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Solicitation No: <br />Solicitation Tale: <br />2018 -268 -KB <br />FOR CITYWIDE DEMOLITION SERVICES <br />Procurement Contact: <br />Tel; <br />Email: <br />KRISTY RADA <br />305-673-7490 <br />1 KRISTYBADA MIAMIBEACHFL.GOV <br />STATEMENTS OF QUALIFICATIONS CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT <br />Purpose: The purpose of this Response Certification, Questionnaire and Requirements Affidavit Form is to inform <br />prospective Proposals of certain solicitation and contractual requirements, and to collect necessary information from <br />Proposals in order that certain portions of responsiveness, responsibility and other determining factors and <br />compliance with requirements may be evaluated. This Statement of Qualifications Certification, Questionnaire <br />and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and <br />executed. <br />General Proposer Information. <br />FIRM NAME: <br />r �-�•I�i'C•� v.. -4'i"-1 S SIG.rV ��V.0 �� 1 <br />NO. OF YEARS IN BUSINESS: 1 <br />NO. YEARS IN BUSINESS LOCALLY: <br />NO. OF EMPLOYEES: <br />OTHER NAMES) PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: <br />FIRM PRIMARY ADDRESS (HEADQUARTERS): <br />CITY: pc,-� c:lZ <br />STATE: <br />ZIP CODE:�� <br />TELEPHONE NO.: n � q,3 o c+�o g <br />�1 <br />TOLL FREE NO.: <br />FAX NO.: pt `f ` 7T j -f So434 <br />FIRM LOCAL ADDRESS.' <br />l t�'i o -j1, Atrc_ <br />CITY: <br />STATE: 2 <br />ZIP CODE: <br />PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT. <br />ACCOUNT REP TELEPHONE NO.: <br />ACCOUNT REP TOLL FREE NO.: <br />ACCOUNT REP EMAIL: <br />FEDERAL TAX IDENTIFICATION NO.: !! /I <br />The City reserves the right to seek additional information from proposer or other source(s), including but not limited to: any firm or principal <br />information, applicable licensure, resumes of relevant individuals, client information, financial information, or any information the City <br />deems necessary to evaluate the capacity of the proposer to perform in accordance with contract requirements. <br />RFQ 2018 -183 -KB 19 <br />385 <br />