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Miami -Dade County Solicitation RTQ-00918 lr111 i� "1 SuWttal Form. Solicitation NYi9ttil'Q Solicitation Title: Signs and Banners: Purchase, Installation, & Removal Legal Company Name (include dlbla if applicable): Federal Tax Identification Number: I State incorporated/Organized: If Corporation Date Incorporated/Organized Company Operating Address:. (-� Code I MlemDade County Address (if applicable): Code F Company Contact Person: Email Address: Phone Number Company s Internet Web Address: (include area code): ! .... ......... .............. ..... ............._...__ Pursuant to MiaWde County Ordinanod4k4any individual, corporation, partnership, joint venture or other legal entity havinc officer, director, or executive who has been convicted of a felony during the past ten (10) years shall disclose this Informal 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. lQrAI PR FFR NC CFRTI1FICATJ0g{e purpose of this certification, and pursuant to Section 2-8.5 of the Code of "grade County, a 'local business a business located within the limits otDutideiCounty that has a valid Local Business Tax Receipt issalgdd W Gbamtiy least one year prior to bid submission; has a physical business address located within4had'erfii9udtVFao>ih which business is performed and which served as the place of employment for at least three full time employees for the continuous period of one year prior to bid exception, if the business is a certified Small Business Enterprise, the local business location must have served as the place of employment f employee); 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 increbt utbAm County ❑ Place a check mark here only if affirming the Bidder meets the requirements for Local Preference. Failure to complete this certification at this time (bv checking the box above may render the vendor ineligible for Local Preference I QQAl 1-i9 AQ011ART RFn RUS1N sS CFRT1FMpbTJJWurpose of this certification, and pursuant to Section 2-8.5 of the Code of MiamiDade County(mally-headquartered busii9esa Local Business wl ipal place of busirift tiami -Dade County. ❑ Place a check mark here only If affirming thnlEWmquirements for the L f)quartered Preference (IIFi I)jre to complete this certification at this time (by checking the box) may render the vendor ineligible for the LHP The address of the Lodaidgdquartered office is: LOCAL CERTIFIED VETERAN BUSINESS ENTERPRISE CERIUJOAT110Nified Veteran Business Enterprise is a firm that is (a) a local business pursuant to SectMbf the Code of N@ade County and (b) prior to bid submissidild d 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 theslAilddat Certified Veteran Business Enterprise. A copy of the certification must be submitted with the bid. SMALL BUSINESS ENTERPRISE CONTRACT MEASURES (lf Applicable) A Small Business Enterprise (SEE) must be certified by Small Business Development for the type of gocHWdegVw%ddeedesattmrdance with the applicable Commodity Code(s) for this Solicitation. For certification information contact Small Business De36HP0reastratJ§05) 37 hftp:/Iwww.miamidade.gov/smallbusiness/ceoWDWdms.agoe SBE must be certified by the solikibittunission 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. 5/3/2019 7:48 AM P. 11