Supplier Response Form

http://i1335.photobucket.com/albums/w680/support23/MiamiDade_zps695c00e7.png

Miami-Dade County

Procurement Management Services

Solicitation Submittal Form

111 NW 1st Street, Suite 1300, Miami, FL 33128

 

 

Solicitation No. FB-00358

Solicitation Title: Social Media Consulting Services

Legal Company Name (include d/b/a if applicable):

 * 

Federal Tax Identification Number:

 * 

If Corporation - Date Incorporated/Organized:

State Incorporated/Organized:

 Company Operating Address:

 * 

City

 * 

State

Zip Code

 Remittance Address (if different from ordering address):

City

State

Zip Code

 Company Contact Person:

 * 

 Email Address:

 * 

 Phone Number

(include area code):

 * 

 Fax Number

(include area code):

 * 

 Company's Internet Web Address:

 * 

Pursuant to Miami-Dade County Ordinance 94-34, any individual, corporation, partnership, joint venture or other legal entity having an officer, director, or executive who has been convicted of a felony during the past ten (10) years shall disclose this information prior to entering into a contract with or receiving funding from the County.

 Place a check mark here only if the Bidder has such conviction to disclose to comply with this requirement.

LOCAL PREFERENCE CERTIFICATION:  For the purpose of this certification, a “local business” is a business located within the limits of Miami-Dade County (or Broward County in accordance with the Interlocal Agreement between the two counties) that has a valid Local Business Tax Receipt, issued by Miami-Dade County; has a physical business address located within the limits of Miami-Dade County from which business is performed; and contributes to the economic development of the community in a verifiable and measurable way.  This may include, but not be limited to, the retention and expansion of employment opportunities and the support and increase to the County’s tax base. 

 Place a check mark here only if affirming the Bidder meets the requirements for Local Preference.  Failure to complete this certification at this time (by checking the box above) may render the vendor ineligible for Local Preference.

LOCALLY-HEADQUARTERED BUSINESS CERTIFICATION:  For the purpose of this certification, a “locally-headquartered business” is a Local Business whose “principal place of business” is in Miami-Dade County or Broward County in accordance with the Interlocal Agreement between the two counties.

 Place a check mark here only if affirming the Bidder meets requirements for the Locally-Headquartered Preference (LHP).  Failure to complete this certification at this time (by checking the box) may render the vendor ineligible for the LHP.

 

The address of the Locally-headquartered office is:

LOCAL CERTIFIED VETERAN BUSINESS ENTERPRISE CERTIFICATION:  A Local Certified Veteran Business Enterprise is a firm that is (a) a local business pursuant to Section 2-8.5 of the Code of Miami-Dade County and (b) prior to bid submission is certified by the State of Florida Department of Management Services as a veteran business enterprise pursuant to Section 295.187 of the Florida Statutes. 

 Place a check mark here only if affirming the Bidder is a Local Certified Veteran Business Enterprise.  A copy of the certification must be submitted with the bid.

SMALL BUSINESS ENTERPRISE CONTRACT MEASURES (If Applicable)

 

An SBE/Micro Business Enterprise must be certified by Small Business Development for the type of goods and/or services the Bidder provides in accordance with the applicable Commodity Code(s) for this Solicitation. For certification information contact Small Business Development at (305) 375-2378 or access http://www.miamidade.gov/business/business-certification-programs.asp. The SBE/Micro Business Enterprise must be certified by the solicitation's submission deadline, at contract award, and for the duration of the contract to remain eligible for the preference.  Firms that graduate from the SBE program during the contract may remain on the contract.

Is your firm a Miami-Dade County Certified Small Business Enterprise?         YesNo

 

        If yes, please provide your Certification Number:

SCRUTINIZED COMPANIES WITH ACTIVITIES IN SUDAN LIST OR THE SCRUTINIZED COMPANIES WITH ACTIVITIES IN THE IRAN PETROLEUM   ENERGY SECTOR LIST:      

 

By executing this bid through a duly authorized representative, the Bidder certifies that the Bidder is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, as those terms are used and defined in sections 287.135 and 215.473 of the Florida Statutes. In the event that the Bidder is unable to provide such certification but still seeks to be considered for award of this solicitation, the Bidder shall execute the bid response package through a duly authorized representative and shall also initial this space:: .   In such event, the Bidder shall furnish together with its bid response a duly executed written explanation of the facts supporting any exception to the requirement for certification that it claims under Section 287.135 of the Florida Statutes. The Bidder agrees to cooperate fully with the County in any investigation undertaken by the County to determine whether the claimed exception would be applicable.   The County shall have the right to terminate any contract resulting from this solicitation for default if the Bidder is found to have submitted a false certification or to have been placed on the Scrutinized Companies for Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List.

 

 IT IS HEREBY CERTIFIED AND AFFIRMED THAT THE BIDDER SHALL ACCEPT ANY AWARDS MADE AS A RESULT OF THIS SOLICITATION. BIDDER FURTHER AGREES THAT PRICES QUOTED WILL REMAIN FIXED FOR A PERIOD OF ONE HUNDRED AND EIGHTY (180) DAYS FROM DATE SOLICITATION IS DUE. 

Bidder's Authorized Representative's Signature:

 * 

Date

 * 

Type or Print Name

 * 

THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF THE BIDDER TO BE BOUND BY THE TERMS OF ITS OFFER. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE BID NON-RESPONSIVE.   THE COUNTY MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY RESPONSE THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE BIDDER TO THE TERMS OF ITS OFFER.

 

 



Please enter your password below and click Save to save your response.
Please be aware that typing in your password acts as your electronic signature, which is just as legal and binding as an original signature. (See Electronic Signatures in Global and National Commerce Act for more information.)


By completing this form, your bid has not yet been submitted.  Please click on the place offer button to finish filling out your bid.
Username  customersupport
Password    *

Save Close
 * Required fields