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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 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 : 1 st Road from 35th Avenue to 32nd Avenue and 10th Court SW from Oslo <br /> Road to 7th Street SW <br /> 1 . Bidder' s Name / Address : <br /> / l [ sZ <br /> 2 _ Bidder' s Telephone & FAX Numbers : ' Z Z I- - 779 - 4-F '7X` 7 7,J <br /> 79 - �'(� ca* <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? Ales <br /> b . Bidder's Contractor License No : 7f-4L � [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 /> 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 ? Jol <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 />