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7«aelf#y ;e"e eon q. 9006. <br /> 1360 SW Old Dixie Hwy Suite 106 <br /> Vero Beach , FL 32962 <br /> 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 : 0216 <br /> Project Name : 12th Street Sidewalk from 16th Ave to 11th PI . <br /> 407 � qua. <br /> 1 . Bidder' s Name / Address : n .� YU f11r1 lliYio Hwv 5si <br /> "M 106 <br /> Verb ,$each FL 32962` 1G�� <br /> 2 , Bidder' s Telephone & FAX Numbers : 711a 15LO41 %coaW�) Iwo <br /> beAMS6af4l rtes <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? <br /> b . Bidder's Contractor License No : CGC ©Saq '40 [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: Qt-] <br /> 5 . What is the last project OF HIS 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? 0A — <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 . ] h <br /> 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations? <br /> 00456 - Qualifications Questionnaire <br /> 00456 - i <br />