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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br /> NOTICE : THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - <br /> RESPONSIBLE BIDDERS , <br /> UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees the truth and accuracy <br /> ' of all statements and answers herein contained . Failure to comply with these requirements <br /> may be considered sufficient justification to disqualify a Bidder . Attach additional sheets as <br /> req ui red . <br /> ' Documentation Submitted with Project No : 9327 <br /> ' Project Name : Oslo Road and 43 `d Avenue Intersection Improvements <br /> 1 . E dder' s Name [ Address : <br /> 1 <br /> 2 . Bidder's Telephone & FAX Numbers : '� 02 - 3 <br /> A[ oo <br /> a - � z <br /> ' 3 . Licensing P and Corporate Status : <br /> a . Is Contractor License current? <br /> ' b . Bidder' s Contractor License No : C=-s5 Attach a copy of Contractor' s <br /> License to the bid] <br /> c . Attach documentation from the State of Florida Division of Corporations that <br /> 1 indicates the business entity' s status is active and that lists the names and titles of <br /> all officers ., . <br /> ' 4 . Number of years the firm has performed business as a Contractor in construction work <br /> of the type involved in this contract : <br /> 5 . What is the last project OF THIS NATURE that the firm has completed ? <br /> ' 6 . Has the firm ever failed to complete work awarded to you ? . (Z <br /> [ If your answer is "yes , then attach a separate page to this questionnaire that explains <br /> ' the circumstances and list the project name , Owner , and the Owner' s telephone number <br /> for each project in which the firm failed to complete the work . ] <br /> ' T Has the firm ever been assessed li l ! ic+ ated damages ? <br /> [If your answer is "yes , then attach a separate page to this questionnaire that explains <br /> ' the circumstances and list the project name , Owner , and the Owner' s telephone number <br /> for each project in which liquidated damages have been assessed . ] <br /> 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations ? <br /> [ If your answer is "yes , then attach a separate page to this questionnaire that explains <br /> ' the circumstances and list the project name , , Owner, and the Owner' s telephone number <br /> for each project in which OSHA violations were alleged . ] <br /> ' Qualifications Questionnaire <br /> 00456 - 7 <br /> FAPublic Works\Capital Projects\Oslo - 43rd Avenue\CONTRACT DOCUMENTS\Qualifications Questionnaire .doc Rev. 05/01 <br />