HomeMy WebLinkAboutCertification StatementCertification Statement
Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and
retain a copy for your files. Prices should include all costs, including transportation to destination. The
City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a
minimum of 180 days following the time set for closing of the submissions.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted
prices.
We (I) certify that we have read your solicitation, completed the necessary documents, and propose to
furnish and deliver, F.O.B. DESTINATION, the items or services specified herein.
The undersigned hereby certifies that neither the contractual party nor any of its principal owners or
personnel have been convicted of any of the violations, or debarred or suspended as set in section
18-107 or Ordinance No. 12271.
All exceptions to this submission have been documented in the section below (refer to paragraph and
section).
EXCEPTIONS:
We (I) certify that any and all information contained in this submission is true; and we (I) further certify
that this submission is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or
service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and
conditions of this solicitation and certify that I am authorized to sign this submission for the submitter.
Please print the following and sign your name:
SUPPLIER NAME. The Segal Company
ADDRESS. 2018 Powers Ferry Road, Suite 850, Atlanta, GA 30339-7200
PHONE: 678-306-3100 FAX 678-306-3190
EMAIL: rj oyner@segalco . com BEEPER' N/A
SIGNED BY•
TITLE: Vice President & Actuary DATE• 3/08/2013
FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
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Certifications
Legal Name of Firm:
The Segal Company (Eastern States), Inc.
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
Private Corporation
Year Established:
1939
Office Location: City of Miami, Miami -Dade County, or Other
Servicing Office: Atlanta, GA Headquarters: New York, New York
Occupational License Number:
Federal Tax Id: 13-1835864
Occupational Certificate Number: 8544
Occupational License Issuing Agency:
Cobb County
Occupational License Expiration Date:
12-31-2013
Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance No.
10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source Hiring
Agreement.": Yes or No
Ye s
Do you expect to create new positions in your company in the event your company was awarded a
Contract by the City? Yes or No
No
In the event your answer to question above is yes, how many new positions would you create to
perform this work?
N/A
Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration
of all new positions which might be created as a result of this award of a Contract.
N/A
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