreement as of the day and
year first above written.
WITNESS/ATTEST (CONTRACTOR NAME)
Signature Signature
Print Name, Title
Print Name, Title of Authorized Officer or Official
ATTEST: (Corporate Seal)
CONTRACTOR Secretary
(Affirm CONTRACTOR Seal, if available)
ATTEST: CITY OF MIAMI, a municipal corporation of the
State of Florida
Priscilla Thompson, City Clerk Pedro G. Hernandez, P.E., City Manager
APPROVED AS TO INSURANCE APPROVED AS TO LEGAL FORM AND
REQUIREMENTS: CORRECTNESS:
LeAnn Brehm, Director Julio O. Bru, City Attorney
Risk Management Department
CORPORATE RESOLUTION
WHEREAS, , Inc. desires to enter into
an contract with the City of Miami for the purpose of performing the work described in
the contract to which this resolution is attached; and
WHEREAS, the Board of Directors at a duly held corporate meeting has
considered the matter in accordance with the By -Laws of the corporation;
Now, THEREFORE, BE IT RESOLVED BY THE BOARD OF
DIRECTORS that the
(type title of officer)
, is hereby authorized
(type name of officer)
and instructed to enter into a contract, in the name and on behalf of this corporation,
with the City of Miami upon the terms contained in the proposed contract to which this
resolution is attached and to execute the corresponding performance bond.
DATED this day of , 20
Corporate Secretary
(Corporate Seal)
FORM OF PERFORMANCE BOND (Page 1of 2)
BY THIS BOND, We , as Principal,
hereinafter called Contractor, and , as Surety, are bound
to the City of Miami, Florida, as Obligee, hereinafter called City, in the amount of
Dollars ($ ) for the payment whereof Contractor
and Surety bind themselves, their heirs, executors, administrators, successors and assigns,
jointly and severally.
WHEREAS, Contractor has by written agreement entered into a Contract, Bid/Contract
No: 07-08-017, awarded the day of , 20 , with City which
Contract Documents are by reference incorporated herein and made a part hereof, and
specifically include provision for liquidated damages, and other damages identified, and for the
purposes of this Bond are hereafter referred to as the "Contract";
THE CONDITION OF THIS BOND is that if Contractor:
1. Performs the Contract between Contractor and City for construction of
, the Contract being made a
part of this Bond by reference, at the times and in the manner prescribed in the Contract;
and
2. Pays City all losses, liquidated damages, expenses, costs and attorneys fees including
appellate proceedings, that City sustains as a result of default by Contractor under the
Contract; and
3.Performs the guarantee of all Work and materials furnished under the Contract for the
time specified in the Contract; then THIS BOND IS VOID, OTHERWISE IT REMAINS IN
FULL FORCE AND EFFECT.
4. Whenever Contractor shall be, and declared by City to be, in default under the Contract,
City having performed City obligations hereunder, the Surety may promptly remedy the
default, or shall promptly:
4.1. Complete the Project in accordance with the terms and conditions of the
Contract Documents; or
FORM OF PERFORMANCE BOND (Page 2 of 2)
4.2. Obtain a bid or bids for completing the Project in accordance with the terms
and conditions of the Contract Documents, and upon determination by Surety
of the lowest responsible Bidder, or, if City elects, upon determination by City
and Surety jointly of the lowest responsible Bidder, arrange for q contract
between such Bidder and City, and make available as Work progresses (even
though there should be a default or a succession of defaults under the Contract
or Contracts of completion arranged under this paragraph) sufficient funds to
pay the cost of completion Tess the balance of the Contract Price; but not
exceeding, including other costs and damages for which the Surety may be
liable hereunder, the amount set forth in the first paragraph hereof. The term
"balance of the Contract Price," as used in this paragraph, shall mean the total
amount payable by City to Contractor under the Contract and any amendments
thereto, less the amount properly paid by City to Contractor.
No right of action shall accrue on this bond to or for the use of any person or corporation
other than City named herein.
The Surety hereby waives notice of and agrees that any changes in or under the
Contract Documents and compliance or noncompliance with any formalities connected
with the Contract or the changes does not affect Surety's obligation under this Bond.
Signed and sealed this day of , 20
WITNESSES:
Secretary By:
(CORPORATE SEAL)
(Name of Corporation)
(Signature)
(Print Name and Title)
IN THE PRESENCE OF: INSURANCE COMPANY:
By:
Agent and Attorney -in -Fact
Address:
(Street)
(City/State/Zip Code)
Telephone No.:
FORM OF PAYMENT BOND (Page 1of 2)
BY THIS BOND, We , as Principal,
hereinafter called Contractor, and , as Surety, are bound
to the City of- Miami, Florida, as Obligee;- hereinafter called City, in the amount of
Dollars ($ ) for the payment whereof
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and
assigns, jointly and severally.
WHEREAS, Contractor has by written agreement entered into a Contract, Bid/Contract
No., awarded the day of , 20 , with City which -Contract
Documents are by reference incorporated herein and made a part hereof, and specifically
include provision for liquidated damages, and other damages identified, and for the purposes of
this Bond are hereafter referred to as the "Contract";
THE CONDITION OF THIS BOND is that if Contractor:
1. Pays City all losses, liquidated damages, expenses, costs and attorney's fees including
appellate proceedings, that City sustains because of default by Contractor under the
Contract; and
2. Promptly makes payments to all claimants as defined by Florida Statute 255.05(1) for all
labor, materials and supplies used directly or indirectly by Contractor in the performance
of the Contract;
THEN CONTRACTOR'S OBLIGATION SHALL BE VOID; OTHERWISE, IT SHALL
REMAIN IN FULL FORCE AND EFFECT SUBJECT, HOWEVER, TO THE
FOLLOWING CONDITIONS:
2.1. A claimant, except a laborer, who is not in privity with Contractor and who has
not received payment for its labor, materials, or supplies shall, within forty-five
(45) days after beginning to furnish labor, materials, or supplies for the
prosecution of the Work, furnish to Contractor a notice that he intends to look to
the bond for protection.
2.2. A claimant who is not in privity with Contractor and who has not received
payment for its labor, materials, or supplies shall, within ninety (90) days after
performance of the labor or after complete delivery of the materials or supplies,
deliver to Contractor and to the Surety, written notice of the performance of the
labor or delivery of the materials or supplies and of the nonpayment.
2.3. No action for the labor, materials, or supplies may be instituted against
Contractor or the Surety unless the notices stated under the preceding
conditions (2.1) and (2.2) have been given.
2.4. Any action under this Bond must be instituted in accordance with the longer of
the applicable Notice and Time Limitations provisions prescribed in Section
255.05(2), or Section 95-11, Florida Statutes.
FORM OF PAYMENT BOND (Page 2 of 2)
The Surety hereby waives notice of and agrees that any changes in or under the
Contract Documents and compliance or noncompliance with any formalities connected
with the Contract or the changes does not affect the Surety's obligation under this Bond.
Signed and sealed this day of , 20
ATTEST:
(Secretary)
(Corporate Seal)
IN THE PRESENCE OF:
By:
By:
Contractor
(Name of Corporation)
(Signature)
(Print Name and Title)
day of ,20
INSURANCE COMPANY:
Agent and Attorney -in -Fact
Address:
(Street)
(City/State/Zip Code)
Telephone No.:
CERTIFICATE AS TO CORPORATE PRINCIPAL
, certify that I am the Secretary of the
corporation named as Principal in the foregoing Performance and Payment Bond (Performance
Bond and Payment Bond); that , who signed the Bond(s) on behalf
of the Principal,_was_then of said corporation; that I know his/her signature; and
his/her signature thereto is genuine; and that said Bond(s) was (were) duly signed, sealed and
attested to on behalf of said corporation by authority of its governing body.
(SEAL)
Secretary (on behalf of)
Corporation
STATE OF FLORIDA )
SS
COUNTY OF MIAMI-DADE )
Before me, a Notary Public duly commissioned, qualified and acting personally, appeared
to me well known, who being by me first duly
sworn upon oath says that he/she has been authorized to execute the foregoing Performance and
Payment Bond (Performance Bond and Payment Bond) on behalf of Contractor named therein in
favor of City.
Subscribed and Sworn to beforeme this day of , 20
My commission expires:
Notary Public, State of Florida at Large
Bonded by
City Hall Emergency Structural Repairs Bid No.: 07-08-018
PERFORMANCE AND PAYMENT GUARANTY FORM
UNCONDITIONAL/IRREVOCABLE LETTER OF CREDIT: (Page 1 of 2)
Date of Issue
Issuing Bank's No.
Beneficiary: Applicant:
City of Miami
444 SW 2nd Avenue
Miami, Florida 33130
Amount:
in United States Funds
Expiry:
(Date)
Bid/Contract Number
We hereby authorize you to draw on
(Bank, Issuer name)
at by order
(branch address)
of and for the account of
(contractor, applicant, customer)
up to an aggregate amount, in United States Funds, of available by your
drafts at sight, accompanied by:
1. A signed statement from -the Gity Manager or -his authorized designee, that the drawing is
due to default in performance of certain obligations on the part of
(contractor, applicant, customer) agreed upon by and between the City of Miami, Florida
and (contractor, applicant, customer), pursuant to Bid/Contract No.
for (name of project) and Section 255.05, Florida Statutes.
Drafts must be drawn and negotiated not later than
(expiration date)
City Hall Emergency Structural Repairs Bid No.: 07-08-018
PERFORMANCE AND PAYMENT GUARANTY FORM
UNCONDITIONAL/IRREVOCABLE LETTER OF CREDIT: (Page 2 of 2)
Drafts must bear the clause: "Drawn under Letter of Credit No. (Number), of
(Bank name) dated
This Letter of Credit shall be renewed for successive periods of one (1) year each unless we
proxideihe City of Miami with written notice of our intent_to_terminate the credit herein extended,
which notice must be provided at least thirty (30) days prior to the expiration date of the original
term hereof or any renewed one (1) year term. Notification to the City that this Letter of Credit will
expire prior to performance of the Contractor's obligations will be deemed a default.
This Letter of Credit sets forth in full the terms of our undertaking, and such undertaking shall not in
any way be modified, or amplified by reference to any documents, instrument, or agreement
referred to herein or to which this Letter of Credit is referred or this Letter of Credit relates, and any
such reference shall not be deemed to incorporate herein by reference any document, instrument,
or agreement.
We hereby agree with the drawers, endorsers, and bona fide holders of all drafts drawn under and
in compliance with the terms of this credit that such drafts will be duly honored upon presentation
to the drawee.
Obligations under this Letter of Credit shall be released one (1) year after the Final Completion of
the Project by the
(contractor, applicant, customer)
This Credit is subject to the "Uniform Customs and Practice for Documentary Credits," International
Chamber of Commerce (1993 revision), Publication No. 500 and to the provisions of Florida law. If
a conflict between the Uniform Customs and Practice for Documentary Credits and Florida law
should arise, Florida law shall prevail. If a conflict between the law of another state or country and
Florida law should arise, Florida law shall prevail.
Authorized Signature
City Hall Emergency Structural Repairs Bid No.: 07-08-018
Paae 95