D W South Miami 4Proposal i l Checklist For
BID FORM __
RESPONDENT QUALIFICATION T T T
The response to this questionnaire shell be utilized of the CITYSovardl proposd Evaluation and
FE%IONDENT selection.
1. Number of similar construction projects completed,
) In the past 5 y
Q
In the 5 years On ul
b) In the past 10 years
B C)
In the past 10 years On &hedule
2. Ust , the last three () completed similar projects
a) Project Narne:
Preb) 0,
7T4
Owner
Owner Address:
N uJ rd
ah
Owner Telephoner
a SAP � - 3
Original Contract Completion Time
(Days):
Original Contract Completion Date,
A_ u Fin Contract Completion
Deter
0 t
Original Contract i
1 O
Actual n Contract s
) Project New.
Owner .-
Owner Address:
Thomas F. Pepe _ 0 of 0
12 -5 -1
Owner _ hone:
Original Contract Completion Time
(Days):
IJ .S
Original ontr Completion Dater.
, f 2.-0 f
Actual And Contract Completion
Date:
I q 1 2-c
Original Contract i : a --Lc) 00 0 0
Actual Fin Contract i
C) of Narner °
Owner
Owner Ad drew
40 J 9v rns CJ, PbG RL 3 J fl
Owner Telephone:
(cif - - 1 I )°
Original Contract Completion Time
( ):
Original Contract Completion e:�
Actual And Contract : Completion
Date.
_
Original Contract i
Actual Fin Contract i
1 of
Thomas �s F. Pepe
12 -5 -14
EVALUATION IT I
LIST F PROPOSED SUBCONTRACTORSAND I I L SUPPLIERS
NON COLLUSION I VIT
AC
PUBLIC ENTITY CRIMESAND CONFLICTSOF INTEREST
DRUG FREEWORKPLACE
ACKNOWLEDGEMENT OF CONFORMANCEWITH STANDARDS
RELATED PARTY TRANSACTION VERIFICATION FORM
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