Attachment C - Local Office Certification Form.pdf

FORM‐

7/22/2

Solic

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‐City of Miami Lo

CITY

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(1) Has verifiable months i purposes minimu owner of

(2) If the term of precedin procurem the twelv lease with corporate or propos review a checks o review a

(3) Has received Dade Co

(4) Has received required and

(5) Has c eligible f documen proposal.

cal Office Certifica

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e: ________ ated under C ans a busine had a staffe street addre mmediately p of this secti m of forty (40 the local bus business is l no less than g the date bi ent officer o e (12) mont hin the corpo limits of the als were rece nd approval b r other rent p nd approval b had, for a for the purch unty, if appli had, for a for the purc by either the ertified in w or considerat tation in supp tion

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Chapter 18/A ss within the d and fixed o ss that is loc receding the on, "staffed"

0) hours per c iness; a post o ocated in the twelve (12) m ds or propos r its designee hs immediatel rate limits of city for a ter ived shall be y the chief pr ayment docum y the chief pro minimum of tw ase or contra cable; and minimum of tw hase or contr city or Miam riting its com ion under this port of this lo

LOCAL

de, Chapter 1 e and Number: __________________

_ (Bidder/Pr Article III, Se e city which office or dis cated within date bids or p shall mean v calendar wee office box sha e permanent s months, been sals were rec ; for recently ly preceding f the city that rm of no less acceptable to rocurement of mentation in w ocurement of welve (12) m act at issue, a welve (12) m ract at issue, mi-Dade Cou mpliance with s section; prov ocal office ce

L OFF

18, Article II

______ (i.e.

roposer) he ection 18-73 meets all o tribution poi the corporat proposals w verifiable, fu ek, whether all not be suf structure pur n in effect fo ceived, and y-executed lea the date bids documents, than the twe o satisfy the re fficer or its de writing that d fficer or its d months imm a current bus months imm any license unty that aut the foregoin vided, howe rtification is

FICE C

II, Section

IFQ/IFB/RF

reby certifi 3, of the Co f the followi int, operating e limits of th ere received ll-time, on-si as a duly au ficient to con suant to a lea r no less tha be available ases that hav s or proposa in writing, co lve (12) mon equirements esignee; furt documents lo esignee;

ediately prec iness tax rec ediately prec or certificat horizes the p g at the time ver, that the b borne by the

ERTIF

18-73)

FP/RFQ/RFL

es complianc de of the Ci ng criteria:

g within a pe he city, for a for the purcha te employmen thorized empl stitute a local ase, such lease an the twelve for review a e been in effe ls were receiv ontinuous bus ths immediate of this section her requiring cal office ten eding the da eipt issued by eding the da e of compete erformance of of submittin urden of proo e business app

FICATI

LI No. 1234 ce with the ity of Miam ermanent stru a minimum o ase or contrac nt at the loca loyee, officer l office within e must be in

(12) months and approval ect for any pe ved, a prior f siness residen ely preceding n, and shall be that historica nancy shall be ate bids or pr y both the cit ate bids or pr ency and cert f said busine ng its bid or p of to provide plicant submi

ION

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Local Offic mi, Florida, a ucture with of twelve (12 ct at issue; fo al office for r, principal n the city;

writing, for s immediatel by the chie eriod less tha fully-executed nce within th g the date bid e available f al, cleared ren e available fo roposals wer ty and Miami roposals wer tificate of us ess operation proposal to b all supporting itting a bid o e s a r a or a y ef n d e s or nt r e i-e e s;

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City of Miami - Attachment C RFP 2130386

FORM‐City of Miami Local Office Certification 7/22/2013

PLEASE PROVIDE THE FOLLOWING INFORMATION:

Bidder/Proposer Local Office Address: _____________________________________________________

Does Bidder/Proposer conduct verifiable, full-time, on-site employment at the local office for a minimum of forty (40) hours per calendar week?

______YES ______NO

If Bidder/Proposer’s Local Office tenancy is pursuant to a lease, has Bidder/Proposer enclosed a copy of the lease?

______YES ______NO ______N/A

Has Bidder/Proposer enclosed a copy of the Business Tax Receipt (BTR) issued by the City of Miami and Miami-Dade County?

City of Miami: ______YES ______NO______ Exempt

Cite Exemption:

Miami-Dade County: ______YES ______NO______ Exempt

Cite Exemption:

Has Bidder/Proposer enclosed a copy of the license, certificate of competency and certificate of use that authorizes the performance of Bidder/Proposer’s business operations?

______YES ______NO

Bidder/Proposer’s signature below certifies compliance with the Local Office requirements stated under Chapter 18/Article III, Section 18-73, of the Code of the City of Miami, Florida, as amended.

Print Name (Bidder/Proposer Authorized Representative)

Signature Date

FORM‐City of Miami Local Office Certification 7/22/2013

STATE OF FLORIDA

COUNTY OF ________________

Certified to and subscribed before me this _____ day of _______________, 20______, by

(NOTARY SEAL)

(Signature of Notary Public-State of Florida)

(Name of Notary Typed, Printed, or Stamped)

Personally Known _____________________OR Produced Identification ____________________________

Type of Identification Produced_______________________________________________