HomeMy WebLinkAboutSoutheastern - City of Sunny Islse RTQ 22-12-01 Signed FormsDELIVER TO: REQUEST TO QUALIFY
City of Sunny Isles Beach SECTION 6
City Clerk BID SUBMITTAL FORMS
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
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Of sup
OPENING: 2:30 P.M.
Monday, January 9, 2023
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
12/8/2022 Pages 31+
Sealed bids are subject to the Terms and Conditions of this Request to Qualify 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.
RTQ 22-12-01
Citywide Printing Services
A Bid Deposit in the amount of 0% of the total amount of the bid shall accompany all bids
A Performance Bond in the amount of 0% 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
Procurement Manager. Firm Name:
Genesis Cuevas
Commodity Code(s): T9 UT1I CAS M?A) PKIIV HANG Cd/ ?"l -'/V C.
RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS
FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON-RESPONSIVE
City of Sunny Isles Beach I Request to Qualify No. 22-12-01 11
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
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: Jt �-r#EAJ767�1 Pk/V TI, 6&AArANyi 27iv6.
AUTHORIZED SIGNATURE:
TITLE OF OFFICER: Cv ry Tib I oL L E2
:123
City of Sunny Isles Beach I Request to Qualify No. 22-12-01
R� —7 6" ' soy'
BID SUBMITTAL FORM
Bid Title: Citywide Printing Services
L?�"Y op SU0 P3'=
The undersigned Vendor proposes and agrees, if this submittal 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 resulting purchase order or work order for the Contract Price and within the Contract Time indicated
in this Submittal and in accordance with the other terms and conditions of the Contract Documents.
The Vendors accepts all of the terms and conditions of the Advertisement or Request to Qualify and Instructions to
Vendors. This Submittal will remain subject to acceptance for 90 days after the day of Bid opening. The Vendor
agrees to sign and submit the Agreement with the 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 Vendor represents, as more fully set forth in the Agreement, that:
■ The Vendor 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 furnishing of the Work.
■ The Vendor has studied carefully all specifications and requirements.
■ The Vendor 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 Vendor.
■ 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 Vendor has not directly or indirectly
induced or solicited any other Vendors to submit a false or sham Bid; the Vendor has not
solicited or induced any person, firm or corporation to refrain from Bidding; and Vendor
has not sought by collusion to obtain for itself any advantage over any other Vendors or
over the City.
The City and the successful Vendor will establish completion times for each individual Work Item and the successful
Vendor 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 to Qualify No. 22-12-01 —ell
` "Y Jp SVV4 Pte,_
Firm Name:
5 wrf ER. TW� j Pl? I NTIuG (XK-PA ' zNC.
Street Address:
950 S� Fl,ST)rEE T H/ALEA H3-70/0Mailing Address (if different):
Telephone No. J QS & — J ?07 Fax No. 3u 5 ^ Sff IQ903
Email Address: FEIN W n"1 FEIN No. JS-� 7b?/_ _ /
*'By signing this document the vendor agrees to all Terms
Signature:
(Signature/6f
authorized agentt)
Print Name:0(JG r - w
r9w
Title: CO N 12 v L L El�
THE EXECUTION OF THIS FORM CONSTITUTESTHE UNEQUIVOCAL OFFER OF VENDOR TO BE BOUND BYTHE TERMS
OF ITS SUBMITTAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED
REPRESENTATIVE SHALL RENDER THE SUBMITTAL NON-RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS SOLE
DISCRETION, ACCEPT ANY SUBMITTALTHAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS
THE VENDOR TO THE TERMS OF ITS OFFER.
City of Sunny Isles Beach I Request to Qualify No. 22-12-01 it,
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AFFIDAVITS
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City of Sunny Isles Beach I Request to Qualify No. 22-12-01 •
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_ City of Sunny Isles Beach
y` 18070 Collins Avenue
Sunny Isles Beach, FL 33160
a€ su" Telephone: (305) 947-0606 Fax: (305) 949-3113
STATE OF FLORIDA((� rr )
COUNTY OF PAC)` 1
The undersigned being first duly sworn as provided by law, deposes, and says:
This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be
relied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid.
The undersigned is authorized to make this Affidavit on behalf of,
S t) rr j4C-7ASfiERN /�?1*rrAyl (OM PPI ff/ �.�.
(Name of Corporation, Partnership, Individual, etc.)
a, COMMU-QUPL WIN VG formed under the laws of Fwilel bk
(Type of Business) (State)
of which he is V „' AA � D fi?
(Sole Owner, Partner, President, etc.)
Neither the undersigned nor any person, firm, or corporation named above nor anyone else to the knowledge of the undersigned, have
themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or
employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein.
This Bid is genuine and not collusive or a sham; the person, firm or corporation named above has not colluded, conspired, connived or agreed
directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall
refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with
any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids
described above true; and further; neither the undersigned, nor the person, firm or corporation named above has directly or indirectly
submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent
thereof.
Oa 52 ►- CPLVO-HOU CO NTO LI- ea
AFFIANT'S NAME AFFIANT'S TITLE
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this day of U /TN V' I tt 20 23
Personally Known " or Produced Identification
Type of identification
(Affix seal here)
IN MR Rodger A. Heckman
Notary Public
3 State of Florida
a Comm# HH066017
t �e Expires 11/22/2024
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NOTA PUBLIC (name printed or typed)
1 of 8
Ot4t4y
PUBLIC ENTITY CRIMES
;M
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
0; sus ' Telephone: (305) 947-0606 Fax: (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.133(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.
This sworn statement is submitted to City of Sunny Isles Beach
by RO )36 -#?r CiR w r)4ou CO QU T R� LLER
J°print individual'sr name and
for
�
[print name of entity submitting sworn statement]
whose business address is:
9SO S F 3T H S k E'"G T, }� 1�1 L�jK N , FL 3319 /D
and (if applicable) its Federal Employer Identification/number (FEIN) is 6S d 71 q
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: )
2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), 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.
I 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.
I 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
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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.
5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
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.
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 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, E N THE�INF MATION CONTAINED IN THIS FORM.
By:
(Sig
�f1ej L� U/THa K/
(Print CC))d
(Title)
Sworn to and subscribed before me this 6 day of , TML NKK/ , 20 2-3, by
(AFFIX NOTARY STAMP HERE)
��Nt Rodgerk Heckman Signature: Notary Public — State of Florida
se Notary Public
t oStateofFlorida Print or Type Commissioned Name
�: N 18r Comm# HH066017
Perso �IFy KX46*Rs 11/24 OR Produced Identification
Type of Identification Produced
EQUAL OPPORTUNITY /
AFFIRMATIVE ACTION
City of Sunny Isles Beach
I Sill. hats 18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 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: CDiNff20 ILL ER
Firm: 30THFASTWN PK+ )t1TIP6 (bMPAn1y, 1IC,
Address: 7SO SE N, .-rEE —7
P/ALEPM, FL 33000
4 of 8
a4s�N�.YYfs<F�� CONFLICT OF INTEREST
n City of Sunny Isles Beach
*t
`= 18070 Collins Avenue
1 * Sunny Isles each, FL 33160
f.Pk 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 � a� ECOUNTY OF
BEFORE ME, the undersigned authority, personally appeared ) ` v g�/`Lr ` hy/rH o "
l.
who was duly sworn, deposes, and states:
1. 1 am the C-0 N7 1?6 LLE -/Z of,360 Ett-7ERN PRS N7-AJ6 (_aAnPPtNV1al
--rkC-
office in /1/�I i� M ( A E and principal office
in
2. The above named entity is subm tting a Bid for the ity o Sunny Isles Beach, Bid No. 2z / 2 'a)
described as C i 77y 0111) F p�►/ 7 -/Nei V%LES The Affiant has made diligent
inquiry and provides the information contained in this Affidavit based upon his own knowledge.
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.
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.
5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise
ineligible from participation in contract letting by any local, State, or Federal Agency.
6. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of
interest due to any other clients, contracts, or property interests for this project.
7. 1 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.
8. 1 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.
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.
Dated this day of -J-AP UARy 202-3
�/wTHU N, U ti 7f?d LL
AFFIAQIT v v� " Print or Type Name and Title
Sworn to and subscribed before me this day of JA ti 64 RAY_ 2023.
Personally Known, OR
❑ Produced Identification -Type of Identification
_.►ar.. RodgerA.an
NOTARY PUBLIC STATE OF FLORIDA Xla; "
Notary Public
Comm# HH066017
5 of 8 S�NQE 19�e Expires 11/22/2024
DISPUTE DISCLOSURE
!.` City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
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.
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
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
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.
30u1^14 fA�'T�" N ORI ING CoMPAUY1 1lV(-• x/23
Firm Date
Author- ` d Signature Print or Type Name and Title
31=
C,} of SUO Ptk4
STATE OF FLORIDA )
COUNTY OF )
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:i7zzl—
I
Title: UkTgU LLL�2
The foregoing instrument was acknowledged before me this (O day of
aN O WY 20 23 , by kcher"t Cai-�A-hcn [name
of person], as ( C",rr, acv- [type of authority], for
�s4-,) Pr,, -) -ft r,ci Co.,T'r)(., [name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
,jW Rodger A. Heckman
o� Notary Public
=State of Florida
`? Commp HH066017
r'NCE I Expires 11/22/2024
Al .
4a
Notary Public — State of Florida
RC)dger Aa Hec l�--Irnctn
Print or Type Commissioned Name
Personally Known OR Produced Identification
Type of Identification Produced
7of8
E -Verify Affidavit
Florida Statute 448.095 directs all public employers, including municipal governments, to verify the
employment eligibility of all new public employees through the U.S. Department of Homeland Security's E -
Verify System, and further provides that a public employer may not enter into a contract unless each party
to the contract registers with and uses the E -Verify system.
Florida Statute 448.095 further provides that if a contractor enters into a contract with a subcontractor, the
subcontractor must provide the contractor with an affidavit stating that the subcontractor does not employ,
contract with, or subcontract with an unauthorized alien.
In accordance with Florida Statute 448.095, all contractors doing business with the City of Sunny Isles
Beach are required to verify employee eligibility using the E -Verify system for all existing and new
employees hired by the contractor during the contract term. Further, the contractor must also require and
maintain the statutorily required affidavit of its subcontractors. It is the responsibility of the awarded vendor to
ensure compliance with E -Verify requirements (as applicable). To enroll in E -Verify, employers should visit
the E -Verify website () and follow the
instructions. The contractor must, as usual, retain the 1-9 Forms for inspection.
By affixing your signature below you hereby affirm that you will comply with E -Verify requirements.
SDv�11� � �ST ren WI NT/Oa Cv AAPNJ_y, -rIVC.
Company Na
Uttero"7gnature
RUB&-kT ChWT'th'ON
Print Name
X5`07/7//?
Federal Employer Identification Number (FEIN)
Sworn to and subscribed before me on this this
By � (� iQiAM
A Is personally known to me
// GZ2 3
D tae
CONTROL
OLL�
Title
(0 day of �TN MA ARy _,202_g
❑ Has produced identification (type of identification produced: )
Signature of Notary Public
Rodger A. hackman
Notary Public
z c State of Florida
Comm# HH066017
Print or Stamp of Notary Pubfi'c -- `` Expiration Date
8 of 8