HomeMy WebLinkAboutAppendixAPPENDIX
AFFIDAVITS
FORMAL BIDS
MIAMI-DADE COUNTY BID NO.: 87.20 -0/09 -OTR
RENTAL OF OFFICE TRAILERS (Pre -Qualification)
Miami•Dode County
MIAMI, Department of Procurement Management
amil Affirmation of Vendor Affidavits
fn occordcrice with Ordinance 07-143 amending Section 2-8.1 of the Code of Miami -Dade County, effective June 1, 2008,
vendors are required to complete a new Vendor Registration Package, including a Uniform Affidavit Packet (Vendor Affidavits
Form), before being awarded a new contract. The undersigned affirms that the Vendor Affidavits Form submitted with the
Vendor Registration Package is current, complete and accurate for each affidavit listed below.
Federal Employer
Contract No.: Identificatlon Number(FEIN): ... ........ .... .____.
Contract Title:
Affidavits and Legislation/ Governing Body
Miami -Dade County Ownership Disclosure
Sec. 2-8.1 of the County Code
Miami -Dade County Employment Disclosure
County Ordinance No. 90-133, amending Section 2.8-1(d) (2) of
the County Code
3• Mia; W i i i i aw County EmploymentDrug-free
Workplace Certification
Section 2-8.1.21b) f the County Code
4• Mtaml-Dade County Disability Non -Discrimination
Article 1, Section 2-8.1.5 Resolution R 182-00 amending
R-385-95
�• Miami Dade Count' Debarment Disclosure
Section 10.38 of the County Code
Name of Affiant
Miami -Dade County Vendor Obligation to County
Section 2-8.1 of the County Code
Miami -Dade County Code of Business Ethics
Article 1, Section 2-8.Ily and 2-11(15)(1) of the County Code through (6)
and (9) of the County Code and County Ordinonce No 00-1 amending
Section 2-11. i(c) of the County Code
Miami -Dade County Family Leave
Article V of Chapter I I of the County Code
Miami -Dade County Living Wage
Section 2-8.9 of the County Code
_
Miami -Dade County Domestic Leave and Reporting
Article 8 Section I I A-60 l IA -67 of the County Code
Printed Title of Affiant
Signature of Affiant
Name of Firm Date
Address of Firm State Zip Code
Notary Public - State of
Subscribed and swum to (or offirmed) before me this
by
Type of identification produced
Signature of Notary Public
Notary Public Information
County of
day of,
20
We or she is personally known tome ❑ or has produced Identification ❑
-- Serial Number
Print or Stamp of Notary Public Expiration Date Notary Public Seal
Page 1 of 4 Revised 5/27/08
MIAMI-RADE COUNTY BID NO.: 8720-0/09-OTR
RENTAL FF 'RAIL re- u lifi n
FAIR SUBCONTRACTING PRACTICES
(Ordinance 97-35)
In compliance with Miami -Dade County Ordinance 97-35, the Bidder shall submit with the bid proposal a
detailed statement of its policies and procedures (use separate sheet if necessary) for awarding
subcontractors in accordance with Section 1, Paragraph 1.15
❑ NO SUBCONTRACTORS WILL BE UTILIZED FOR THIS CONTRACT
Signature
Date
Page 2 of 4 Revised 5/27/05
MIAMI-DADE COUNTY
Firm Name of Prime Contractor/Respondent:
Bid No.:
SUBCONTRACTOR/SUPPLIER LISTING
(Ordinance 97-104)
Title:
BID NO.: 8720 -0/09 -OTR
This forms, or a comparable listing meeting the requirements of Ordinance No. 97-104 MUST be completed, signed and submitted by all bidders and respondents
on County contracts for purchases of supplies, materials or services, including professional services which involve expenditures of $100,000 or more, and all
bidders and respondents on County or Public Health Trust construction contracts which involve expenditures of $100,000 or more. A bidder or respondent who
is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or
materials to be supplied from those identified, except upon written approval of the County.
This form, or a comparable listing meeting the requirements of Ordinance No. 97-104, MUST be completed, signed and submitted even though the bidder or
proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer should enter the word "NONE" under the appropriate heading of
sab form 100 in those instances where no subcontractors or suppliers will be used on the contract.
Business Name and Address of First Tier
Subcontractor/Subconsultant
Principal Owner
Scope of Work to be Performed by
Subcontractor/Subconsultant _
(Principal Owner)
Gender Race
I
Business Name and Address of Direct
Supplier
Principal Owner
Supplies/Materials/Services to be
Provided b Supplier
(Principal Owner)
Gender Race
-J
I certify that the representations contained in this 5ubcontractoriauppiler i.isnng are in ►lle ucbl vl ..,y
Prime Contractor/Respondent's Signature
Print Name
(Duplicate if additional space is needed)
Page 3 of 4
Print Title Date
FORM 100
Revised 5/27/08
MIAMI -DADS COUNTY BID NO.: 8720 -0/09 -OTR
RENTAL OF OFFICE TRAILERS (Pre -Qualification)
MIAMI-DADE COUNTY f�
CERTIFICATION OF RECYCLED
ENVIRONMENTALLY ACCEPTABLE PACKAGING
PRODUCT CONTENT
RESOLUTION (R-738-92)
MINIMUM
CERTIFIED CONTENT
Bid )tem
RECYCLED PRODUCTS
RECOVERED MATERIALS
RECYCABLE PRODUCTS
Number
%
Corn osition
Type of
Material
%
Composition
Type of
Material
%
Composition
Type of
Material
DEFINITIONS
"Recycled Material" shall be defined as any waste material or by-products that have been recovered or diverted
from solid waste.
"Recycled Product" shall be defined as any product which is in whole or in part composed of recovered
materials.
"Recyclable Product" shall be defined as the ability of a product and its packaging to be reused,
reconditioned for use, or recycled through existing recycling collection programs.
"Waste Reducing Product" shalt be defined as any product which will result in less waste generated due
to its use rather than another product designed to serve the same function with a greater waste
generation rate. This shall include, but not limited to those products that can be reused, refilled or have a
longer life expectancy and contain a lesser amount of toxic constituents.
I have the knowledge to certify and do so by certify that the Minimum Materials Content in our product(s) are
as specified on this form and conform with the definitions as shown above.
NAME
ADDRESS
CITY
STATE
ZIP
' SIGNATURE
TITLE
Page 4 of 4 Revised 5/27/08