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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 /> with Pro <br /> Documentation Submittedj� ect No : 9205 <br /> Project Name : 4th Street Widening from U . S . 1 to WesUof Otd Dixie <br /> 1 . Bidder's Name / Address : I IO 1 YC, C41 <br /> 2 . Bidder' s Telephone & FAX Numbers : ( 992) asL4- . S00 Pbqlie <br /> l 1 --7 3\ b 121N AAX <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? tIVS <br /> b . Bidder's Contractor License No : [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 /> 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 ? RD <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? N � <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 - Qualifications Questionnaire <br /> 00456 -t <br /> F:\Public Works\Capital Projects\Fourth Street-Old Dixie-US1 \CONTRACT DOCUMENTS\00456 - Qualifications Questionnaire.doc <br />