MB VCA Questionnaire ,G7
MdANAI I VISITOR AND
B EAC H(AUTHORITY CONVENTION
MIAMI BEACH VISITOR AND CONVENTION AUTHORITY
QUESTIONNAIRE
Applicant's Name: City of Miami Beach
Principal Office Address: 1700 Convention Center Drives Miami Beach, Florida 33139
Official Representative: Jimmy L. Morales, City Manager
Partnership (Circle One)
Corporation
If a Corporation, answer this:
When Incorporated: 1915
In what State: Florida
For Profit or Non Profit: Municipality
If a Foreign Corporation:
Date of Registration with
Florida Secretary of State:
Name of Resident Agent:
Address of Resident Agent:
President's Name:
0 KIT �
Questionnaire(continued)
Vice-President's Name:
Treasurer's Name:
Members of Board of Directors:
If a Partnership:
Date of organization:
General or Limited Partnership*:
Name and Address of Each Partner:
NAME ADDRESS
* Designate general partners in a Limited Partnership
I. Number of years of relevant experience in operating similar business:98 years
2. Have any similar agreements held by Applicant ever been canceled?
Yes ( ) No (X)
If yes,give details on a separate sheet.
3. Has the Applicant or any principals of the applicant organization failed to qualify as a
responsible Bidder, refused to enter into a contract after an award has been made,
failed to complete a contract during the past five (5) years, or been declared to be in
default in any contract in the last 5 years? No
Questionnaire (continued)
If yes, please explain:
4. Has the Applicant or any of its principals ever been declared bankrupt or reorganized
under Chapter 11 or put into receivership?Yes (- ) No(X)
If yes, give date, court jurisdiction, action taken, and any other explanation deemed
necessary on a separate sheet.
5. Person or persons interested in this bid and Qualification Form have ( ) have not (X)
been convicted by a Federal, State, County, or Municipal Court of any violation of law,
other than traffic violations. To include stockholders over ten percent (10%). (Strike
out inappropriate words).
Explain any convictions:
6. Lawsuits (any) pending or completed involving the corporation, partnership or
individuals with more than ten percent (10%) interest:
A. List all pending lawsuits:
N/A
B. List all judgments from lawsuits in the last five (5)years:
C. List any criminal violations and/or convictions of the Applicant and/or any of
its principals:
Questionnaire(continued)
7. Conflicts of Interest. The following relationships are the only potential, actual, or
perceived conflicts of interest in connection with this grant application: (If none, state
same.)
N/A
8. Public Disclosure. In order to determine whether the members of the Miami Beach
Visitor and Convention Authority (MBVCA) have any association or relationships
which would constitute a conflict of interest, either actual or perceived, with any
Applicant and/or individuals and entities comprising or representing such Applicant,
and in an attempt to ensure full and complete disclosure regarding this contract, all
Applicants are required to disclose all persons and entities who may be involved with
this application. This list shall include public relation firms, lawyers, lobbyists, as well
as disclose any relationship; financial, corporate business or relative, either real or
perceived, with any MBVCA Board Member. The City of Miami Beach, City Clerk's
Office shall be notified in writing if any person or entity is added to this list after
receipt of applications. (Use additional sheet if needed).
N/A
Questionnaire (continued)
The Applicant understands that information contained in this Questionnaire will be relied
upon by the MBVCA in awarding the proposed grant and such information is warranted by
the Applicant to be true. The undersigned Applicant agrees to furnish such additional
information, prior to acceptance of any applications relating to the qualifications of the
Applicant, as may be required by the Executive Director. The Applicant further understands
that the information contained in this questionnaire may be confirmed through a background
investigation conducted by the Miami Beach Police Department. By submitting this
questionnaire the Applicant agrees to cooperate with this investigation, including but not
necessarily limited to fingerprinting and providing information for credit check.
WITNESS: IF PARTNERSHIP:
Signature Print Name of Firm
Print Name Address
By:
General Partner
Print Name
WITNESS:
City of Miami Beach
Signature Print Name of Corporation
1700 Convention Cent 4r Drive: Mi ' i Beach FL 33139
Print Name Address
By:
President
CORPORATE SEA •••• ` Attest: Ad 13 Secretary
`NOORP ORATED=
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