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City of Tamarac Resolution R-2003-101
Temp. Reso #10109 April 18, 2003 Page 1 of 1 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-2003-101 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, AUTHORIZING AN ADDITIONAL EXPENDITURE NOT TO EXCEED $50,000 FOR THE PURCHASE OF AQUATIC, ORNAMENTAL AND TURF HERBICIDES UTILIZING CITY OF TAMARAC BID NO. 03- 01 B; PROVIDING FOR CONFLICTS; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the Public Works Department utilizes a variety of chemicals for weed control and fertilizing within City maintained canals and rights -of -way; and WHEREAS, in order to effectively provide these services, it is necessary to purchase certain quantities of chemicals on an annual basis; and WHEREAS, the City of Tamarac publicly advertised Bid No. 03-01 B for Landscaping and Aquatic Chemicals in the Sun -Sentinel on September 15t" and 22"d, 2002; and WHEREAS, on October 2, 2002, seven (7) bids were opened and reviewed in order to determine cost and responsiveness to the City's technical specifications; and WHEREAS, three (3) of the seven (7) bidders provided the lowest responsive and responsible bids for various individual items and the Bid was awarded to these three bidders on November 13, 2002 through Resolution R-2002-326, hereto attached as Exhibit 1;and WHEREAS, Resolution R-2002-326 also authorized an annual expenditure not to exceed $81,700 for the purchase of a variety of chemicals utilizing Bid No. 03-01 B; and WHEREAS, an additional $50,000 is available and has been transferred within the Stormwater Fund for the purpose of purchasing a larger quantity of chemicals than was Temp. Reso #10109 April 18, 2003 Page 2 of 2 anticipated based on the increased need for aquatic vegetation control this fiscal year; and WHEREAS, the Interim Director of Public Works recommends that the City authorize an additional expenditure not to exceed $50,000 for Fiscal Year 2003 utilizing Bid No. 03-01 B awarded on November 13, 2002 through Resolution R-2002-326; and WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in the best interest of the citizens and residents of the City of Tamarac to authorize an additional expenditure not to exceed $50,000 for Fiscal Year 2003 utilizing Bid No. 03-01 B awarded on November 13, 2002 to the three (3) lowest responsive responsible bidders, Helena Chemical Company, Agro Distribution, LLC DBA Pro Source One, and UAP Timberland LLC, for the provision of landscaping and aquatic chemicals. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, THAT: SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution upon adoption hereof. SECTION 2: The additional expenditure not to exceed $50,000 for the purchase of aquatic chemicals utilizing Bid No. 03-01 B, awarded on November 13, 2002 through Resolution R-2002-326, is hereby approved. SECTION 3: All resolutions or parts of resolutions in conflict herewith are hereby repealed to the extent of such conflict. SECTION 4: If any clause, section, other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications of this 1 Resolution, SECTION 5: passage and adoption. Temp. Reso #10109 April 18, 2003 Page 3 of 3 This Resolution shall become effective immediately upon its PASSED, ADOPTED AND APPROVED this 14t" day of May, 2003. ATTEST: MARION S ENSON, CMC CITY CLERK I HEREBY CERTIFY that I have approved this RESOLUTION ai to form. MITCPtE1 CITY A' OE SCH-RE IBER Mayor RECORD OF COMMISSION VOTE: MAYOR SCHREIBER DIST 1: COMM. PORTNER DIST 2: COMM. FLANSBAUM-TALABISCO DIST 3: COMM. SULTANOF DIST 4: V/M ROBERTS _ TR 10109 Temp. Reso #9961 EXHIBIT 1 October 28, 2002 Page 1 of 1 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-2002-_.%Wa_ A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, AUTHORIZING THE AWARD OF BID NO, 03-01 B FOR THE PURCHASE OF AQUATIC, ORNAMENTAL AND TURF HERBICIDES TO HELENA CHEMICAL COMPANY, AGRO DISTRIBUTION, LLC DBA PRO SOURCE ONE, AND UAP TIMBERLAND LLC; AUTHORIZING AN ANNUAL EXPENDITURE OF FUNDS IN AN AMOUNT NOT TO EXCEED $81,700; PROVIDING FOR CONFLICTS, PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the Public Works Department utilizes a variety of chemicals for weed control and fertilizing within City maintained canals and rights -of -way; and WHEREAS, in order to effectively provide these services, it is necessary to purchase certain quantities of chemicals on an annual basis; and WHEREAS, the City of Tamarac publicly advertised Bid No. 03-01 B for Landscaping and Aquatic Chemicals in the Sun -Sentinel on September 15`h and 22"d, 2002,,and WHEREAS, on October 2, 2002, seven (7) bids were opened and reviewed in order to determine cost and responsiveness to the City's technical specifications; and WHEREAS, three (3) of the seven (7) bidders provided the lowest responsive and responsible bids for various individual items as per the copy of the Bid and bid tabulation being hereto attached as Exhibit 1;and WHEREAS, funding is available in the adopted Public Works operating budget for said purpose; and WHEREAS, the Director of Public Works and Purchasing and Contracts Manager recommend that the City award Bid No. 03-01 B to the three (3) lowest responsive and Temp. Reso #9961 October 28, 2002 Page 2 of 2 responsible bidders for individual items as listed in the bid tabulation; and WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in the best interest of the citizens and residents of the City of Tamarac to award Bid #03-01 B to the three (3) lowest responsive responsible bidders, Helena Chemical Company, Agra Distribution, LLC DBA Pro Source One, and UAP Timberland LLC, for the provision of landscaping and aquatic chemicals. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, THAT: SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution upon adoption hereof. SECTION 2: The award of Bid No. 03-01 B for the purchase of Landscaping and Aquatic Chemicals to the three (3) lowest responsive responsible bidders, Helena Chemical Company, Agro Distribution LLC DBA Pro Source One, and UAP Timberland LLC, for a period of one (1) year with two (2) additional two (2) year renewal options, for an annual expenditure not to exceed $81,700, is hereby approved. SECTION 3: There are sufficient funds available in the Public Works operating budgets for said purpose. SECTION 4: All resolutions or parts of resolutions in conflict herewith are hereby repealed to the extent of such conflict. SECTION 5: If any clause, section, other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications of this 1 II U Fj Resolution. SECTION 6: passage and adoption. Temp. Reso #9961 October 28, 2002 Page 3 of 3 This Resolution shall become effective immediately upon its PASSED, ADOPTED AND APPROVED this 13t' day of November, 2002. ATTEST: MARION W ENSON, CMC CITY CLERK I HEREBY CERTIFY that I have approved this RESQLUTION as to form. MITCHEL CITY A t TOE SCHREIBER "Mayor RECORD OF COMMISSION V TE: MAYOR SCHREIBER DIST 1: V/M PORTNER DIST 2: COMM. MISHKIN DIST 3: COMM. SULTANOF DIST 4: COMM. ROBERTS . .•. U•1117 t)•17 Cl:alM;ln 'p��� ro q.p In;lr/ r3 o•ra:/n L7. V+iri7:A :N' •- L) ' t") ! L-J I �! 1 f l LT ; W 1�) fry ; 1•. 1�• I '• . l7 �! ! dD ' �i) l) ' u, I N ' �! f 4'J � � My h„ 4! � N ri t ,a . C) Ci V i �a• tV t {Q . Q i `� • 19 : t� u_7 vi O) i fV n <ri tO i QG_ I ' Z • J1 : 1M1 : : V). Vi V) V7 , fV']) fV V) 00 . 0D : 0 I 1 W % • Af! • Cf : 1 ulk! ¢;: j • C O 1447 i0 017 N n N , y(� O j O ' L'0 ' C] I (� 4 . 7 : C � -11 OO j OD t� C) 4 O : r... N r. 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N 5. a 03 N p c E, . j •.a,J j 0 J a 0 a a 0 U) Q U �o dU uj LL Cn 00 �a V J a C LL LL C 6 LL Or 93 4LL a cn w,l Q Ug w0 rp UO N mc?�r N �_4eq $Q N H I] t1i — ca co U 0 n C) Z O z w 5 � w U WcnLna)OWO Q 0 Y r Y �= UJ U) w O i LU V Z� I.- w w W w a O'r�'Yrr O w 0 W O �j T Q wU3U)u)v)rnM Z W W LU W W W J a 0rYr5-Yr Lll W N J U 0 w LU Q Z 0cf)(0 W LU W U)W W W c W a Q z> Y Y Y w a ua W W 9 zZOMWOOO 0 W o� T W � 0Y}rI}�-Y>- a D %, W w U L] LU Li In z w LU fD W FO 2 ZWOMOMO 0rziz�i w w 0 C Purchasing Division City of Tamarac "Committed to Excellence... Always" INVITATION TO BID BID NO. 03-01 B Sealed bids, addressed to the Purchasing and Contracts Manager of the City of Tamara( Broward County, Florida, will be received in the Purchasing Office, 7525 NW 88th Avenuf Tamarac, Florida 33321-2401 until Wednesday, October 2, 2002 at 2:00 p.m., at whit time bids will be publicly opened and announced for: Landscaping and Aquatic Chemicals All bids received after the date and time stated above will be returned unopened to tr. Bidder. All Bidders are invited to attend the opening. The City of Tamarac is hereby requesting Bids, from qualified vendors, to provic Landscaping and Aquatic Chemicals, as per the conditions and specifications contained this document. One original and two copies (2) of the bid shall be submitted on an official bid for furnished with the bid package and those submitted otherwise will not be consider( responsive. The submittal shall be plainly marked Bid No. 03-0113, Landscaping ar Aquatic Chemicals opening on Wednesday, October 2, 2002 at 2:00 p.m, on tl outside of the envelope. The City reserves the right to accept or reject any or all bids, or any part of any bid, waive any informalities, and to award in the best interest of the City of Tamarac. Bid documents will be available for review and may be obtained from the Purchasing Offi, at the above address. For non -technical inquiries, contact the Purchasing Office at (95 724-2450; and for technical issues, contact Wes Tipton at (954) 724-2519. Steven J. Beamsderfer Buyer Publish Sun Sentinel: 9/15/02 & 9/22/02 7525 NW 88th7 Avenue 0 Tarnorac, Horida 33321-2401 9 (9`_)4) 724-2-V)U 0 1 F.), (�41 7<z'141ir Is www.ic,n'c i TABLE OF CONTENTS Landscaping and Aquatic Chemicals BID 03-01 B Instructions to Bidders 3 General Terms and Conditions............................................................................. 3 SpecialConditions.................................................................................I............10 BidCoversheet Checklist.................................................................................... 11 BidForm.............................................................................................................12 Nan -Collusive Affidavit........................................................................................18 Certification......................................................................................................... 20 Bidder's Qualification Statement......................................................................... 21 References......................................................................................................... 24 Vendor Drug -Free Workplace............................................................................. 25 City of Tamarac INSTRUCTIONS TO BIDDERS BID NO. 03-1 B Purchasing Division It is the intent of the City to award this bid to the lowest responsible and responsive bidder. The City reserves the right to accept or reject any or all bids and to waive any informality concerning the bids when such rejection or waiver is deemed to be in the best interest of The City of Tamarac. The City reserves the right to award the bid on a split order basis, lump sum or individual item basis unless otherwise stated. GENERAL TERMS AND CONDITIONS These general terms and conditions apply to all offers made to the City of Tamarac by al prospective Bidders including but not limited to Request for Quotes, Request for Bids anc Request for Proposals. As such the words "bid" and "proposal" are used interchangeably it reference to all offers submitted by prospective bidders. 1. SUBMISSION OF THE BID. The Bidder is directed to deliver sealed bids to the City's Purchasing Office, City of Tamarac 7525 N. W. 88th Avenue, Tamarac, Florida 33321, no later than 2:00 PM, Wednesday October 2, 2002. At this time the bids will be opened, the names of all Bidders will bf announced and all bids shall be a matter of public record. All Bidders and their representative., are invited to attend. The Bidder must show the bid number, bid name, time and date of thf bid opening on the outside of the sealed bid package. Delivery of the sealed bids to the Cit, Purchasing Office on or before the above date is solely and strictly the responsibility of the Bidder. Late bids will be returned unopened to the Bidder. It is the Bidder's responsibility to read and understand the requirements of this bid. Unles'. otherwise specified the Bidder must use the bid form furnished in the bid packet. Bidders art required to state exactly what they intend to furnish to the City via this Solicitation and mus indicate any variances to the terms, conditions and specifications of this bid, no matter hov slight. If variations are not stated in the bid, it shall be construed that the Bidder's bid full', complies with all conditions identified in this bid. The Bidder shall submit one (1) original ant two (2) copies of the bid. The ORIGINAL bid must be manually and duly signed in ink by Corporate Officer, Principal, or Partner with the authority to bind the bidding company or firr by his/her signature. All quotations must be typewritten or filled in with pen and ink. Bid having erasures or corrections must be initialed in ink by the Bidder. All prices, terms ani conditions quoted in the submitted bid will be firm for acceptance for sixty days from the dat, of the bid opening unless otherwise stated by the City. 2. BONDING Not applicable for this bid. 'Tp is Grty of Tamarac 3. WITHDRAWAL OF BID Purchasing Divisini Any Bidder may withdraw its bid prior to the indicated opening time. The request fo withdrawal must be submitted in writing to the City Purchasing Office. 4. PUBLIC ENTITY CRIMES STATEMENT A person or affiliate who has been placed on the convicted vendor list following a convicto, for public entity crime may not submit a bid on a contract to provide any goods or service to a public entity, may not submit a bid on a contract with a public entity for the constructio or repair of a public building or public work, may not submit bids on leases of real propert to public entity, may not be awarded or perform work as a contractor, supplies subcontractor, or consultant under a contract with any public entity, and may not transac business with any public entity in excess of the threshold amount provided in Sectio 287.017, for Category Two for a period of 36 months from the date of being placed on th convicted vendor list. 5. NON -COLLUSIVE AFFIDAVIT Each Contractor shall complete the Non -Collusive Form and shall submit the form with th Proposal. CITY considers the failure of the Contractor to submit this document to be major irregularity and may be cause for rejection of the Proposal. 6. QUANTITIES Quantities shown are estimates only. No guarantee or warranty is given or implied by th City as to the total amount that may or may not be purchased from any resulting contrac The City reserves the right to decrease or increase quantities or add or delete any itet from the contract if it is determined that it best serves the interests of the City. 7. PRICES PAYMENTS AND DISCOUNTS Bid prices shall be fixed and firm to the extent required under Special Conditions. Paymei will be made only after receipt and acceptance of materials/services. Cash discounts mG be offered for prompt payment; however, such discounts shall not be considered determining the lowest net cost for bid evaluation. Bidders are encouraged to provide prompt payment terms in the space provided on the B Form. If no payment discount is offered, the Bidder shall enter zero (0) for the percentac discount to indicate net 30 days. If the Bidder does not enter a percentage discount, it understood and agreed that the payment terms shall be 2% 10 days, net 30 days effecth on the date that the City receives an accurate invoice or accepts the product, whichever the later date. Payment is deemed to be made on the date of the mailing of the check. MY. City of Tamarac. Purchasing Division two, 8. DELIVERY All items shall be delivered F.O.B. destination to a specific City address. All delivery costs and charges must be included in the bid price. All exceptions shall be noted. Failure to do so may be cause for rejection of the bid. The City reserves the right to cancel orders or any part thereof, without obligation if delivery is not made at the time -specified in the bid. 9. BRAND NAMES Manufacturers' name, brand name, model number or make is used in these specifications for the sole purpose of establishing minimum requirements of quality, performance and design. 10. SAMPLES AND DEMONSTRATIONS When requested, samples are to be furnished free of charge to the City. If a sample is requested it rnust be delivered within seven days of the request unless otherwise stated in the bid. Each sample must be marked with the bidders name and manufacture's brand name. The City will not be responsible for returning samples. The City may request a full demonstration of any product or service before the award of a contract. All demonstrations will be done at the expense of the Bidder. 11. CONDITIONS OF MATERIALS All materials and products supplied by the Bidder in conjunction with this bid shall be new warranted for their merchantability, fit for a particular purpose, free from defects anc consistent with industry standards. The products shall be delivered to the City in excellent condition. In the event that any of the products supplied to the City are found to be defectivE or do not conform to the specifications, the City reserves the right to return the product to the Bidder at no cost to the City. 12. COPYRIGHTS OR PATENT RIGHTS The Bidder warrants that there has been no violation of copyrights or patent rights it manufacturing, producing or selling the goods shipped or ordered as a result of this bid. ThE seller agrees to hold the City harmless from all liability, loss or expense occasioned by and such violation. 13. SAFETY STANDARDS The Bidder warrants that the product(s) supplied to the City conforms with all respects to th( standards set forth in the Occupational Safety and Health Act and its amendments to an, industry standards if applicable. 0'. City al Tamarac Purchasing Divisior 14. PERFORMANCE Failure on the part of the Bidder to comply with the conditions, terms, specifications an( requirement of the bid shall be just cause for the cancellation of the bid award. The City may by written notice to the Bidder, terminate the contract for failure to perform. The date o termination shall be stated in the notice. The City shall be the sole judge of nonperformance 15. DEFAULT In the event that the Bidder defaults on the contract or the contract is terminated for cause du( to performance, the City reserves the right to obtain the materials or services from the nex lowest Bidder or other source during the remaining term of the contract. Under thi! arrangement the City will charge the Bidder any excess cost occasioned or incurred thereb, and shall apply to any bid bond required. 16. TERMINATION FOR CONVENIENCE OF CITY Upon seven (7) calendar days written notice delivered by certified mail, return receiK requested, to the Bidder, the CITY may without cause and without prejudice to any other rigY or remedy, terminate the agreement for the CITY's convenience whenever the CIT' determines that such termination is in the best interest of the CITY. Where the agreement i terminated for the convenience of the CITY the notice of termination to the Bidder must stat that the contract is being terminated for the convenience of the CITY under the terminatio clause and the extent of termination. Upon receipt of the notice of termination fc convenience, the Bidder shall promptly discontinue all work at the time and to the eater indicated on the notice of termination, terminate all outstanding sub -contractors and purchas orders to the extent that they relate to the terminated portion of the Contract and refrain fror placing further orders and sub -contracts except as they may be necessary, and complete ar continued portions of the work. 17. ASSIGNMENT The Bidder shall not transfer or assign the performance required by this bid without the pric written consent of the City. Any award issued pursuant to this bid and monies that mE become due hereunder are not assignable except with prior written approval of the City. 18. EMPLOYEES Employees of the Bidder shall at all times be under its sole direction and not an employee 1 agent of the City. The Bidder shall supply competent and physically capable employees. Tt City may require the Bidder to remove an employee it deems careless, incompeter insubordinate or otherwise objectionable. Bidder shall be responsible to the City for the ac and omissions of all employees working under its directions. .;w City or Tamarac mm Purchasing Division 19. TAXES The City of Tamarac is exempt from all Federal, State, and Local taxes. An exemption certificate will be provided where applicable upon request. 20. BID PREPARATION EXPENSE The Bidder preparing a bid in response to this bid shall bear all expenses associated with its preparation. The Bidder shall prepare a bid with the understanding that no claim foi reimbursement shall be submitted to the City for the expense of bid preparation and/or presentation. 21. OMISSION OF DETAILS Omission of any essential details from these specifications will not relieve the Bidder o' supplying such product(s) as specified. 22. INSURANCE REQUIREMENTS Bidder agrees to, in the performance of work and services under this Agreement, comply witf all federal, state, and local laws and regulations now in effect, or hereinafter enacted durinc the term of this agreement that are applicable to Contractor, its employees, agents, of subcontractors, if any, with respect to the work and services described herein. Bidder shall obtain at Bidder's expense all necessary insurance in such form and amount w required by the City's Risk & Safety Officer before beginning work under this Agreement Bidder shall maintain such insurance in full force and effect during the life of this Agreement Bidder shall provide to the City's Risk & Safety Officer certificates of all insurance requires under this section prior to beginning any work under this Agreement. Bidder shall indemnify and save the City harmless from any damage resulting to it for failure of either Bidder or and subcontractor to obtain or maintain such insurance. The following are required types and minimum limits of insurance coverage, which the Bidde agrees to maintain during the term of this contract: Line of Business/ Coverage Commercial General Liability Including: Premises/Operations Contractual Liability Personal Injury Explosion, Collapse, Underground Hazard Products/Completed Operations Broad Form Property Damage Cross Liability and Severability of Interest Clause Limits Occurrence Aggregate $1,000,000 $1,000,000 City of Tamarac :W..:;. .. _.....__.................. Y........ _ ............_.__ _ Puwrhasiny Divrsioi Automobile Liability $1,000,000 $1,000,000 Workers' Compensation & Employer's Liability Statutory The City reserves the right to require higher limits depending upon the scope of work unde this Agreement. Neither Bidder nor any subcontractor shall commence work under this contract until they have obtained all insurance required under this section and have supplied the City with evidence c such coverage in the form of an insurance certificate and endorsement. The Bidder wi ensure that all subcontractors will comply with the above guidelines and will maintain thl necessary coverages throughout the term of this Agreement. All insurance carriers shall be rated at least A-VII per Best's Key Rating Guide and b, licensed to do business in Florida. Policies shall be "Occurrence" form. Each carrier will giv, the City sixty (60) days notice prior to cancellation. The Bidder's liability insurance policies shall be endorsed to add the City of Tamarac as a "additional insured". The Bidder's Worker's Compensation carrier will provide a Waiver c Subrogation to the City. The Bidder shall be responsible for the payment of all deductibles an self -insured retentions. The City may require that the Bidder purchase a bond to cover the fu amount of the deductible or self -insured retention. If the Bidder is to provide professiom services under this Agreement, the Bidder must provide the City with evidence of Profession, Liability insurance with, at a minimum, a limit of $1,000,000 per occurrence and in th aggregate. "Claims -Made" forms are acceptable for Professional Liability insurance. 23. INDEMNIFICATION The Bidder shall indemnify and hold harmless the City of Tamarac, its elected and appointe officials and employees from any and all claims, suits, actions, damages, liability, an expenses (including attorneys' fees) in connection with loss of life, bodily or personal injury, c property damage, including loss of use thereof, directly or indirectly caused by, resulting fron arising out of or occurring in connection with the operations of the Bidder or h. Subcontractors, agents, officers, employees or independent contractors, excepting only suc loss of life, bodily or personal injury, or property damage solely attributable to the groE negligence or willful misconduct of the City of 'rainarac or its elected or appointed officials an employees. 24. CLARIFICATION TO TERMS AND CONDITIONS Where there appears to be variances or conflicts between the General Terms and Conditior and the Special Conditions and/or Detailed Specifications outlined in this bid, the Speci Conditions and/or the Detailed Specifications shall prevail. The Bidder shall examine all bid documents and shall judge all matters relating to & adequacy and accuracy of such documents. Any inquires, suggestions, request concernir clarification or solicitation for additional information shall be submitted in writing to the City Tamarac Purchasing and Contract Manager, The City shall not be responsible for or interpretations given by tiny City r'ml,lryec: c; City of Tamarac PurchDivis.k ........_.__._ ...... ....___.._..�... ..............�_. ....... ... .... __._.......... ... _...... ........asing 25. BID TABULATION Bidders who wish to receive a copy of the bid tabulation should request it by enclosing stamped, self-addressed envelope with their bid, or by requesting a tabulation be sent to the fax machine. Bid results will not be given out by telephone. The City does not notii unsuccessful bidders of contract awards. Pursuant to Florida Statute Chapter 119, Section 7(m), sealed bids or proposals received t an agency pursuant to invitations to bid or requests for proposals are exempt from th provisions of subsection (1) and s. 24(a), Art. I of the State Constitution until such time as th agency provides notice of a decision or intended decision pursuant to s. 12057(3)(a) c within 10 days after bid or proposal opening, whichever is earlier. 26. RECORDS/AUDITS The Contractor shall maintain during the term of the contract all books, reports and records accordance with generally accepted accounting practices and standards for records direct related to this contract. The form of all records and reports shall be subject to the approval the City's Auditor. The Contractor agrees to make available to the City's Auditor, durir normal business hours and in Broward, Dade or. Palm Beach Counties, all books of accour reports and records relating to this contract far the duration of the contract and retain them f1 a minimum period of one (1) year beyond the last day or the contract term. TT Purchasing Divisic City of Tamarac �._ _ __..._......._..._......... ... ......._......... . SPECIAL CONDITIONS BID NO. 03-01 B 1. PURPOSE OF BID The City of Tamarac is hereby requesting Bids, from qualified vendors, to obtain fixed pricf for various Aquatic, Ornamental and Turf herbicides and additives for an initial perk beginning upon date of approval by City of Tamarac Commission through December 3 2003. The City reserves the right to extend the contract for two (2) additional two (2) year perioc providing all parties agree to the extension, and all of the terms, conditions, and specificatioi remain the same. 2. DELIVERY: All deliveries by bidders fleet or common carrier are to be palletized and secured by prop banding and/or wrap material to prevent shipping, unloading, or handling accidents. The C reserves the right to refuse any delivery, at no cost to the City or its employees, that does r meet this requirement. The City is not responsible for any accident or spillage wh chemicals are in transit to their designated receiving points and until actual delivery accepted. All deliveries must be made Monday through Friday between the hours of 7: A.M. and 3:00 P.M. Deliveries must be scheduled twenty-four (24) hours in advance calling the Stormwater Supervisor at (954) 724-2519 so adequate personnel can unlo trucks and store materials in the storage shed. 3. LABELING: Two (2) complete sets of specimen labels and any supplemental labeling covering the itei offered must accompany all bids. Each label must carry the appropriate EPA registrat number(s) for the material specified. Two (2) original copies of Material Data Safety She, must be included with bid material. I Cir.y of Tamarac COMPANY NAME: (Please Print): Phone: :Sly( FaxP Cg( � 4 - ? 72 3 -_ BEFORE SUBMITTING YOUR BID MAKE SURE YOU... Ell. Carefully read the General Terms & Conditions, Special Conditions and th General Requirements. ❑ 2. Carefully read the Detailed 'Specifications, and then rp operiy fill out the BI FORMS. ❑ 3. Fill out and sign the NON -COLLUSIVE AFFIDAVIT and have it properly notarize, ❑ 4. Sign the CERTIFICATION page. Failure to do so will result in your Bid beir deemed non -responsive. ❑ 5. Fill out the BIDDERS QUALIFICATION STATEMENT. 5. Fill out the REFERENCES page. ❑ 7. Sign the VENDOR DRUG FREE WORKPLACE FORM. ❑ g. Include proof of insurance. ❑ 9. Subunit ONE (1) Original AND TWO (2) Photocopies of your bid, clear marked with the BID NUMBER AND BID NAME on the outside of the packag ❑ 10. Make sure your Bid is submitted PRIOR to the deadline. Late Bids will not I accepted. Failure to provide the requested attachments may result in your bid being deemed non -responsive. THIS SHOULD BE THE FIRST PAGE OF YOUR BID. ^n hrirchmir?g L.'iwai City Of Taml3r;rc: BID NO. 03-OI B Submitted by: r �� �" 1 .► �-- C-). Date Bidder THIS BID IS SUBMITTED TO: 9�/31,ho City of Tamarac Purchasing and Contracts Manager 7525 Northwest 88`" Avenue Tamarac, Florida 33321 1. The undersigned Bidder proposes and agrees, if this bid is accepted, to enter int, contract with the City to perform and furnish all Work as specified herein for I Contract Price and within the Contract Period indicated in this bid. 2. This bid will remain subject to acceptance for sixty (60) days after the day of opening. Bidder will sign and submit the necessary documents required by the C within fifteen (15) days prior to the date of the City's Award. a) Bidder has familiarized itself with the nature and extent of the contract documents, locality, and all local conditions and laws and regulations that i any manner may affect cost, progress, performance or furnishing of the We b) Bidder has given the City written notice of all conflicts, errors or discrepant that it has discovered in the contract documents and the written resolution thereof by the City is acceptable to Bidder. c) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation; Bidder has not directly or indirectly induced or solicited any otl Bidder to submit a false or sham Bid; Bidder has not solicited or induced a person, firm or corporation to refrain from bidding; and Bidder has not soul, by collusion to obtain for itself any advantage over any other Bidder or ovt the City. 3. Bidder will complete the Work for the prices shown in the "Bid Form". 4_ Bidder agrees that the Work will be substantially performed and complet accordance with the schedules established herein. No Text I I CL 9'm M= 0 :3 Cl U) Li. z 0 z CL (i yE �� Cc )cc 0) z cu 0 U_ a) cu cF E -0 C: CIS Co 'D CD cm: ZZ a .CL a V)0)2 co 0 j; OL ti '0 U) :E V) U) ch E CL (D cn o 0 (D C: C: 0 (D vi 2- —cb 0 U_ 0 a- m M Q M 0 CL (D o =� .2: -D cl 0 LO 0 LO 0 C) 0 C) C) CD CL 5(D C 4) cr -0 cu !E =3 cu ai y CP (a CY co 4) U) 3 4) U) m M 'o (M co M cr a .0 Co .0 .2 !2 Q 0 JD CL 0 c a CS c: Z�._ 5 0 c :3 0 U.) U.) 0 0 U-) 0 -0 4) (o 0 a- C) C� x (� d- Cl CL C) ItT CID >1 0) ;r CM Ui (D U) a c M cr 0 c 0 0 0 a)U o M o 0- o 0- m CD m (D o CL w 0 o >, M .0 " An -C C; _ C� TI co 0) L_ A 00 . E al — co a) 0 cc ! tJ p O C: 0 0 c (D C? cz! Q I f.- '.'i:y rif rz7rr.�u::ar: _...._........_.__...._.._ ___ _ . ._.... .... % _.._......................... urc ,� sinf i;ivi: BID FORM (continued) BID No. 03-OI B The City reserves the right to reject any bid, if it deems that a vendor has deliberately provic erroneous information. The undersigned declare to have specific and legal authorizatioi obligate their firm to the terms of this bid, and further, that they have examined the Invitaboi Bid, the instructions to Bidders, the Specifications, and other documents included in this request, and hereby promises and agrees that, if this bid is accepted, they will faithfully f't the terms of this bid together with all. guarantees and warranties thereto. The undersigi bidding firm further certifies the product and/or equipment meets or exceeds the specifics as stated in the bid package; and also agrees that products and/or equipment to be delivE which fail to meet bid specifications will be rejected by the City within thirty (30) day, delivery. Return of rejection will be at the expense of the bidder. �f -[�''��YY �- C. �i wed ✓�c7'ic: �S.%� Company Name r_. qC . /J. `7l s 5 i . Address City, St te, ZIP Contractor's License Number Authorized Signat Typed/Printed Name Telephone & Fax Number u99 963E Federal Tax ID# City of Tamarac,w- BID FORM (continued) BID NO. 03-018 Bidders Name: rr_'i-q-�..`S. TERMS: %Fri .% Net days Delivery/completion:-calendar days after receipt of Purchase Order To be considered eligible for award, one (1) Original and two (2) cop of this bid foi MUST be submitted with the Bid. NOTE: Bid submittals without the manual signature of an authorized agent of the Bid( shall be deemed non -responsive and ineligible for award. IF "NO BID" IS OFFERED, PLEASE PROVIDE THE FOLLOWING INFORMATION: Please indicate reason(s) why a Bid Proposal is not being submitted at this tin Return the Bid Form to avoid removal of Bidder from the City of Tamarac's vent listing. City of Tamarac BID FORM (continued) BID NO. 03-01 B Bidder's Name: n c CcLf! Variations: The Bidder shall identify all variations and exceptions taken to the Instructions to Bidders, i Special Conditions and any Technical Specifications in the space provided below; provide however, that such variations are not expressly prohibited in the bid documents. For ee variation listed, reference the applicable section of the bid document. If no variations are list here, it is understood that the Bidder's Proposal fully complies with all terms and condition: f is further understood that such variations may be cause for determining that the Bid Prope is non -responsive and ineligible for award: Section JctL C.. Variance r - �^ Section kaY2d_<<qAaZ Variance Section �� c-c • , VarianceA_�� Section Variance Attach additional sheets if necessary. C Ifi U �'� `t"c: in n S CAT'e` t of cxci n-)�O 41 �]C�t/Y�--+` YY)a`Y) V1_CQ 4U* Ce.. (_ CAS ' ' Bra l F)ccduic-k- or) 4L Ri(4 J�O L pe s t NON -COLLUSIVE AFFIDAVIT State of )SS-. County of deposes and says that: being first duly sworn, 1. He/she is the (0) ► nSr, Partner, Officer, Representative o Agent) of ^� " . , the Offeror that has submitted the attached Proposal; 2. He/she is fully informed respecting the preparation and contents of the attach Proposal and of all pertinent circumstances respecting such Proposal; 3. Such Proposal is genuine and is not a collusive or sham Proposal; 4. Neither the said Offeror nor any of its officers, partners, owners, ages representatives, employees or parties in interest, including this affiant, have in F way colluded, conspired, connived or agreed, directly or indirectly, with any od Offeror, firm, or person to submit a collusive or sham Proposal in connection with i Work for which the attached Proposal has been submitted; or to refrain from biddinc connection with such Work; or have in any manner, directly or indirectly, sought agreement or collusion, or communication, or conference with any Offeror, firm, person to fix the price or prices in the attached Proposal or of any other Offeror, o fix any overhead, profit, or cost elements of the Proposal price or the Proposal pric( any other Offeror, or to secure through any collusion, conspiracy, connivance, unlawful agreement any advantage against (Recipient), or any person interestec the proposed Work; 5. The price or prices quoted in the attached Proposal are fair and proper and are tainted by any collusion, conspiracy, connivance, or unlawful agreement on the pai the Offeror or any other of its agents, representatives, owners, employees or partie interest, including this affiant. Signed, s led and delivered in the presence of:�• By wit e ,, Wi ness Printed Name Title a F'tlrrt►,;�sinc ?L")ivrsic �..r!�� c�, Tamarac � .._.,....w•. _ �..._.___ ACKNOWLEDGMENT NON -COLLUSIVE AFFIDAVIT State of Florida County of 14, 1 Is I On this the / 5r day of �' �. 2002, before me, tF undersigned Notary Public of the State of Florida, personally appeared: and (Name(s) of individuai(s)kho appeared before notary) whose name(s) is/are Subscribed to within the instrument, angi he/she/they acknowledc thatch%he/they executed it. WITNESS my hand and official seal. NOTARY PUBLIC SEAL OF OFFICE: Z.779 F, R �-411 /TA""A -,P- - Q� NOTARY PUBLIC:,,�TATE OF FLORIDA (Name of Notary Public: Prin Stamp, or Type as Commissioner P9 Personally known to me, ( ❑ Produced identification (Type of Identification Produce( ❑ DID take an oath, ❑ DID NOT take an o� City Of iamarar:_......_.._..._...�.._..�Jurchasiny Liivis: CERTIFICATION THIS DOCUMENT MUST BE SUBMITTED WITH THE BID. We (1), the undersigned, hereby agree to furnish the item(s)/service(s) described in t Invitation to Bid. We (1) certify that we(I) have read the entire document, including t Specifications, Additional Requirements, Supplemental Attachments, Instructions to Bidde Terms and Conditions, and any addenda issued. We agree to comply with all of t requirements of the entire Invitation To Bid. Indicate which type of organization below: INDIVIDUAL ❑ If "Other", Explain: PARTNERSHIP ❑ CORPORATION [wf OTHER [ u orized Signat Name (Printed r Typed) Title Federal EnIployer I.D./Social Security Company Name Address City/Stafe/Zip Telephone �5.� (- _�%5.�...:"..�'_���- Contact Person Fax N tuber C. y of i �amar�q, , . _........ _...._ ...._ � _....__._._._ l=urrtuasing Divi- BIDDER'S QUALIFICATION STATEMENT The undersigned certifies under oath the truth and correctness of all statements and all answers to questions made hereinafter: SUBMITTED TO: City of Tamarac Purchasing & Contracts Manager 7525 NW 88t' Avenue Tamarac, Florida 33321-2401 CHECK ONE; (Corporation ❑ Partnership ❑ Individual ❑ Joint Venture ❑ Other SUBMITTED BY (Company Name) ADDRESS: CITY, STATE ZIP: / �rz--4 1. State the true, exact, correct and complete name of the partnership, corporate s trade or fictitious name under which you do business and the address of the plac business: Correct Name of Bidder EsZY504 Principal address of Business 90�_ t). /�7G���✓ City, State Zip? f f L 2. If Offeror is a corporation, answer the fo owing: a. Date of Incorporation _ / 9 ? 0 b. State of Incorporationre_ C. President's name d. Vice President's name hn e. Secretary's name: - f. Treasurer's namefl g. Name and address of Resident Agentj��_L 3. If Offeror is an Individual or a Partnership, answer the following: Date of Organization Name, address and ownership units of all partners (if necessary, use separate shee NAME ADDRESS OWNERSHIP U MY rf � lliF.l(F�(: ( „� �(-'tirchesin(r Divi: _ ._....._.._ ............................. ......_._.....,_ _. __ _ c _._._ ....__._.... _._ —_ State whether general or limited partnership 4. If offer is other than an individual, corporation or partnership, describe organization and give the name and address of principals: NAME ADDRESS 5. If Offeror is operating under a fictitious name, submit evidence of compliance with the Florida Fictitious Name Statute. 1 6. How many years has your organization been in business under its present name? 40 r • S 12 a. Under what former names has your organization operated? 7. Indicate registration, license numbers or certificate numbers for the businesses professions that are the subject of the Bid. Please attach certificate of compete and/or state registration. 8. Have you ever failed to complete any work awarded to you? If so, state when, where and why: 9. State the names, telephone numbers and last known addresses of three (3) own individuals or representatives of owners with the most knowledge of work that have performed or goods you have provided (government owners are preferre( references): NAME ADDRESS PHONE �, y ��ur;hw...... 10. List the pertinent experience of the key individuals of your organization (continue on insert sheet, if necessary). /l n A <LLA:3/;a `b I Z .� 141 4. vlw j-/f!fJ h 1 r .� _ r ;11 a,hey oz; j 41--cam -_ :.—e-- ,� 11. State the name of the individual who will have personal supervision of the wort c:5AP c u vULF THE BIDDER ACKNOWLEDGES AND UNDERSTANDS THAT THE INFORMATION CONTAINEC RESPONSE TO THIS QUALIFICATIONS STATEMENT SHALL BE RELIED UPON BY THE OWNEF AWARDING THE CONTRACT AND SUCH INFORMATION IS WARRANTED BY BIDDER TO BE TR THE DISCOVERY OF ANY OMISSION OR MISSTATEMENT THAT MATERIALLY AFFECTS " BIDDER'S QUALIFICATIONS TO PERFORM UNDER THE CONTRACT SHALL CAUSE THE OWNEF REJECT THE PROPOSAL, AND IF AFTER THE AWARD, TO CANCEL AND TERMINATE THE AW/ AND/OR CONTRACT. (Signature) v ACKNOWLEDGEMENT BIDDER'S QUALIFICATION STATEMENT State of Florida county of S �Z .--.:�- On this the / 6rday of ,', 2002, before me, the undersigned Notary Publ of the State of Florida, personally appeared and (Name(s) of indivi(fual(s) who appeared before notary) whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. NOTARY PUBLIC SEAL OF OFFICE: NOTARY PUBLI a , STATE OF FLORI (Narhe of Notary Public: Pr Stamp, or Type as Commission Personally known to me ❑ Produced identificati (Type of Identification Produc DID take an oath, or ❑ DID NOT take an, r,itv of Tamar, .................... ....... REFERENCES Please list name of government agency or private firm(s) with whom you have done busine,, within the past five years'. Your Company Name Address City State Zip Phone/Fax Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name'. Address City State Zip Phone/Fax Contact Name I y of l;�mrar�,r. r !'larch ;mr� L)IV/ ---�.__ w.. � _ .. �.... ...._..... _.._....... _... .. _..... ........ c �..._._ .._.......— _ . _ _._._.. _.__._._ ...._ .. �_ Y _ -- VENDOR DRUG -FREE WORKPLACE Preference may be given to vendors submitting a certification with their bid/proposal certifj they have a drug -free workplace in accordance with Section 287.087, Florida Statutes. I requirement affects all public entities of the State and becomes effective January 1,1991. ' special condition is as follows: IDENTICAL TIE BIDS - Preference may be given to businesses with drug -free workpl, programs. Whenever two or more bids that are equal with respect to price, quality, and ser are received by the State or by any political subdivision for the procurement of commoditie contractual services, a bid received from a business that certifies that it has implement( drug -free workplace program shall be given preference in the award process. Establisl procedures for processing tie bids will be followed if none of the tied vendors have a drug-1 workplace program. In order to have a drug -free workplace program, a business shall: 1. Publish a statement notifying employees that the unlawful manufacture, distribut dispensing, possession, or use of a controlled substance is prohibited in workplace and specifying the actions that will be taken against employees violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the busine policy of maintaining a drug -free workplace, any available drug counsel rehabilitation, and employee assistance programs, and the penalties that may imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual servi that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, a condition of working on the commodities or contractual services that are under the employee will abide by the terms of the statement and will notify the employ( any conviction of, or plea of guilty or nolo contendere to, any violation of chapter or of any controlled substance law of the United States or any state, for a viola occurring in the workplace no later that five (5) days after each conviction. 5. Impose a section on, or require the satisfactory participation in a drug ab assistance or rehabilitation program if such is available in the employ, community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace thro implementation of this section. As the person authorized to sign the stateme _.certify that this form complies fully with the above requirements. r� l/ �'Kuthorized Signatwa Company Name City AGRO DISTRIBUTION. LLC COMPANY NAME: (Please Print): Phone: Y �. ;. Sx:_ Fax:_!-�C�i BEFORE SUBMITTING YOUR BID MAKE SURE YOU... ❑ 1. Carefully read the General Terms & Conditions, Special Conditions and the i General Requirements. ❑ 2. Carefully read the Detailed Specifications, and then r�Y fill out the BIC FORMS. ❑ 3. Fill out and sign the NON -COLLUSIVE AFFIDAVIT and have it properly notarized ❑ 4. Sign the CERTIFICATION page. Failure to do so will result in your Bid bein! deemed non -responsive. ❑ 5. Fill out the BIDDERS QUALIFICATION STATEMENT. ❑ 6. Fill out the REFERENCES page. [] 7_ Sign the VENDOR DRUG FREE WORKPLACE FORM. ❑ 8. include proof of insurance. 1 [] 9. Submit ONE (1) Original AND TWO (2) Photocopies of your bid, clearl marked with the BID NUMBER AND BID NAME on the outside of the package ❑ 10. Make sure your Bid is submitted PRIOR to the deadline. Late Bids will not t accepted. Failure to provide the requested attachments may result in your bid being deemed non -responsive. THIS SHOULD BE THE FIRST PAGE OF YOUR BID. City of Tamarac a 10 o -:I J BID NO.03-01 B AGRG DISTRIBUTION, LLC Submitted by: DBA PRO SOURCE ONF. Bidder THIS BID IS SUBMITTED TO: City of Tamarac Purchasing and Contracts Manager 7525 Northwest 88t' Avenue Tamarac, Florida 33321 1lurchasmg Division Date10� 1. The undersigned Bidder proposes and agrees, if this bid is accepted, to enter into a contract with the City to perform and furnish all Work as specified herein for the Contract Price and within the Contract Period indicated in this bid. 2. This bid will remain subject to acceptance for sixty (60) days after the day of bid opening.. Bidder will sign and submit the necessary documents required by the City within fifteen (15) days prior to the date of the City's Award. a) Bidder has familiarized itself with the nature and extent of the contract documents, locality, and all local conditions and laws and regulations that in any manner may affect cost, progress, performance or furnishing of the Work. b) Bidder has given the City written notice of all conflicts, errors or discrepancies that it has discovered in the contract documents and the written resolution thereof by the City is acceptable to Bidder. c) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation; Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; Bidder has not solicited or induced any person, firm or corporation to refrain from bidding; and Bidder has not sought by collusion to obtain for itself any advantage over any other Bidder or over the City. 3. Bidder will complete the Work for the prices shown in the "Bid Form". 4. Bidder agrees that the Work will be substantially performed and complete it accordance with the schedules established herein. Cyi sn CD LL. 0 Z U CL 4- C3 (7, 1 nc, ,J(zg Cc Cdl cn C, tro C. (n C C V) :(n W 0 . C 0 0 o 0 0 cn (n 0 (1) cn co :02 M _j m m•to w 0 0 _j 0 0 - C3 CD J M -J 4M -j C,=D, (D C) Q 0 0 cp C) (=) �o 0 (z) C) U) :,CD, U-) in Lf) o N ►cq C) 0 to Lo CD CD 04 co Cf) C14 m wo [on r r -3) ID C,) U) to N 'C", Cl) 4) co om m m co to M m m lu ca m m co n (D 0 .,',M Q. c m (D — Lo CC Lr) LO LO U') U') co CV N. x x x 0 X C) C> X .:"C%4, C%4 Lf "gr C-4 N i'O'7 L [ . c c r - 0 c . C: 0, r-0 'o .2 o co 018 Go- 0 0. 0, CL (9 C(L id. fQ C: (D (DI (D M C13 LUTIJ. io, 0 0 c: 0 co w L 0 0 LL 1 d1 O rq u" C 0 d _ Q Z U � 1 m m W 0 N N 0 c M CA C7 .O C CR N :3 0 O c C:so •n. w ca. bra U) � E E2 2- N U W w- o � O = ,7 -0 CL cr 7 � O � O w M Co vi E cn ai E CO 0, �Ma CD �C. (D0 G a o F— ( U mo CU CU L U as L) "'urchasinp Division BID_ FORM (continued) BID NO. 03-b1 B The City reserves the right to reject any bid, if it deems that a vendor has deliberately provide, erroneous information. The undersigned declare to have specific and legal authorization t obligate their firm to the terms of this bid, and further, that they have examined the Invitation t ecifications,and other documents included in this bi Bid, the instructions to Bidders, the Sp request, and hereby promises and agrees that, if this bid is accepted, they will faithfully fulf nties thereto. The u the terms of this bid together with all guarantees and warraspecific bidding firm further certifies the product and/or equipment meets or exceeds the secific i as stated in the bid package; and also agrees that products and/or equipment to be delivere which fail to meet bid specifications will be rejected by the City within thirty (30) days ! delivery. Return of rejection will be at the expense of the bidder. AGRU bISTRi-BUTION, LLC OBA PRO SOURCE ONE '1 Company Name i�uthor a Signature Address Typed/ rinted Name Ci State, ZI ` r� Telephone & Fax umber ty, Contractor's License Number Federal Tax ID# 0 C�fv o! T&martac Y........_..........._._ __..........._ ��.�_ �__.. _._.—..�._.__. :,'•�:NasinG' 17ivisipr BID FORM (=Hnued) BID NO.03-01 B AGRO DISTRIBUTION. LLC Bidders Name- _ �,t2NE _ TERMS: _% Net days Delivery/completion: � calendar days after receipt of Purchase Order To be considered eligible for award, one (1) original and two (2) codes of this bid fon .' MUST be submitted with the Bid. NOTE: Bid submittals without the manual signature of an authorized agent of the Bidd, shall be deemed non -responsive and ineligible for award. IF "NO Bib" IS OFFERED, PLEASE PROVIDE THE FOLLOWING INFORMATION: Please indicate reason(s) why a Bid Proposal is not being submitted at this tim Return the Bid Form to avoid removal of Bidder from the City of Tamarac's vend listing. a �t �'tlr(:hrsin� Unrivior C:i!y of Tan7#)r8r. -._. BID FORM M (continued) BID NO. 03-OI B AGRO WSTRIBUTION. LLC Bidder's Name_ DBA PRO SOURCE ONE Variations: The Bidder shall identify all variations and exceptions taken to the instructions to Bidders, the Special Conditions and any Technical Specifications in the space provided below; provided however, that such variations are not expressly prohibited in the bid documents. For eaci variation listed, reference the applicable section of the bid document. If no variations are lister here, it is understood that the Bidder's Proposal fully complies with all terms and conditions. is further understood that such variations may be cause for determining that the Bid Propos,- is non -responsive and ineligible for award: Section _A(Ne Variance Section ` ' Variance r Sections, N% E. Variance �. r Variance Section r Attach additional sheets if necessary. City of Tamarac" —A NON-cOLLUME AFFIDAVIT Pirrc-li tsinq Divisior; i State of Lam- -- SS: County of Y^ being first duly sworn, deposes and says that: i 1. He/she is the Y�`�.��r -� f ' ,Owner, Partner, Officer, Representative or Agent) of r, c Offeror that has submitted the attached Proposal; 2. He/she is fully informed respecting the preparation and contents of the attache Proposal and of all pertinent circumstances respecting such Proposal; 3. Such Proposal is genuine and is not a collusive or sham Proposal; 4. Neither the said Offeror nor any of its officers, partners, owners, agent representatives, employees or parties in interest, including this affiant, have in at way colluded, conspired, connived or agreed, directly or indirectly, with any oth Offeror, firm, or person to submit a collusive or sham Proposal in, connection with ti Work for which the attached Proposal has been submitted; or to refrain from bidding connection with such Work; or have in any manner, directly or indirectly, sought agreement or collusion, or communication, or conference with any Offeror, firm, person to fix the price or prices in the attached Proposal or of any other Offeror, or fix any overhead, profit, or cost elements of the Proposal price or the Proposal price any other Offeror, or to secure through any collusion, conspiracy, connivance, unlawful agreement any advantage against (Recipient), or any person interested the proposed Work; 5. The price or prices quoted in the attached Proposal are fair and proper and are r ' tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part l the Offeror or any other of its agents, representatives, owners, employees or parties interest, including this affiant. Signed s Mo and delivered in the presence of: L / W itncs5 Witness/ i Printe Name r Title ' r'(!rijlviSiV� Tamarac �ify of ... , �.......-...�.__....................._.._._.-_.r...�..._.....-.� ACKNOWLEDGMENT NON -COLLUSIVE AFFIDAVIT State of Florida `. County of On this the day of 2002, before me, th undersigned Notary Public of the State of Florida, personally appeared: and (Name(s) of individual(s) who appeared before notary) whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledc "1 that he/she/they executed it. WITNESS my hand and official seal. NOTARY PUBLIC, STATE OF FLORID, NOTARY PUBLIC SEAL OF OFFICE: (Name of Notary Public: Prin Stamp, or Type as Commissioner ❑ Personally known to me, ❑ Produced identificatio (Type of Identification Produce .1 ❑ DID take an oath, ❑ DID NOT take an o; r.)urchastng Dwislol (,it l of 7 arr►ww. ..__ ,_„........_._...._....._ � �....___ �.._ .... _.,...... ...._._._._._.....,..� CERTIFICATION THIS DOCUMENT MUST BE SUBMITTED WITH THE BID. We (1), the undersigned, hereby agree to furnish the item(s)/service(s) described in th, Invitation to Bid. We (1) certify that we(I) have read the entire document, including th Specifications, Additional Requirements, Supplemental Attachments, Instructions to Bidder., Terms and Conditions, and any addenda issued. We agree to comply with all of th requirements of the entire Invitation To Bid. . I Indicate which type of organization below: INDIVIDUAL ❑ PARTNERSHIP ❑ If "Other", Explain: I ll t' -Authorized Sign ture Title ACxRO MSTRIBV'r'`"`. D,BA FRO SOU ktL Company Name f City/-9tate/Zip Cant ct erson CORPORATION OTHER Nam (Printed Or Typed) Federal Employer I. /Social Security Address Telephone C42>LA M (f� l._...._ Fax Number Pwchdsina Diyisic)r (Ay or Tarr'jara,- � _�....1 e" --I'------ - BIDDER'S QUALIFICATION STATEMENT The undersigned certifies under oath the truth and correctness of ail statements and of all answers to questions made hereinafter: SUBMITTED TO: City of Tamarac Purchasing & Contracts Manager 7525 NW 88`" Avenue Tamarac, Florida 33321.2401 CHECK QN Corporation ❑ Partnership DAaq� jy1�8A,Vgture ❑ Other SUBMITTED BY (Company Name) DBA PRO SoURCE ONE ADDRESS:ti - --_ CITY, STATE ZIP: 'ML` 1. State the true, exact, correct and complete name of the partnership, corporatioi trade or fictitious name under which you do business and the address of the place business: AGRQ DISTRIBUTION, LLC Correct Name of Bidder DBA pRO sOURCE ONCE Principal address of Businesr City, State Zip 2. If Offeror is a corporation, answer the following: a. Date of Incorporation b. State of Incorporation C. Presidents name d. Vice President's name e. Secretary's name: f. Treasurer's name g. Name and address of Resident Agent 3. If Offeror is an Individual or a Partnership, answer the following: Date of Organization Name, address and ownership units of all partners (if necessary, use separate sheet) NAME ADDRESS OWNERSHIP UN City of 7S7!28 l4C PurcbastnL PIn11Sio State whether general or limited partnership 4. If offer is other than an individual, corporation or partnership, describe th organization and give the name and address of principals: NAME ADDRESS i I 5. If Offeror i operating and a fictitious name, submit evidence of compliance with the Florida Fictitio ame Statute. 6. How many y W rs has your organization been in business under its present name? a. Under what former names has your organization operated? 7. Indicate registration, license numbers or certificate numbers for the businesses professions that are the subject of the Bid. Please attach certificate of competen and/or state registration. 8. Have you ever failed to complete any work awarded to you? If so, state when, where and why: 9. State the names, telephone numbers and last known addresses of three (3) owne individuals or representatives of owners with the most knowledge of work that y have performed or goods you have provided (government owners are preferred references): NAME ADDRESS PHONE , 10 of Tamarac List the pertinent experience of the key individuals of your organization (continue on insert sheet, if necessary). l�r+�isic�: 11. State the name of the individual a will have personal supervision of the work: THE BIDDER ACKNOWLEDGES AND UNDERSTANDS THAT THE INFORMATION CONTAINED I' RESPONSE TO THIS QUALIFICATIONS STATEMENT SHALL BE RELIED UPON BY THE OWNER I AWARDING THE CONTRACT AND SUCH INFORMATION IS WARRANTED BY BIDDER TO BE TRUE THE DISCOVERY OF ANY OMISSION OR MISSTATEMENT THAT MATERIALLY AFFECTS TH ' BIDDER'S QUALIFICATIONS TO PERFORM UNDER THE CONTRACT SHALL CAUSE THE OWNER T, 3 REJECT THE PROPOSAL, AND IF AFTER THE AWARD, TO CANCEL AND TE INATE THE AWAR AND/OR CONTRACT. /17`o {— ; (Sian lure) ACKNOWLEDGEMENT BIDDER'S QUALIFICATION STATEMENT State of Florida County of%,!'c?X�c' On this the day of , 2002, before me, the undersigned Notary Public of the State of Florida, personally appeared and (Name(s) of individual(s) who appeared before notary) whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. NOTARY PUBLIC SEAL OF OFFICE: NOTARY PUBLIC, STATE OF FLORID, (Name of Notary Public: Prin Stamp, or Type as Commissioner 0 Personally known to me, c 0 Produced identificatiol (Type of Identification Produce( ❑ DID 1 .,4 c: c,<ath, ar ❑ DID fJr T ltak(_l ar, o.- Purchasino Jrtosif)i ciev of Tarnaror REFERENCES Please list name of government agency or private firm(s) with whom you have done busines within the Dast five vears: Your Company Name Address City State Zip Phone/Fax Agency/Firm Name' Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name. Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City state Zip Phone/Fax Contact Name IkC R0 DISTRIBUTION, LI-C DBA PRO sOURCE ORE el.'.. vs\ LLC) City 0, forilar3CF,�c }��3slr)r Dlt�isi 7 1 ti VENDOR DRUG -FREE WORKPLACE Preference may be given to vendors submitting a certification with their bid/proposal certifyin they have a drug -free workplace in accordance with Section 287.087, Florida Statutes. Thi i requirement affects all public entities of the State and becomes effective January 1, 1991. Th special condition is as follows: IDENTICAL TIE BIDS - Preference may be given to businesses with drug -free workplac programs. Whenever two or more bids that are equal with respect to price, quality, and servit are received by the State or by any political subdivision for the procurement of commodities contractual services, a bid received from •a business that certifies that it has implemented drug -free workplace program shall be given preference in the award process. EstablishE procedures for processing tie bids will be followed if none of the tied vendors have a drug-frE .. workplace program. In order to have a drug -free workplace program, a business shall: 1. Publish a statement notifying employees that the unlawful manufacture, distributio dispensing, possession, or use of a controlled substance is prohibited in tl• workplace and specifying the actions that will be taken against employees f, violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the businesE policy of maintaining a drug -free workplace, any available drug counselin rehabilitation, and employee assistance programs, and the penalties that may I imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual service that are under bid a copy of the statement specified in subsection (1). 4. In -the statement specified in subsection (1), notify the employees that, as condition of working on the commodities or contractual services that are under bi the employee will abide by the terms of the statement and will notify the employer any conviction of, or plea of guilty or nolo contendere to, any violation of chapter 8' or of any controlled substance law of the United States or any state, for a violatii { occurring in the workplace no later that five (5) days after each conviction. 5. Impose a section on, or require the satisfactory participation in a drug abu assistance or rehabilitation program if such is available in the ernployet community, by any employee who is so convicted. 5. Make a good faith effort to continue to maintain a drug -free workplace throu implementation of this section. As the person authorized to sign the stateren certify that t '� form complies fully with the above requirements. AGRO DISTRIBUTION, LL C Autho ized Signature Company Name COMPANY NAME: (Please Print):-1 L(-c- Phones': L-,14 L2 BEFORE SUBMITTING YOUR BID, MAKE SURE YOU... El 1. Carefully read the General Terms & Conditions, Special Conditions and th General Requirements. E] 2. Carefully read the Detailed Specifications, and then grol2erly fill out the BI FORMS. 73. Fill out and sign the NON -COLLUSIVE AFFIDAVIT and have it properly notarize 4. Sign the CERTIFICATION page. Failure to do so will result in your Bid beir deemed non -responsive. E] 5. Fill out the BIDDERS QUALIFICATION STATEMENT, 116. Fill out the REFERENCES page. E] 7. Sign the VENDOR DRUG FREE WORKPLACE FORM. 8. include proof of insurance. 9. Submit ONE (1) Original AND TWO (2) Photocopies of your bid, cleat marked with the BID NUMBER AND BID NAME on the outside of the packaG E] 10, Make sure your Bid is submitted PRIOR to the deadline. Late Bids will not I accepted. Failure to provide the requested attachnie, tits may result in your bid being deemed non -responsive. THIS SHOULD BE THE FIRST PAGE OF YOUR BID. 7_1 71 0 sir.= ... .,.... ;�.•;,+. BID FORM BID NO. 03-01 B Submitted by: i 9..i �A r . i:: p:` .. r �. �...,-..... Date Bidder THIS BID IS SUBMITTED TO: City of Tamarac Purchasing and Contracts Manager 7525 Northwest 881h Avenue Tamarac, Florida 33321 i , The undersigned Bidder proposes and agrees, if this bid is accepted, to enter intc contract with the City to perform and furnish all Work as specified herein for tl Contract Price and within the Contract Period indicated in this bid. 2. This bid will remain subject to acceptance for sixty (60) days after the day of t opening. Bidder will sign and submit the necessary documents required by the C within fifteen (15) days prior to the date of the City's Award. a) Bidder has familiarized itself with the nature and extent of the contract documents, locality, and all local conditions and laws and regulations that it any manner may affect cost, progress, performance or furnishing of the Wo b) Bidder has given the City written notice of all conflicts, errors or discrepanci that it has aiscovered in the contract documents and the written resolution thereof by the City is acceptable to Bidder. c) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation; Bidder has not directly or indirectly induced or solicited any otl- Bidder to submit a false or sham Bic]; Bidder has not, solicited or induced a[ person, firm or corporation to refrain from bidding: and Bidder has not sous by collusion to obtain for itself any advantage over any other Bidder or oveI the City. 3. Bidder will complete the Work 'far the prices shown in the "Bid Form". 41 Bidder agrees that the Work will be substantially performed and completr accordance with the schedules established herein. Lo 0 Z.0 Al 6 CJ K 4 A. 41! 'a r r:~; W r_ U) 2 0=w-jMoo(,3 J 0 CO-j 0C31 C> C) LO C) LO C) Q LO N CV) 0) U) r1p, cc Lq J 0 04 x LO CN 0 M (L 0 V) W (1) 0 U) c a c 0 c 0 a 0 0 0 a 0 0 U) C-) in 0 M C) 0 0 C) C%4 C) a 0 a U) LO CD 0) ul U) (n U) U) a cn USN? m a) C13 (D j6 m a- , w M (D Co (D m m kq 0 :3 m LO C7 In U-) im U') 4") -j 0 —j C) x Na x x x x -J C) X N x " x LO LO C'4 'tt t V CN qd* CN CN U) 'W N (14 c C 0 0 m c 0 0 0 0 c 0 0 0 0 0 'ra m cu :5 to Ol rx :L m :3 -5 0 CF) — (7) — I or UJ 75 2 U) U) cc -05 ol _0 r- _0 1 --I 0) a) '2 E: r 0 Y M z a (D C c I - i •� � W 4 Cl) inLLC m 1 ■ k a mm .:fli "a" O �0•.:.M ,� N•.IC1 .E W. as is C7 N. 0 Q O O .Vi ;W::::.: � CD N �- 5DI of 0 I C I L r• co N .[ % 0 v...• �fCD 1 I i U) 0 v. IMCO0C -i. tTJ U CL U O � N C rn P W G N C C N c G N C (n 0 a-+ qNj 0 0 0 O D 0I O 0 L c.1 i a a � al� Cj -Ory- q.-= j In 0 a c Q) d 0� 0 N > N M (� t- r (D r 1,- U) 1- ? f I 11] O N U -0 tv UI cr - �] (on it f I IU, �. U - -_ .0 O (D Iro is is q) i 0I f O1fJ..iri u7 a UIa cn p) afl1 c X X C7 XI0 "Cf �00 � �= N N ct N Eye CO OS C _ Cl O j 0! U o} L' n.. :OD a_ , o_ (D a �, a -ja�') m ai •. 0 0 (� v i i I C! r)�Y j I vI� N hll ' U cu JI _ IZ�°I 1 � � m m; O% � � -7- c C BID FORM (continued) i E I E I I 1 r BID NO, 03-01 B The City reserves the right to reject any bid, if it deems that a vendor has deliberately provic erroneous information. The undersigned declare to have specific and legal authorizatior obligate their firm to the terms of this bid, and further, that they have examined the Invitatior Bid, the instructions to Bidders, the Specifications, and other documents included in this request, and hereby promises and agrees that, if this bid is accepted, they will faithfully fu the terms of this bid together with all guarantees and warranties thereto. The undersigr bidding firm further certifies the product and/or equipment meets or exceeds the specificat as stated in the bid package; and also agrees that products and/or equipment to be deliver which fail to meet bid specifications will be rejected by the City within thirty (30) days delivery. Return of rejection will be at the expense of the bidder_ Company Name Address Authorized Signature Typed/Prints d Name f....,� �6',3,L� ,r_._��-•I ]-'! l�-�R.L=._....._...�!c���y.�.~11,K_. � �,�Y%r..i�� `�w•-,��+"'1--""�m—+—=•�....�.��� �Jfy,�}""��)�e:�i City, State, ZIP Telephone & Fax Number Contractor's License Number Federal Tax ID# BID FORM (continued) BID NO. 03-0113 Bidders Name:'`' TERMS: _% Net ZC . days Delivery/completion: calendar days after receipt of Purchase Order To be considered eligible for award, one (1) original and two (2) copies of this bid for MUST be submitted with the Bid. NOTE: Bid submittals without the manual signature of an authorized agent of the B& shall be deemed non -responsive and ineligible for award. IF "NO BID" IS OFFERED, PLEASE PROVIDE THE FOLLOWING INFORMATION: Please indicate reason(s) why a Bid Proposal is not being submitted at this tirt Return the Bid Form to avoid removal of Bidder from the City of Tamarac's vend listing. r BID FORM (continued) BID NO. 03-01 B Bidder's Name: Variations: The Bidder shall identify all variations and exceptions taken to the Instructions to Bidders, th Special Conditions and any Technical Specifications in the space provided below; provide( however, that such variations are not expressly prohibited in the bid documents. For eac variation listed, reference the applicable section of the bid document. If no variations are lists here, it is understood that the Bidder's Proposal fully complies with all terms and conditions. is further understood that such variations may be cause For determining that the Bid Propos, is non -responsive and ineligible for award: Section / d Variance Section _...._... Section Section Variance Variance Variance Attach additional sheets if necessary. ...... ....... . ....... . ........ I NON -COLLUSIVE AFFIDAVIT State of SS: County of being first duly sworn, deposes and says that: 1 He/she is the (Owner, Partner, the Officer, Representativebi Agent) of Offeror that has submitted the attached Proposal; 2. He/she is fully informed respecting the preparation and contents of the attach4 Proposal and of all pertinent circumstances respecting such Proposal, 3. such Proposal is genuine and is not a collusive or sham Proposal; 4. Neither the said Offeror nor any of its officers, partners, owners, agen representatives, employees or parties in interest, including this affiant, have in a way colluded, conspired, connived or agreed, directly or indirectly, with any ott Offeror, firm, or person to submit a collusive or sham Proposal in connection with t Work for which the attached Proposal has been submitted; or to refrain from biddinc connection with such Work; or have in any manner, directly or indirectly, sought agreement or collusion, or communication, or conference with any Offeror, firm, person to fix the price or prices in the attached Proposal or of any other Offeror, or fix any overhead, profit, or cost elements of the Proposal price or the Proposal price any other Offeror, or to secure through any collusion, conspiracy, connivance, unlawful agreement any advantage, against (Recipient), or any person intereste( the proposed Work; 5. The price or prices quoted in the attached Proposal ;)re fair and proper and are tainted by any collusion, conspiracy, connivance, or 1.11llaWfUl agreement on the pat the Offeror or any other of its agents, representatives, owners, employees or partie interest., including this affian t. Signe seail?d and delivered in the presence of: By Witne Witness Printed Name Title I + L IF ACKNOWLEDGMENT NON -COLLUSIVE AFFIDAVIT State of Florida r�(( County of _ �.�C 1 ter L L ,_ ._ w On this the day of -�A-•� rr 2002, before me, tf undersigned Notary Public of the State of Florida, personally appeared: µ^, y ! ►,,, ;y and (Name(s) of individual(s) who appeared before notary) whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowled, that he/she/they executed it. r WITNESS my hand and official seal. �-#— NOT PUBLIC, S TE OF FLORID R NOTARY PUBLIC y, I t A�GYr'[':?F SEAL OF OFFICE: ""^�-,w::cmaisinu: zr�7ztx_.i- �;�4. �,...-��,.Y ' A = � a`"'` �'' " (Name of Notary Public: Prir ~ X3carxni liana moulu"'`6wi%CA, ' Stamp, or Type as Commissione ❑ Per ally known to me, _ Produced identificatic (Type of Identification Produce 9DID take an oath DID NOT take an o CERTIFICATION THIS DOCUMENT MUST RE SUBMITTED WITH THE BID. We (1), the undersigned, hereby agree to furnish the item(s)/service(s) described in & Invitation to Bid. We (1) certify that we(1) have read the entire document, including & Specifications, Additional Requirements, Supplemental Attachments, Instructions to Bidder Terms and Conditions, and any addenda issued. We agree to comply with all of tt requirements of the entire Invitation To Bid. t Indicate which type of organization below: t INDIVIDUAL ❑ PARTNERSHIP ❑ CORPORATION ❑ OTHER �c If "Other", Explain: (^ -Name /ith rized Signature (Printed Or Typed) ^�-fir „s_._.- r,�,�� s_°_�:�: : �,—�. �� _...............�.__.......__._ � �:�� •�- .•._�. ...J....._....-_�_.-.__ ...... _. _. ..... Federal Employer I.D./Social Security Title kA.- 1. _. 1 Company Name Address City/State/Zip Telephone j)J�/�y i r F F,.....L`LI...A./•7......�T"'---•—..-:,......`.�...Aw..�.-`��.....5...: (J ...��, r-- M1', �' W it-•µ ...�" • ^- '•-+. I--S.w �r✓�'�:..... •..J .. .............._E•.k1.a.� ......._...—.r,..---... f Contact Person Fax Number ,•.,,., n i,.�Y:1 r...,rr,�f�;i�ar�r •.�j:,r.�;rr, BIDDER'S QUALIFICATION STATEMENT The Undersigned certifies under oath the truth and correctness of all statements and of all answers to questions made hereinafter: SUBMITTED TO: City of Tamarac Purchasing & Contracts Manager 7525 NW 88th Avenue Tamarac, Florida 33321-2401 CHECK ONE: ❑Corporation E] Partnership ❑ Individual ©.Joint Venture ❑ Other SUBMITTED BY (Company Name) ]j� 14 j.,Cjf �• _ ADDRESS: �'r i - +�. L Viz` � _ CITY, STATE ZIP:,��w 1. State the true, exact, correct and complete name of the partnership, corporatio trade or fictitious name tinder which you do business and the address of the place lousiness: Correct Name of Bidder Principal address of Business City, State Zip wL, ix.. x4,� 2. If Offeror is a corporation, answer the following: a. Date of Incorporation__. b. State of Incorporation C. President's name -- _ d. Vice President's name -- _.... _..._...� e. Secretary's name: - �w- f. Treasurer's name g. Name and address of Resident Agent 3. If Offeror is an Individual or a Partnership, answer the following: Date of Organization Name, address and ownership units of all partners (if necessary, use separate sheet) NAME ADDRESS OWNERSHIP UN r . ' i%i i i F' .. ���`�.,.� .. _.._.......... ....._�._..., .... ... ....... ........... .... .... I ........... . .+rr f1 State whether general or limited partnership._ __.. 4. If offer is other than an individual, corporation or partnership, describe th organization and give the name and address of principals: NAME ADDRESS ` �^ � ..,.g .y.. r�+.r 7.i „�,�k ._�.....-r��w rP t •• 7 -_� r • _...rt�.'.=t! r' M _ �.a t 't�['�.. 5. YIf Offeror is operating under a fictitious name, submit evidence of compliance with the Florida Fictitious Name Statute. 6. How many ypars has your organization been in business under its present name? 'mow a. Under what former names has your organization operated? Indicate registration, license numbers or certificate numbers for the businesses professions that are the subject of the Bid. Please attach certificate of competen and/or state registration. 70'p ` YR ..3. t p � � t . _\ �r• ��-r.. s 8- Have you ever failed to complete any work awarded to you'? If so, state when, where and why: g. State the names, telephone numbers and Iast. known addresses of three (3) own( individuals or represeniatives of owners with the most knowledge of work that) have performed or goods you have provided (governMent owners are preferred references): NAME ADDRESS PHONE _.._ . .. _!-' ....._... _.............-_..____ _.... •-- .: •_X _ . � ;. � , � ,. Imo_ `...f .. .: - ..... % .. .F.. ••ter.^ Y+� i"-; - 1�, 10 List the pertinent experience of the key individuals of your organization (continue on insert sheet, if necessary). -,�.iw�...�L.�'; �_..._.�.:.:..�.: 1•:_�"s. �1,.. i'....� 1...,..,,.�=+ii.. �. S.. .E'.�_�-_ ;.. �.�...f«.��t.::.1�5.1: ��•..' I 11. State the name of the individual who will have personal supervision of the work: THE BIDDER ACKNOWLEOGE'S AND UNDERSTANDS THAT THE INFORMATION CONTAINED I RESPONSE TO THIS QUALIFICATIONS STATEMENT SHALL BE BELIED UPON BY THE OWNER I AWARDING THE CONTRACT AND SUCH INFORMATION IS WARRANTED BY BIDDER TO BE TRUE THE DISCOVERY OF ANY OMISSION OR MISSTATEMENT THAT MATERIALLY AFFECTS TH BIDDER'S QUALIFICATIONS TO PERFORM UNDER THE CONTRACT SHALL CAUSE THE OWNER T REJECT THE PROPOSAL, AND IF AFTER THE AWARD, TO CANCEL AND TERMINATE THE AWAR AND/OR CONTRACT. ' Si Sri tureh��`:. - -. j( , ACKNOWLEDGEMENT BIDDER'S QUALIFICATION STATEMENT State of Florida . County of On this the day of 2002, before me, the undersigned Notary Public of the State of Florida, per ovally appeared ;., ti ;i;,. and (Name(s) of individuai(s) who appeared before notary) whose name(s) is/are Subscribed to within the instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal.r-- NOTY PUBLIC, S A E OF FLORID NOTARY PUBLIC ,,. YP;;r,, :i xbet-t W. Howard SEAL OF OFFICE: =?r=t.�m�oui�sionalEM?CM w��ia 13x�iiz: J1ixU' Zc1<7a •... :��, �.� �!«>r��•rnri, (Name of Notary Public: Prin ���ei eeiiii`"��.L•4L1!ri: Exy:++�iiAr, i:u, ��. ' Stamp, or Type as Commissioner G Personally known to me, c G-'roduced identificatior (Type of Identification Producer 2 DID take an oath, or 0 DID NOT take an oe .... ......... REFERENCES Please list name of government agency or private firm(s) with whom you have done businE within the past five years: Your Company Name Address City State Zip Phone/Fax Agency/Firm Name Address City state Zip Phone/Fax Contact Name Agency/Firm Name Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name: Address City State Zip Phone/Fax Contact Name Agency/Firm Name Address City State Zip Phone/Fax Contact Name z (on Z --Z -7 2L