HomeMy WebLinkAboutSupplement 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
C�e.+rrA / Co,v+-rs►c,/ors C 6c /S671(s3
T3 %44 I Gw,r (was "7`rfwslor OJT' as-m9s / Z
1A. What business are you in? S and PP,A/ .
2. What is the last project of this nature that you have completed? e 44-7 oe /a;40; ,L) , "h Z,ut / - CoSo 7// /! T C /4ni7'
(1.7 o > ,a,;14-1; C1-f1/1/ /3- 36Z s�
3. Have you ever failed to complete any work awarded to you? If so, where and why?
/OC
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.
5. Give names, addresses and telephone numbers of three
institutions for which you have performed work:
iAfrii Fix Fs/ear z.
(name)
/t.iJce /A)vArez
(name)
O CAsR/
(name)
e.o fir
(address)/
/06 (6, Iven t o Ce•// e,- A
(address)
individuals, corporations, agencies, or
305= ( 6--/t17
(phone #)
r C75.70-y)
(phone #)
10726 C,q-jM- i/ /al. 3oS•Z35! yZCZ
(address) (phone #)
Bid No. 11-12-002
Page 34
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
See AllAc`e.)
(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
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 (10%) of the contract amount.
(Attach additional sheets if necessary)
Subcontractor Approx. M/WBE Description of Work
Name Percentage Status
zOo
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?
Tuck
l oo
10. What equipment will you purchase for the proposed Work?
/Uoiik
Bid No. 11-12-002 Page 35
11. What equipment will you rent for the proposed Work?
.0o De
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.
/� _�rDr/
ccgrd0 �i4/4A / r s y/1/ OT .7/ ! al,re AS a%raJec(
/(44d p jtr jn hl) /f+dui Thst T 4 4r 606 Aer/
Crear, i' j ec 2607.
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).
Ivl/c CJ..ISk 6'04/
13.1 The correct name of the Bidder is
13.2 The business is a (Sole Proprietorship) (Partnership) (Corporation).
s Co,
13.3 The address of principal place of business is
L Sc Err f. Spirt 2r1 F%n� i,a,�ri �1. 33/3/
13.4 The names of the corporate officers, or partners, or individuals doing business under a
trade name, are as follows:
R Alp! /3,4fL
041
Bid No. 11-12-002 Page 36
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.�
NjjoN-Q
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).
V oNe
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 disputearose; a
description of the subject matter of the dispute; and the final outcome of the claim.
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.
/VdN 1
Bid No. 11-12-002 Page 37
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.
�o
13.11. Under what conditions did the Bidder request Change Orders during the last five (5)
years? /-
c_ 4. e carcfaty l► Ave leer, fe /A,OQJ
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?
Bid No. 11-12-002 Page 38
Telephone No. /Fax No.
4) Company Name
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
Address
c>1< AdeA-1-fi
Contact Person/Contract Amount l / ,L /4av
Telephone No. /Fax No. 3°3 • `//6- /ZOd
Company Name
Address
/0 /Akt i f ac 4
(/5 coix1l,i- ;cw lent,'- /of.
Contact Person/Contract Amount/);ke /l /u4e z "S,c4/�u,
Telephone No. /Fax No. 3/ 675 %od - 73-7d2tf
3) Company Name n
i ava� oT eu7 ��' !)A/
Address 16 776 (' A ; Car / (1 45T
Contact Person/Contract Amount RA (,-)4 C flsR /5 $' l , ,;/
/zyzct 231/-412r/
e, f-f O ( /orA/
Address 83oc /Q 0 S-3 Cr.
Contact Person/Contract Amount eAriie,'ii t /iv/
Telephone No. /Fax No. `.S/sq3- �7 f0 lox y7v•6��
Bid No. 11-12-002 Page 39
00502. SUPPLEMENT TO BID FORM:
CUSTOMER REFERENCE LISTING (Page 2 of 2)
5) Company Name O('A,O e Cc*t#1 47 n
Address r 200 S_ T o 4 `�vu., !'�wA/
Contact Person/Contract Amount CAA(W cs f 7 . 4> f
Telephone No. IFax No. 41'07- 631C-787 Vo7-836-7 '37
6) Company Name
Address
Contact Person/Contract Amount
Telephone No. IFax 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.
Bid No. 11-12-002 Page 40
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 11V1THIN THE CORPORATE LIMITS OF THE CITY OF MIAMI.
iw ro Cep,4 s / Se,-,a(ceJ 6-ot-e,
Legal Name of Firm: '
Entity Type: (Check One) Partnership Sole Proprietorship _orporation
Po 000 // // _ z//2/%9
Corporation Document No: Date Established
30/a W-00‘‘26c ' /OA
/0
Occupational License No: Date of rssuance
--Office Location -(Establishment of the. bidder/proposer): ;
PRESENT
StreetAddress:
ST ?mod
City:
/ A /fA/LJ
State: How long at this location:
PREVIOUS
Street Address: 2 /r
AAA) s�
City: /11�1 State
7
How long at this location:
According to Section 18-85 of the City of Miami Code, as amended:
"...when a responsive, responsible non -local bidder submits the lowest bid price, and the bid
submitted by one or more responsive, responsible local bidders who maintain a local office, as
defined in Section 18-73, is within fifteen percent (15%) of the price submitted by the non -local
bidder, then that non -local bidder and each of the aforementioned responsive, responsible local
bidders shall have the opportunity to submit a best and final bid equal to or lower than the
amount of the low bid previously submitted by the non -local bidder. Contract award shall be
made to the lowest responsive, responsible bidder submitting the lowest best and final bid. In
the case of a tie in the best and final bid between a local bidder and a non -local bidder, contract
award shall be made to the local 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.
Bid No. 11-12-002 Page 41
00510. OFFICE LOCATION AFFIDAVIT (Page 2 of 2)
Authorize Signature Authorized Signature
rd o / 4i44 R a /)4' 734r4
Print Name
Print Name
Pesde4f . t%'.0,4.
'moo c�4Sc
_ 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
.,,t Palkar 0 &ADO
and acknowledged the foregoing instrument as his/her act and deed.
That he/she has produced
(407) 398-0153 FloridallotarySer oe.00m
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.
personally appeared before me
I-e.EtnU
as identification.
kL
JELEANY VALDIVIA NOTARY PUBLIC:
tc MY COMMISSION # EE041823
EXPIRES November 15, 2014
My Commission Tres:
Bid No. 11-12-002 Page 42