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HomeMy WebLinkAboutChoice EnvironmentalF E 2 Aoy".-, sunny woo Beam Office Of the city Clerk— DELIVER TO: - L 2011 City of Sunny Isles Beach INVITATION TO BID City Clerk > i .nr I:�es Beacf, SECTION 4 OPENA 'Ei:00yR 18070 Collins Avenue BID SUBMITTAL FORMS February 02, 2011 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 January 05, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid 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. IFB 11 -01 -01 Waste Management 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 Agent: Firm Name: Marcanthony Tulloch Commodity Code(s): 63112, 74502, 74504, 74511, 74514, 74521 • RETURN ONE ORIGINAL AND TWO COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PAGE 23 OF 28 BID No. 11 -01 -01 • ENVIRONMENTAL Table of Contents Chapter 1 Cost Proposal Chapter 2 Acknowledgment of Addenda Chapter 3 Bid Submittal Form Chapter 4 Affidavits a. Non - Collusion Affidavit • b. Public Entity Crimes Affidavit c. Equal Opportunity / Affirmative Action Affidavit d. Conflict of Interest Affidavit e. Dispute Disclosure Form f. Anti - Kickback Affidavit Chapter 5 Licenses Chapter 6 Certificates of Insurance • 2860 State Road 84, Suite 103, Fort Lauderdale, FL 33312 • Tel: 954- 797 -7974 • Fax: 954 - 797 -7984 0 www.choicewaste.com • • • BID FORM SCHEDULED SERVICES # Description Est. Pulls Annually Unit Price Extended Total 1 2 Yard (Recyclables) 104 $ ` $ 2 2 Yard (Trash) 156 $ $ 3 3 2 Yard (Trash) 156 $ $ 4 6 Yard (Recyclables) 104 $ A , Li $ I L+ q q, 6 � 5 4 Yard (Trash) 208 $ 3: $ c, sj 6 2 Yard (Trash) 104 $ a . 9 $1319 ONDEMAND SERVICES # I Description Est. Pulls Annually Unit Price Extended Total 7 20 Yard (Trash) 37 $ tD j . �' C $ q (G 0-20, o 8 2 Yard (Trash) 15 $ ( $ c GRAND TOTAL Lines 1— 8): $ 3 ;�,�c'� *Quantities listed are estimates and are not guarantied and change with out notice PAGE 24 OF 28 BID NO. 11 -01 -01 • SECTION 4 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 Addendum #1, Dated I __a() i I Addendum #2, Dated i— 4 �L-2 c i I Addendum #3, Dated Addendum #4, Dated • Addendum #5, Dated 0 PART II: Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: Ser-oI(es- T- �jC. AUTHORIZED SIGNATURE: DATE: TITLE OF OFFICER: V lid. e c eSI4 ill PAGE 25 OF 28 BID No. 11 -01 -01 N � r � ti }S• y tr •..- �5 =� Addendum No. 1 CITY OF SUNNY ISLES BEACH Waste Management Services CITY RFQ BID NO. 11 -01 -01 To All Bidders: Bidders for the above - referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the Contract Documents shall become a part of and have precedence over anything shown or described otherwise. Please be advised that the Pre -Bid that was scheduled for January 18, 2010 has been cancelled. The Pre -Bid meeting will not be rescheduled. END OF SECTION • x 11 �S.fNY �S�F s S� lx FLOG 5 C,TY OF sutA PNO Addendum No. 2 CITY OF SUNNY ISLES BEACH Waste Management Services CITY RFQ BID NO. 11 -01 -01 11597T.1111111-3081M Bidders for the above - referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the Contract Documents shall become a part of and have precedence over anything shown or described otherwise. ➢ Amendment to Section 3.0, paragraph 3.4 shall be replaced with the following (additions are underlined in red and deletions are 6tr+sken in black); 3.4 RENTAL RATES The bidder shall supply an all inclusive flat monthly rate that will include all labor and materials required to complete the job. The bidder shall take into consideration the items listed bellow in their monthly rental rate and these items shall not be included on the monthly invoice as additional charges to the City; • Mobilization / Trip • Fuel / Environmental Charges • Permits • Equipment • Pick up • Disposal • Administration Fees ➢ Response to Questions: 1) Is there a Bid Security or a Performance Bond with the Bid 11 -01 -01 that has to be submitted? Section 1 of the bid states that there is; yet sections 2 and 3 of the Bid state that there is none. y C\ x S� lx FLOG 5 C,TY OF sutA PNO Addendum No. 2 CITY OF SUNNY ISLES BEACH Waste Management Services CITY RFQ BID NO. 11 -01 -01 11597T.1111111-3081M Bidders for the above - referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the Contract Documents shall become a part of and have precedence over anything shown or described otherwise. ➢ Amendment to Section 3.0, paragraph 3.4 shall be replaced with the following (additions are underlined in red and deletions are 6tr+sken in black); 3.4 RENTAL RATES The bidder shall supply an all inclusive flat monthly rate that will include all labor and materials required to complete the job. The bidder shall take into consideration the items listed bellow in their monthly rental rate and these items shall not be included on the monthly invoice as additional charges to the City; • Mobilization / Trip • Fuel / Environmental Charges • Permits • Equipment • Pick up • Disposal • Administration Fees ➢ Response to Questions: 1) Is there a Bid Security or a Performance Bond with the Bid 11 -01 -01 that has to be submitted? Section 1 of the bid states that there is; yet sections 2 and 3 of the Bid state that there is none. 0 No Bonds are required for this bid. 2) Is the Sunny Isles Beach expecting City of Sunrise and Miami Dade county Franchise fees or is the city exempting themselves from the franchise fee? Please see amendment above. 3) In several locations signature is being required from "an authorized agent' but then it is requesting the title of officer. Does an officer from the Corporation have to sign off on the proposal? These forms can be sign by any authorized agent of the firm. END OF SECTION • • ���� -71-1 e' BID SUBMITTAL FORM Bid Title: Waste Management Services The undersigned Proposers proposes and agrees, if this Bid 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 Instructions 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, site, locality, and all local conditions and Law and Regulations that in any manner may affect cost, progress, performance, or furnishing of the Work. • The Proposer has studied carefully all reports and drawings of subsurface conditions and drawings of physical conditions. The Proposer has obtained and carefully studied (or assumes responsibility for obtaining and carefully studying) all such examinations, investigations, explorations, tests and studies which pertain to the subsurface or physical conditions at the site or otherwise may affect the cost, progress, performance, or furnishing of the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, and no additional examinations, investigations, explorations, tests, reports or similar information or data are or will be required by Proposer for such purposes. ■ 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 Proposer understands and agrees that the Bid is for unit prices to furnish and install individual Work Items for maintenance and /or repair work, complete in place. Estimates are provided for the purposes of Bid Evaluation and to establish unit prices for individual Work Items for maintenance and /or repair work PAGE 26 OF 28 BID No. • to be contracted by the City under individual Purchase Orders, based on the unit prices established under this Bid. 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. FIRM NAME: Cho►ce rtjv1P_ 0rnen +a1 se Street Address: Mailing Address (if different): 'Fd ax Laa(if 17 Ari e , FL 3 -r-� 31 a Telephone No. 7 0 Fax No. o -<A- M Email Address: f nsct \jj n '(.tyjr ,e 0 CIU 1,WNMEIN No. jjQ- _1jaj 113 LL • * °BYSIGNING THIS DOCUMENT THE BIDDER AGREES TO ALL TERMS 9 SIGNATURE: (SIGNATURE OF AUTHORIZED AGENT) PRINT NAME: ;(1 t h (i e� Sao i n d TITLE: \1 1 c e 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. PAGE 27 OF 28 BID No. 9 0 PAGE 28 OF 28 BID No. �3NNY /S` le< r C> C OF SUT4 • SUNNY ISt E, f O� B NON - COLLUSION AFFIDAVIT V City of Sunny Isles Beach 18070 Collins Avenue o a1�a �`' Sunny Isles Beach, FL 33160 s,N ' Telephone: (305) 947 -0606 Fax: (305) 949 -3113 STATE OF FLORIDA ) COUNTY OF 3 CUM� The undersigned being first duly swom 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, C hL(Ir f lc c cl Yt-I (Name of Corporation, Partnership, Individual, etc.) a, 2 -e C V C 1 r iilCt Cp Ihaal , formed under the laws of n�4 (Type o Bu sin es (State) of which he is V11 C f- Pe S -l-D f- T (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, 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 in Paragraph 10.2 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 in Paragraph 10.2, has directly or indirectly submitted said Bid contents thereof, or divulged information or data relative thereto, to any association or to any memb or agent thereof. C C P(` FS 41) i= /`)T AFFIANT'S. NAME AFFIANT'S TITLE 1'Y1 i Ch ( -( SCIv i n C� TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this � �I day of SC: V1 �A(1 208— � l Personally Known, O?S — or Produced Identification Type of identification (Affix seal here) NOTARY PUBLIC - STATE OF FLORIDA Jennifer Loomis Commission #DD647426 Expires: MAR. 06, 2011 BONDED THRU ATLANTIC BONDING CO., INC. DECEMBER 28, 2010 1 � f NOTARY PUB n me inte or ed) 1 of 7 SUNNY IS4Fs ' s \� ➢� sF`' .F 00 os• •N Y CI SUH PUBLIC ENTITY CRIMES City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 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. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by 104 for��..r ��t-t-- o entity sm�R'n9 so "I ge Q i(n (" a,):l c1 1 Sc le `,' I C Ir � 0 � /�.I C • whose business address is: > c� �� �iGC(a i �Ai I 01-:> and (if applicable) its Federal Employer Identification number (FEIN) is 610 01a j =31 -1' (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(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. 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 DECEMBER 28, 2010 2 of 7 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. 11.5. 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. 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 1S 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 PROVI SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN TH MATION CONTAINED IN THIS FORM. B %I (Signature)m ( hcue l ` cli l o t) (Printed I t]', e 1` C-e Pees.iaent (Title) Sworn to and subscribed before me this day of �C� Y1l A GV \! , 20_ij_, by (AFFIX NOT A�Yf���l��'l�', OF FLORIDA � ' Jennifer Loomis Commission #DD647426 Signature: Nota Zlic — State of Florida Expires; MrIR. 06, 2011 .._ P r1 ✓1 i' 2 LL (?�Yl.� .S BONDER THR%j MIMnC 99N9ING Co., INC. Print or Type Commissioned Name Personally Known_ OR Produced Identification Type of Identification Produced 10/1998 3 of 7 • • O� SJNNY f S(��B ,Z �7 pN EOUAL OPPORTUNITY / AFFIRMATIVE ACTION City of Sunny Isles Beach 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: Firm: ha e I �� ► no - \) -, ee PIC- s iAe nt f� I [ � � �) e l�L� �V rnt✓n�I �r r2 �' � C c'S, �. �,� c= . Address: J&i-) S' Af, MA st-L I F( 1 o3 DECEMBER28,2010 'F7)2 i uG�r'cic��� FL 33 i 4 of 7 SJNNV iS�F r of .: Bm !' n • u _ i. tC'>> FLOS OSW' !� pN O! SUN CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 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 9 i? 0U i k i-) BEFORE ME, the undersigned authority, personally appeared I !L �� tt ` Cl V 1 Y1 �? ,who was duly sworn, deposes, and states: 18.1. 1 am the \J 1 C,(-)- P(� *S ►( fi of with a local office in V0 icT LLt u[, eF'C Ci. FE f 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: Landscape Maintenance Services. 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. Sworn to and subscribed before me this day of SCI n au vii b/ Personally Known - OR O Produced Identification ; Type of Identification NOTARY PUBLIC STATE OF FLORIDA NOTARY PUBLIC - STATE OF FLORIDA "" , Jenni r Loolrus `-- Commission #1)D647426 Expires; MAFt, 06, 20'1.1 sorrsEH THRH AT, 4 ns a4"tNi? CQ,, INC,. DECEMBER 28, 2010 5 of 7 (P rrf • `+VNNY S1 J !' n 1F C99jy i.1 O0.\90 SWr 5 li H 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. 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 If yes, state the nature of the request for equitable adjustment, contract claim, litigation, or prot t at e 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. Oyxe i Firm Date rn,(c I sai I n6- V r2ecsiderl+ Autho ized Signature Print or Type Name and Title DECEMBER 28, 2010 6 of 7 • • 011 S,NNY �S�f s cc suti STATE OF FLORIDA ) COUNTY OF��� °� !ZD ) 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: (y)"C.hct' CA Q, no Title: y i (: �? P 2 s'i c�+ vi t The foregoing instrument was acknowl dged before me this day of C. C 1 , 201, by ` fIC [name of person], 1 as T, K-es'Ar-n-t- [type of authority], for h r" j Lc Ec , mNr -ISe t��, pct [name of party on behalf of whom instrument was executed]. + jc AFFIX NgTWjA[#l!j1�,flERE0RID:`, Jennifer Loomis Commission #DD647426 No3jry Pu is -- -State of Florida .,;''►?. Expires. MAR• 06, 2011 BONDED THgU ATLpN is BONDING CO., INC. - -- Print or Type Commissioned Name Personally Known OR Produced Identification Type of Identification Produced DECEMBER 28, 2010 7 of 7 • • CHOICE ENVIRONMENTAL SVC OF MIA INC 13300 NW 38 AVE OPA LOCKA, FL 33054 PLEASE DETACH AT PERFORATION City of Opa -locka 990005063 Department of Business and Licensing Occupational License CHOICE ENVIRONMENTAL SVC OF MIA INC 13300 NW 38 AVE OPA LOCKA, FL 33054 LICENSE FEE $259.00 IS HEREBY LICENSED TO ENGAGE IN THE BUSINESS, PROFESSION OR OCCUPATION OF STORAGE PER SO FT IN THE CITY OF OPA- LOCKA, WITH THE FOLLOWING RESTRICTIONS: 2011 ISSUED ON 06/18/2010 UNTIL SEPTEMBER 30, 2011 SUBJECT TO THE PROVISIONS OF THE CITY OF OPA -LOCKA ORDINANCES AND STATE AND COUNTY REGULATIONS NOW IN FORCE. NOTE: THIS LICENSE DOES NOT CONSTITUTE A CERTIFICATION THAT THE LICENSEE IS QUALIFIED TO ENGAGE IN THE BUSINESS OR OCCUPATION SPECIFIED HEREIN. CITY OF OPA -LOCKA CITY MANAGER DISPLAY AS REQUIRED BY LAW BY: LICENSE CLERK 43IAM DADE COUNTY 2tt10 LOCAL BUSINESS Title RECEIPT 2011 FIRST -CLAS TAX COLLECTOR MIAN,I -DADS COUNTY - STATE OF FLORIDA U.S. POSTAS 140 W. FL AGLfR ST. EXPIRES SEPT 30,.2011 PAID 1etFLQOR MUST BE DISPL.AYEO.AT P.LACE.OF BUSINESS' M1Ahi1. FL MIAMI, i, FL 33430 PURSUAtiT TO COUNTY CODE CHAPTEfi SA - ART; 8.& 1{i s PERMIT NO,', THIS IS NOT A BILL —DO NOT PAY 532994 -2 BUSINESS NAME i LOCATION CHOICE ENVTRONMENTAL SERVICES OF MIAMI INC 13300 NW 38 CT 33054 OPA LOCAA OWNER CHOICE ENVIRONMENTAL SVCS OF MIA Sec. Type of Business 213 KOVING SERVICE (LOCAL) Ttos Jr ONLT A L OWNS" TRY RECEIPT. a DOEe NOT PERMIT THE NOLOEA TO VIOLATE ANY EXISTING REGULATORY DA RENEWAL RECEIPT NO, 395747-0 EMPLOYEE /S 6 IONO LAWS OF Ysie DO NOT FORWARD cOwm DA CRIES, NOR vOEe n EMP EXEMPT THE AOLOER FROM 811 uTX-_ CHOICE ENVIRONMENTAL SERVICES OF JMOM T AEOIN{EOsY LAw:TN MIAMI INC F ThET"O&MRR° C41AURC4 WILLIAM HERNANDEZ CEO TONS. 13300 NW 38 CT PAYMENT RECEIVED OPA LOCAA FL 33054 NAANFDAOE COUNTY TAX COLL>;CTQR: olo 0 0401017010172001 0000�a5.00 154 SEE OTHER SIDE • 0 � � 2 CL @ m � k v cc � � E c O .� � w w 0 � � k k a � �� •S © - u � • � � 0 § �k= 8 2 2 § a % a § 0 o k � z_ W � Z � a ./ m k � cc � � E c O .� � w w 0 � � k k a � �� •S © - u � • � � 0 § �k= 8 2 2 § a % a § 0 o k � z_ / m k � CD o A § o a - § \ k @ -rz 2 % = � a � § a§� t § � p �n §/� CL �2E a ?| a E, \ } 4 F, L ACC?R °® CERTIFICATE OF LIABILITY INSURANCE 1�26�2011YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES PF BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis of New Jersey, Inc. 1015 Briggs Road, Suite 100 PO BOX 5005 CONTACT NAME: Joan M. Williams PHONE FAX A/c No Ext: - - AC, No):856-914-1 SRI E -MAIL ADDRESS: oan.williams@willis.com Mt. Laurel NJ 08054 PRODUCER CUSTOMER ID #: Chris Stafford - CHOIENV INSURER(S) AFFORDING COVERAGE NAIC # 12/10/2010 INSURED INSURERA:Natl Union Fire Iris Cc of Pittsburg 19445 Choice Environmental Service Inc. 2860 State Road 84 INSURER B: Everest Indemnity Insurance Co 10851 INSURER C: Interstate Fire and Casualty Co. 22829 Suite 103 INSURER D: DAMAGE T RENTED PREMISES Ea occurrence Ft. Lauderdale FL 35312 INSURER E : CLAIMS -MADE FX-1 OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: 148318848 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD LIMITS A GENERAL LIABILITY GL4572060 12/10/2010 12/10/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $100,000 CLAIMS -MADE FX-1 OCCUR MED EXP (Any one person) $5,000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO - X LOC $ AUTOMOBILE LIABILITY CA1469461 12/10/2010 12/10/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000, 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS C UMBRELLA LIAB X OCCUR UM000048406268 12/10/2010 12/10/2011 EACH OCCURRENCE $5,000,000 X AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ X $ RETENTION $5,000 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 8 Umbrella 71G1000237 -101 12/10/2010 12/10/2011 $10 million each occurrence/ Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Named Insured includes: Choice Environmental Services, Inc. Choice Environmental Services of Miami, Inc. See Attached... CERTIFICATE HOLDER CANCELLATION © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach FL 33160 AUTHORIZED REPRESENTATIVE PCT,� a 3.,. © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: Chris Stafford - CHOIENV LOC #: CCOREP ® ADDITIONAL REMARKS SCHEDULE Page, of 1 AGENCY NAMED INSURED Willis of New Jersey, Inc. Choice Environmental Service Inc. 2860 State Road 84 POLICY NUMBER Suite 103 Ft. Lauderdale FL 35312 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Choice Environmental Services of Collier, Inc. Choice Environmental Services of Ft. Pierce Choice Environmental Services of St. Lucie, Inc. American Waste LLC Choice Environmental Services of Broward, Inc. Choice Environmental Services of Miami -Dade, Inc. Choice Recycling Services of Broward, Inc. Choice Recycling Services of Miami, Inc. Choice Recycling, Inc. Choice Sanitary Services of Florida Inc. Choice Sanitation Inc. Earthcare Resource Management of South Florida Inc. Eco Waste Gulfstream Holdings LP Immokalee Disposal Corp. Mac Pac Waste and Recycling Public Waste United Environmental Services of South Florida Choice Environmental Services of Highlands County, Inc. Choice Environmental Services of Lee County Fto - Additional Insured subject to form 87950 (10 /05) eneral Liability - Additional Insured subject to form 61712 (08/07) - Waiver of Subrogation subject to form CG2402 (10/93) Certificate Holder Additional Insured subject to policy forms. AGUHD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) ll%.� 1 1/26/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Breen Ragland Group PHONE (407) 833 -0300 FAX No: (407)333 -3277 255 Primera Blvd. A DRIESS: Suite 434 PRODUCER p0000069 CUSTOMER ID Lake Mary FL 32746 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Zenith Insurance Companv 113269 INSURER B: Choice Environmental Services, Inc. INSURER C: 2860 SR 84 INSURER D: Suite 103 INSURER E: Ft Lauderdale FL 33312 INSURER F: COVERAGES CERTIFICATE NUMRFRCL10102100719 REVISION NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL 1 SUBR WV POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR EACH OCCURRENCE $ $ $ _ $ $ $ $ DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL& ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE OT- LOC PRODUCTS - COMP /OP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ $ $ $ $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ $ $ $ AGGREGATE DEDUCTIBLE RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 2069830803 6/1/2010 6/1/2011 X WC STATU- OTH- TORY LIMITS E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) GtK I It•IGA I t HULUtK CANCELLATION City of Sunny Isles Beach 18070 Collins Ave Sunny Isles Beach, FL 33160 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE James Breen /MEGAN ACORD 25 (2009109) © 1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD