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31456 - QUALIFICA' <br />ESTIONNAIRE <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 of all <br />statements and answers herein contained. Failure to comply with these requirements may be considered <br />sufficient justification to disqualify a Bidder. Attach additional sheets as required. <br />Documentation Submitted with Project No: 0522, 0436 <br />Project Name: <br />1. Bidder's Name/ Address:�S 4, <br />2_ Bidder's Telephone & FAX Numbers: 7 7,j <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? Ales <br />b. Bidder's Contractor License No: 7fL4.1 [Attach a copy of Contractor's <br />License to the bid] <br />c. Attach documentation from the State of Florida Division of Corporations that indicates <br />the business entity's status is active and that lists the names and titles of all officers. <br />4. Number of years the firm has performed business as a Contractor in construction work of <br />the type involved in this contract: r� <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />4IVUry y Toa""J C&I dsT4R <br />6. Has the firm ever failed to complete work awarded to you? IV E) <br />[If your answer is "yes, then attach a separate page to this questionnaire that explains the <br />circumstances and list the project name, Owner, and the Owner's telephone number for <br />each project in which the firm failed to complete the work.] <br />7. Has the firm ever been assessed liquidated damages? 0 o <br />[If your answer is "yes, then attach a separate page to this questionnaire that explains the <br />circumstances and list the project name, Owner, and the Owner's telephone number for <br />each project in which liquidated damages have been assessed.] <br />8. Has the firm ever been charged by OSHA for violating any OSHA regulations? 043 <br />[If your answer is "yes, then attach a separate page to this questionnaire that explains the <br />circumstances and list the project name, Owner, and the Owner's telephone number for <br />each project in which OSHA violations were alleged.] <br />00456 - Qualifications Questionnaire <br />00456 - i <br />FAEngineering\Petition Paving\05221 st Rd. from 32nd Ave. to 35th Ave\Bid Documents\00456 - Qualifications Questionnaire.doc <br />