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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 /> required . <br /> Documentation Submitted with Project No : 03.78 <br /> Project Name : 26 ' BRMOE"'kEPLACEMENT <br /> 1 , Bidder' s N^ale / Addr s : S hal n � ) c , <br /> 2 . Bidder's Telephone & FAX Numbers : . b <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? <br /> b . Bidder' s Contractor License No : <br /> License to the bid] — [Attach a copy of Contractor's <br /> c . Attach documentation from the State of Florida Division of Corporations that <br /> 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 ? <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 /> 7 . Has the firm ever been assessed liquidated 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 /> 00456 - 1 0378"00456 - Qualifications Questionnaire <br /> FAEngineering\Capital Projects\0378.26th Street Bridge\037B-26th Street Bridge CONTRACT DOC\0378-00456 - Quallficatlons Questionnaire.doc Rev. 05/01 <br />