RFQ_495344_Attachment_B_-_Attestation_of_Qualifications.pdf

ATTACHMENT B

ATTESTATION OF QUALIFICATIONS

RFQ NO. 202526

Commercial Solid Waste Hauling Services

THIS IS A MUST (FILL OUT) FORM.

FAILURE TO TIMELY AND FULLY COMPLETE AND RETURN THIS ATTACHMENT

WITH RESPONSE MAY AUTOMATICALLY DEEM THE PROPOSER NON-

RESPONSIVE.

LEGAL Name of Applicant (PROPOSER):

FULL BUSINESS Address, INCLUDING ZIP CODE of Applicant (PROPOSER):

Date:

Proposers1 must answer and provide all required documentation cited below. Proposers may use this format or may respond in another format within its Response to this RFQ, so long as all information is provided in the same order as outlined below.

1. Identification Information on Applicant

A. Name of Applicant

If the applicant is a partnership, LLC, LLP, or corporation, the name, business address of the principal officers and stockholders(Owning 5% or more of the stock) and any person having any financial or controlling interest in the partnership or corporation or other business entity shall be required. Provided, however, that if the corporation is a publicly owned corporation having more than 25 shareholders, then only the name and business address of the local and/or State of Florida managing officer(s) shall be required. Detail all information below or within submitted Response. The City will be unable to determine the qualifications of a Proposer should this information not be provided with Response and material omissions will cause the Proposer to be deemed non-responsive. Use a separate attached sheet indicating question numbers(s) if needed.

1 For purposes of this form Applicant shall have the same meaning as proposer. Applicant also means the business entity ( e.g. corporation, partnership, LLC, etc, et. al.) submitting this proposal.

B. Character of Applicant

The applicant, to determine qualifications for participation in the Franchise Agreement, if an individual, or in the case of a firm, corporation, partnership, association, LLC, organization, or other business entity any person(s) having any financial, controlling, or managing interest therein, should be of good moral character. In making such determination, the following information submitted by the applicant shall be considered:

(1) Penal History

If the applicant is an individual, a record of all convictions and the reasons therefore shall be provided by the applicant. If the applicant is other than an individual, then records of all convictions and the reasons therefore of the principal controlling officer(s) or applicant shall be provided. However, in the case of a publicly held corporation having 25 or more shareholders, only the aforementioned information applicable to its local managing officer(s) shall be required. Indicate convictions below, if applicable, and reasons. Also confirm the

Public Entity Crimes Statute2 does not apply to Proposer. The City will be unable to determine the qualifications of a Proposer should this information not be provided with Response.

(2) Fingerprints

The fingerprints of the persons mentioned in this subsection, a full set of which for each of such persons shall accompany response. Indicate from what public agency the attached fingerprints are provided. (The City of Homestead Police

Department does not provide fingerprint services or fingerprint cards to the general public)

(3) Business History

Indicate whether such applicant has operated a solid waste collection removal business in this or another state under a franchise, permit or license, and if so, where and whether such franchise, permit or license has ever been revoked , held or found to be in default, or suspended and the reasons therefore. The City will be unable to determine the qualifications of a Proposer should this information not be provided with Response.

2 See Florida Statute §287.133,”Public entity crime”, etc.

(4) Existence of Business Entity

If the applicant is a corporation or other incorporated business entity , provide proof of incorporation and proof of that corporation’s good standing in the state of incorporation. If applicant is a foreign corporation, applicant should submit information or material certifying that the applicant is allowed and qualified to do business in the State of Florida. If applicant is other than a corporation and is operating under a fictitious name, applicant should submit information that such fictitious name is registered under state law and held by applicant. Indicate below that such proof is being provided to the City. The City will be unable to determine the qualifications of a Proposer should this information not be provided with

Response. If the Applicant does business under a Fictitious Name please attach proof of compliance with the “Fictitious Name Act”.3

2. Equipment and Method of Operation

The applicant, in order to qualify for participation in the Agreement, shall possess equipment capable of providing safe and efficient service. In making such a determination and approving the method of operation for each applicant, the Department of Solid Waste shall now require the following information:

A. Provide the type, number and complete description of all equipment to be used by the applicant for providing service pursuant to the Agreement in the space below or on an attachment. The City will be unable to determine the qualifications of a

Proposer should this information not be provided with Response.

B. Provide a statement / attestation that the applicant shall use only City and/or

County-approved disposal sites for disposing of all garbage, garden trash, industrial waste, and solid waste material which applicant collects and removes, except those sites which heretofore have been approved by the State of Florida

Department of Environmental Protection. The City will be unable to determine the qualifications of a Proposer should this information not be provided with

Response

3 Florida Statute §865.09

3. Insurance Requirements

Proposer must submit a Statement attesting that proof of insurance will be provided in a form acceptable by the City Risk Manager within ten (10) days after receipt of Notice of

Award, and shall maintain its insurance, with the City listed as Additional Insured, in current status throughout the duration of the Agreement. The City will be unable to determine the qualifications of a Proposer should this information not be provided with

Response

It should be noted that the City will be unable to determine Proposer’s qualifications should all required information requested above not be provided with Response.

Therefore, any Proposer who fails to provide any of the above will not be able to provide services unless deemed fully qualified and approved by the City.

I hereby certify that the above information provided, and its corresponding documentation, is true and correct. I fully understand that any false or misleading information, or information not provided as requested by the City for the purposes of deceit or deception, shall be grounds for the determination of being deemed “not qualified” and that I understand that I shall have no recourse in the finding by the City.

I further certify that the undersigned is legally authorized to sign this statement on behalf of the applicant for participation in the Agreement.

Signed: Print Name:

Telephone No: Fax Number:

Pager No. Cell Number:

Email Address:

Witnessed by: Print Name:

Date:

Notary/ Jurat