03-_Mispah_Parking_Lot_Replacement-_Forms.pdf

City of Leesburg, Florida 250301- Mispah Parking Lot Replacement-Rebid

CITY FORMS

Page CF-1 of 5

Complete ALL the forms in this section and submit them through Bonfire.

General Vendor Information

Company Name:

Physical Address:

Mailing Address:

Phone No.: FEIN No.:

Email Address:

Financial Status: □Poor □ Good □ Excellent No. of Years in Business:

No. of Personnel Currently Employed: No. of Personnel Available for this

Project:

Principal Name Title

Describe the type of work normally performed by your company:

Provide information regarding who may be contacted regarding this bid response.

Primary Contact

Name:

Title:

Address:

Phone No.:

Mobile

Phone No.:

Email Address:

Page CF-2 of 5

BIDDER’S CERTIFICATION

• I have carefully examined the Invitation to Bid, Instructions to Bidders, General and/or Special

Conditions, Specifications, the Bid submitted and any other documents accompanying or made a part of this invitation.

• I hereby promise to furnish the goods or services specified in the Invitation to Bid at the prices or rates set forth in my bid. I agree that my bid will remain firm for the period established in the bid document in order to allow the City adequate time to evaluate the bids and make award.

Furthermore, I agree to abide by all conditions of the bid.

• I certify that all information contained in this bid is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this bid on behalf of the vendor / contractor as its act and deed and that the vendor / contractor is ready, willing and able to perform if awarded the bid.

• I further certify that this bid is made without prior understanding, agreement, connection, discussion, or collusion with any person, firm or corporation submitting a bid for the same product or service; no officer, employee or agent of the City of Leesburg or of any other bidder interested in said bid; and that the undersigned executed this Bidder’s Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so.

• I further certify that having read and examined the specifications and documents for the designated services and understanding the general conditions for contract under which services will be performed, does hereby propose to furnish all labor, equipment, and material to provide the services set forth in the Solicitation.

• I hereby declare that the following listing states any clarifications, any and all variations from and exceptions to the requirements of the specifications and documents. The undersigned further declares that the “work” will be performed in strict accordance with such requirements, and understands that any exceptions to the requirements of the specifications and documents may render the bidder's submission non-responsive.

NO EXCEPTIONS WILL BE ALLOWED AFTER THE BID IS SUBMITTED.

Please check one:

I take NO exceptions I take the exceptions listed here:

(If more space is needed, please indicate exceptions here and attach additional pages as needed)

Page CF-3 of 5

ADDENDUM ACKNOWLEDGMENT

No Addendum were issued.

The undersigned acknowledges receipt of the following addenda to the Invitation to Bid (indicate number and date of each):

Addendum No.

Dated: Addendum No.

Dated:

Addendum

Dated: Addendum

Dated:

FAILURE TO SUBMIT ACKNOWLEDGEMENT OF ANY ADDENDUM THAT AFFECTS THE BID

PRICES IS CONSIDERED A MAJOR IRREGULARITY AND MAY BE CAUSE FOR REJECTION OF THE

BID.

LOCAL VENDOR STATUS DECLARATION

The responding firm and firm that will enter into an agreement with the City, if selected, declares the following selected Local Vendor status.

Provide Physical Address of Business Office or Full Time Sales Office:

My Firm Qualifies as a Tier I - Local Vendor for this solicitation “Tier I Local Vendor” shall be defined as the primary Business Office or a Full Time Sales Office of the vendor being located within the City of Leesburg or the vendor receiving one or more Utility Services (excluding communications/Internet) from the City of Leesburg.

My Firm Qualifies as a Tier II - Local Vendor for this solicitation “Tier II Local Vendor” shall be defined as the primary Business Office or a Full Time Sales Office of the vendor not meeting the definition of a Tier I Local Vendor but nonetheless being located within the 20-Mile Radius as defined in this policy.

My Firm does not qualify as a local vendor

BID CERTIFICATION SIGNATURES

(this section must be signed and completed.)

Name of Business

Telephone Number

By:

Signature e-mail Address

Printed Name Mailing Address

Title City, State, Zip Code

Page CF-4 of 5

SUB-CONTRACTOR LISTING

Bidders using their own forces for the work may skip Section I. If subcontractors are listed below, the Bidder acknowledges that they have fully investigated each subcontractor listed and has in their files evidence each subcontractor has engaged successfully in his line of work for a reasonable period of time, and that the subcontractor maintains a fully equipped organization capable, technically and financially, of performing the work required. The City reserves final approval of any subcontractors listed. Following award of contract the City reserves the right for approval of future subcontractors and refusal of existing or future subcontractors providing work under this contract. If more space is needed use copies of this form.

Section I - Sub-Contractors o My company will not use any sub-contractors.

Sub-Contractor Name and Address How long have you used this subcontractor?

Section II – Equipment Listing Provide a list of all equipment your firm has available for this contract. Attaching a listing of all equipment owned by your company is unacceptable. List only the equipment that will be assigned to this contract.

Equipment Description Equipment Description

Page CF-5 of 5

STATEMENT OF EXPERIENCE - “SIMILAR” PROJECTS

List all SIMILAR projects your firm has completed. Copy this sheet if additional pages are needed. You must use this form. Attaching a separate listing may cause your bid to be deemed non-responsive and rejected.

Project Name/Location:

Project Owner: Date Completed:

Project Description and

Specific Scope: Be Descriptive. Use additional pages.

Contract Amounts: Original $ At Completion $ Briefly Explain Any

Variance:

Contact Person:

Contact e-mail:

Phone Number:

Project Description and

Specific Scope: Be

Project Description and

Specific Scope: Be

ADDENDUM ACKNOWLEDGMENT