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Bid Proposal- National Pool Design IncFORM A BID PROPOSAL Notice to Bidders: The undersigned declares that he /she has carefully examined the Invitation to Bid document and has done a site visit preferably on Thursday, January 25, 2018 at 10:00 AM and is thoroughly familiar with the provisions and the scope of work to be performed. The undersigned proposes to complete the scope of work in accordance with the specifications as provided in the Invitation to Bid 2018 - Jan -02 for the following sum(s): 1. Prepare activity pool surface for resurfacing, including chipping marcite and sanding marcite surface $ �D� JX[7 ®� O 2. Resurfacing entire activity pool using manufacturer exposed aggregate 00 surfacing $ 0 46- 3. Chipping around existing floor tiles and jets $ V oo. O ?J 4. Replacing broken floor jets $ j� '�1 Q e 00 TOTAL BID SUBMITTAL COST IT IS FURTHER AGREED THAT THE SCOPE OF WORK SHALL BE COMPLETED NO LATER THAN MARCH 3, 2018. Bidder Company Name: Q7 fI nC4 11 2001 / 0 -6 1: 0 t Address: 9,3 54 1 V-7 qV2 4! f-1 3 -jl Telephone Number: '!j p S' — 6- L� %— /© '�.® Contact Person: I Q d / AR e, cl ye Authorized Signature: Title: s, -ice n4 P, &-le Date Signed AUM Mill 15 1! age General Provisions I n ✓ I t a t l 0 n i -! .. t o B. d Z 0 1� -Jan J Z FORM B BIDDER ACKNOWLEDGEMENT Bid Title: Miami Shores Village Aquatic Center Activity Pool Resurfacing Bid Number: 2018 - Jan -02 Sealed Bid Submittal Miami Shores Village Attn: Village Clerk 10050 N.E. 2nd Avenue Miami Shores, FL 33138 Bids will be opened in the Village Hall Council Chambers located at 10050 N.E. 2 "d Avenue, Miami Shores, FL 33138 unless otherwise specified. Bids must be received in accordance with the provisions outlined in this document. Name of Vendor: ii --i-o ne 1 f' Federal ID Number: e.Gc A Corporation of the State of: Mailing Address: � `T ,�A J 7 /) ve ()n d- ol19 rL City, State, Zip Code: /� I%;l IS r ✓ , 18 .S Telephone Number: 305— '- 55,C7— /0 X b Fax Number: o S- - 33-)- O L 3 0 Email: 1 ? d-c) t)4+i®0Ci) Poo) CieS+ ' Y►., (C) VYI Authorized Signature: Authorized Signatory's Name: (Please print) A do '�Z d rf'c, ve- L General general Provisions Invitation to Bid 2018-Jan-02 FORM C INFORMATION SHEET - REFERENCES In order to receive Bid Award consideration on the proposed bid, it is a requirement that the following "Information Sheet" be completed and returned with your bid. This information may be used in determining the Bid Award for this contract. Bidder Company Name: C,� PLC 1 !� U Address: 5W I Y % /1Ve 7 f Telephone Number: Contact Person: ICY - /�r� (f �`� �— Title: ?re S I n Number of years in Business: List three (3) governmental agencies or companies where the product(s) and /or services have been provided in the last year. 1. Agency/Cola rr Address: Telephone Number: Contact Person: Project name & Date P Description of Work: _ 2. Agency /Company Na Address: I ?>(,Oo Telephone Numb' Contact Person: Project name & Date Description of Work: "-< Y h Di Title: Provided: 4- n l (1WA I�Unrfff r/Hr TMJM 3. Agency /Company Name: KJJ Address: 1--31)W ' Telephone Numb 170-er — Contact Person:. Project name & Date Pr Varv, duct Pro% Description of Work: - In, r V r _ Title: F. i'" 20)lO 17�P P - age general Provisions Invitation to Bid 2018-Jan-02 FORM D ANTI - KICKBACK AFFIDAVIT STATE OF FLORIDA SS (Subscribed and Sworn) COUNTY OF MIAMI -DADE Before me, the undersigned notary, CL Ylc t A (name of Notary before whom affidavit is sworn), on this (. (day of month) day of f— -b -fLjc,- 4 (month), 20 ) '�K personally appeared alfvtdo [ V, f~ r (name of affiant), know to me to be a credible person and of lawful age, who being by me first duly sworn, one (his /her) oath, deposes and says: I, the undersigned hereby duly sworn, depose and say that no portion of the sum herein bid will be paid to any employees of Miami Shores Village as a commission, kickback, reward of gift, directly or indirectly by me or any member of my firm or by an officer of the company or corporation. Signature of affiant do Printed name of affiant STATE OF FLORIDA, COUNTY OF MIAMI -DADE I D s� � /7 }cue �//? ;f �lz Address of affiant, line 1 14 f iml )`� -3 -3 18' Address of affiant, line 2 (City, State, Zip) Sworn to (or affirmed) and subscribed before me this (,2 day of_�ebruo ry (month), 201 (year), by }) rY c`E �Cc�-n' , e2_ (name of person making statement) --P$ e S'% C(-e r- •- (title of person making statement) > Stamp Commissioned Name Below: ignature of Notary Pu lic — State of Florida Nay;• eR6r� � rl L *I Nsta �uNARQDRiGUEZ a J. Print Name of Notary Public " Comm'sslnn :[G i05164 'MY Comm. Exo;gq May 15.2021 haticralhotaryAssn, Personally known OR Produced Identification [/ Type of Identification Produced . 181Page General Provisions Invitation to Bid 2018- Jan -02