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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br /> � ) NOTICE : THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NOW <br /> RESPONSIBLE BIDDERS. <br /> J ( 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 : 9701 <br /> Project Name: Roadway ImprovemenillI.Lo SR AtA and CR 510 <br /> 1 . Bidder's Name / Address : 3imofft4w k <br /> 13taC6 Su) lSCcl'b, x *tcc , (��,� - 3�4cn2 <br /> 1 2 . Bidder's Telephone & FAX Numbers : 1 � a - 5(pt{ --I `6 �D 77 a. 5(c�f - -7 <br /> 3. Licensing and Corporate Status : <br /> a . Is Contractor License current? /ICES <br /> b . Bidder's Contractor License No : O x"'1140 [Attach a copy of Contractor's <br /> License to the bid] <br /> �j 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: _5641,inor Iq <br /> 5. What is the IcIstro <br /> ject OF THIS NATURE that the firm has completed? <br /> 4 h 51-17 p� /mom <br /> 6 . Has the firm ever failed to complete work awarded to you ? _ND <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? NO <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 ? NO <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 /> 9 . Hasii 1he firm ever been charged with noncompliance of any public policy or rules? <br /> i <br /> [ If your answer is "yes , then attach a separate page to this questionnaire that explains <br /> �I the circumstances and list the project name , Owner, and the Owner's telephone number <br /> for each project .] <br /> 00456 - Qualifications Questionnaire.doc <br /> 00456 - 1 <br /> FPublic Works\Capital Projecls\SR AlA & CR 510 1urn Lanes IRG9701 \BID DOCUMENTS 2006079\00456 - Qualifications Questionnaire.di Rev. 0501 <br />