HomeMy WebLinkAboutSE-Affidavits, ". ,, SUN ��•-
DELIVEIR TO. REQUEST FOR PROPOSAL
OXY of Sunny Isles Beach SECTION 6 OPENING: 2:30 P.M.
City Clerk BID SUBMITTAL FORMS Thursday, January 16, 2020
18070 Collins Avenue
Sunny Isles Beach, FL 33160
PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN
CITY OF SUNNY ISLES BEACH, FLORIDA
NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be
less all taxes. Tax Exemption Certificate furnished upon request.
Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of
12/20/2019 Pages 31+
Sealed bids are subject to the Terms and Conditions of this Request for Proposal and the accompanying
Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or
incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the
address shown above until the above stated time and date, and at that time, publicly opened for
furnishing the supplies or services described in the accompanying Bid Submittal Requirement.
RFP 19-12-01
Printing & Mailing of SIB Living Magazine R Newsletter
A Bid Deposit in the amount of M of the total amount of the bid shall accompany all bids
A Performance Bond in the amount of 9-% of the total amount of the bid will be required upon execution
of the contract by the successful bidder and City of Sunny Isles Beach
PrncummentAaent.• Rrm Name:
6enesr's CLevas Sd () N O�S?. GV2N.l
FAILURE TO SIGN PAGE 32 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON-
RESPONSIVE
City of Sunny Isles Beach I Request for Proposal No. 19-12-01
SECTION 6
BID SUBMITTAL FOR:
ACKNOWLEDGEMENT OF ADDENDA
INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES
PART I:
LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION
WITH THIS BID
PART II:
Addendum #1, Dated P*IJ v2 / �- 2.0-Z,61
Addendum #2, Dated
Addendum #3, Dated
Addendum #4, Dated
Addendum #5, Dated
Addendum #6, Dated
Addendum #7, Dated
Addendum #8, Dated
❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
FIRM NAME
SC)U I RCf�57L--2NJ
AUTHORIZED SIGNATURE: \ DATE: 1Z"Z% -(9
TITLE OF OFFICER: I�I�2CC�GI1 S � MW4 ,(C -71k16 -
City of Sunny Isles Beach I Request for Proposal No. 19-12-01
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Firm Name: S007NCA5JL4M
_3601 sC 61y,1E HI HWiwy 'TUnn7 1 r -L 3Ygg 7
Street Address:
Mailing Address (if different):
Telephone No. -772 , Goo 2527 _Fax No, 7 '7 2. Z n- 3 cl U
Email Address: _ C% UC(Aq 0) SeprIAt, COM FEIN No. _j_r1_L /2/1/_Z/_U_U Q
* "By s/gning this document the vendor agrees to all Terms
Signature:
(Signature of authorized agent)
Print Name: 6 0Ij s 6? lra yigu
Title: Q l`tr1`PC Q-
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THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO
BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE
INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL
NON-RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY
PROPOSAL THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE
PROPOSER TO THE TERMS OF ITS OFFER.
City of Sunny Isles Beach I Request for Proposal No, 19-12-010
BID SUBMITTAL FORM
Bid line: Printing St Mailing Services
The undersigned Proposers proposes and agrees, if this proposal Is accepted, to enter Into an agreement
with The City of Sunny Isles Beach in the form included in the Contract Documents to perform and
furnish all Work as specified or indicated In the Contract Documents for the Contract Price and within the
Contract Time indicated in this Bid and in accordance with the other terms and conditions of the Contract
Documents.
The Proposers accepts all of the terms and conditions of the Advertisement or Invitation to Bid and
Instnxtions to Proposers, including without limitation those dealing with the disposition of Bid Security.
This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposers
agrees to sign and submit the Agreement with the Bonds and other documents required by the Bidding
Requirements within ten days after the date of the City's Notice of Award.
In submitting this Bid, the Proposer represents, as more fully set forth In the Agreement, that:
■ The Proposer has familiarized himself/herself with the nature and extent of the
Contract Documents, Work, locality, and all local conditions and Law and
Regulations that in any manner may affect cost, progress, performance, or
fumishing of the Work.
■ The Proposer has studied carefully all specifications and requirements.
• The Proposer has given the City written notice of all conflicts, errors,
discrepancies that it has discovered in the Contract Documents and the written
resolution thereof by City is acceptable to the Proposer.
■ 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;
the Proposer has not directly or indirectly induced or solicited any other
Proposers to submit a false or sham Bid; the Proposer has not solicited or
induced any person, firm or corporation to refrain from Bidding; and Proposer
has not sought by collusion to obtain for Itself any advantage over any other
Proposers or over the City.
The City and the successful Proposer will establish completion times for each Individual Work Item and
the successful Proposer agrees that the work will be completed within the time frames agreed upon and
stipulated in the individual Purchase Orders and/or Notice to Proceed.
City of Sunny Isles Beach I Request for Proposal No. 19-12-01
CR �J�N Y t=til p
PUBLIC ENTITY GRIMES
City of Sunny Isles Beach
es �� 18070 Collins Avenue
c r " F to*"
o* �,Q' Sunny Isles Beach, FL 33160
°s S,N ' Telephone: (305) 947.0606 Fax: (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 257.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
PUBLIC ENTITY CRIMES
Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate
who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a
public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of
real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub -Contractor, or
Consultant under a Contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on
the convicted vendor list".
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
11,1. This sworn statement is submitted to City of Sunnv Isles Beach
bwnm y �EJA2 uname ^1�� (� O ►lRt C1at — COrItS i�4Q N��t nJ a
for S(tU7fl F/'iC-eelry
n name 01 entity suwmimng sworn statement)
whose business address is:
301 SE 01,ME "16HWAV �;7u8jn, PR_ 3ggcl 7
and (if applicable) its Federal Employer Identification number (FEIN) is �--Cr71-7 ( ( q
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: )
11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1xg), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or with the
United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any
public entity or an agency or political subdivision of any other state of the United States and involving
antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trail court of record relating to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere.
11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means:
a.) predecessor or successor of a person convicted of a public entity crime; or
b.) Any entity under the control of any natural person who is active in the management of the entity
and who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executors, partners, shareholders, employees, members, and agents who are active in
the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
DECEMBER28,2010
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Signature:
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Bonded through National Notary Assn,
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market value under an arm's length agreement, shall be a prime facie case that one person
controls another person. A person who knowingly enters into a joint venture with a person who
has been convicted of a public entity crime in Florida during the preceding 36 months shall be
considered an affiliate.
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11.5.
I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
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person or entity organized under the laws of any state or of the United States with the legal power to
enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
`
services let by a public entity, or which otherwise transacts or applies to transact business with a public
-
entity. The term "persons" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of any entity.
11.6.
Based on information and belief, the statement which I have marked below is true in relation to the entity
submitting this sworn statement. (Indicate which statement applies.)
Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the
State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
determined that it was not in the public interest to place the entity submitting this sworn statement on the
convicted vendor list. (Attach a copy of the final order.)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES, FOR CATEGORY TWO OF ANY ANGE IN THE INFORMATION CONTAINED IN THIS FORM.
By:
(Signa ure)
Grl AAL 5 6ETAn4 I
(Printed Name)
�r2rC�on—Crr� "PtnyAE1 rnJo-
(Title) /�
Sworn to and subscribed before me this 20 day of LG�� ��— 20��, by
` \k SUSAN A. DIETER
Notary Public - Stale of Florida
;-t•/•,�� `.`: y
Commission Y GG 18990/
Signature:
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My Comm. Expires May 29, 2022
Bonded through National Notary Assn,
Personally Known OR Produced Identification
O�h)"NY Olt
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EQUAL OPPORTUNITY /
AFFIRMATIVE ACTION
oP°N Mo'`� City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33180
Telephone; (305) 947-0808 Fax: (305) 949-3113
EQUAL OPPORTUNITY/AFFIRMATIVE ACTION STATEMENT
The contractors and all subcontractors hereby agree to a commitment to the principles and
practices of equal opportunity in employment and to comply with the letter and spirit of
federal, state, and local laws and regulations prohibiting discrimination based on race,
color, religion, national region, sex, age, handicap, marital status, and political affiliation or
belief.
Signed:
Title: _ h(PeC-1ca-- EA4+-1 o- HA VV%G11 C -
Address: 301 SE 01 XI'E hIMkJAY
S?0 MI, P�- 3Y`79-7
DECEMBER28,2010
Apo `VNNY rJl�Jp�`
�. CONFLICT OF INTEREST
u Z
City of Sunny Isles Beach
' 18070 Collins Avenue
Sunny Isles Beach, Fl- 33160
$0" •"� Telephone: (305) 947-0606 Fax: (305) 949-3113
CONFLICT OF INTEREST STATEMENT
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must
disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the
City of Sunny Isles Beach or its agencies.
STATE OF FLORIDA
COUNTY OF W,44- -1 f k%
BEFORE ME, the undersigned authority, personally appeared CSA 2LEs G£OMio L, who was duly sworn,
deposes, and states:
18.1. 1 am the AIau-"- -A(p k- mAPy1r`-wG-- of
SOU'7(Ie-&5;-7e7yzr.J with a local office in �7�A2j� o2�DR and principal office in
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described
as: Printing and mailing. The Affiant has made diligent inquiry and provides the information contained in this Affidavit
based upon his own knowledge.
18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has
no financial interest in other entities submitting Bids for the same project.
18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in
any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for
the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and
execution of the Contract for this project.
18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from
participation in contract letting by any local, State, or Federal Agency.
18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any
other clients, contracts, or property interests for this project.
18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
actively seeking an elected position with the City of Sunny Isles Beach.
18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City
of Sunny Isles Beach.
18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will
immediately notify the City of Sunny Isles Beach.
A
Dated this o2q— day of 2112. r- 5040
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AFF I Print or Type
Nname and Title
Swo and ubscribed before me this 1124 day of ,�2C�o✓l'%�P�' 2Q24
f' Personally Known OR
O Produced Identification ; Type of Identification �n A
NOTARY PUBLIC STATE OF FLORIDA
DECEMBER 28,
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SUSAN A. UIEDIETER;}�.,��wf:;•
NotaryPublic- StateofFlorida
Cornmissfon q GG 18990/
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My Comrn. Expires May 29, 2022
DECEMBER 28,
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DISPUTE DISCLOSURE
u� ix
City of Sunny Isles Beach
s 18070 Collins Avenue
F r L o o Sunny Isles Beach, FL 33160
c, SON ' Telephone: (305) 947-0606 Fax: (305) 949-3113
DISPUTE DISCLOSURE FORM
Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please
explain in the space provided, or on a separate sheet attached to this form.
19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the
Department of Professional Regulations or any other regulatory agency or professional associations within the last
five (5) years?
YES NO
19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a
contract or job related to the services your firm provides in the regular course of business within the last five (5)
years?
YES NO
19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests,
or litigation in the past five (5) years that is related to the services your firm provides in the regular course of
business?
YES NO K If yes, state the nature of the request for equitable adjustment, contract
claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the
monetary amounts of extended contract time involved.
I hereby certify that all statements made are true and agree and understand that any misstatement or
misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid
for the City of Sunny Isles Beach.
Sa '7H E ry
Firm
(-
Authorized Signature
DECEMBER28,2010
Q -2-6–(C
Date
COA0 lE'� C PI�l20 1
Print or Type Name and Title
SUNNY /J�6
�� Jsis
" OPCOGy,t
00 'UM
STATE OF FLORIDA
COUNTY OF WSW
1
ANTI -KICKBACK
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
ANTI -KICKBACK AFFIDAVIT
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By:
The foregoing instrument
60CE�" i FVZ_ . 20 (q , by
of person], as 2i&,c-tt2C-1�2;
executed].
AFFIX NOTARY STAMP HERE:
EiSUSAN A, DIETER
NotaryPublic St�rlcufFlorida
(Ommissiona GG 18990/
MyComm.Expires May 29,2022
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Title: 't-MAOOE-110c-
was acknowledged before me this Z G day of
[name
lP---) a-�arK��j�� _ [type of authority], for
[name of party on behalf of whom instrument was
Y
Notary Public — State of Florida
14.
Print or Type Commissioned Name
Personally Known OR Produced Identification
Type of Identification Produced
DECEMBER28,2010
O�+�NNY Ij�FjI
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to
V 'S
oFT o CONTRACTOR ANTI—BOYCOTT CERTIFICATION
[PURSUANT TO FLORIDA STATUTE § 215.47251
I, WaO 6i��(X( , on behalf of SOU M R15-7C--YN ,
Print Name Company Name
certifies that Com' 'U1H 6157(-_VrJ does not:
Company Name
1. Participate in a boycott of Israel; and
2. Is not on the Scrutinized Companies that Boycott Israel list; and
3. Is not on the Scrutinized Companies with Activities in Sudan List; and
4. Is not on the Scrutinized Companies with Activities in the Iran Petroleum
Energy Sector List; and
5. Has not engaged in business operations in Cuba or Syria.
Signature
A aurfi--,:A--(a �-Ww AE_7r00,
Title
_ ( 2 2 -
Date