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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 : 0813 <br /> Project Name : Eagle Trace Subdivision- Phase If <br /> '�aV4$. y- goat. <br /> 1 . Bidder ' s Name ! Address : 0 &W Old nixie Hwyc, , ,+o 106 <br /> ,Vero Beach , FL 32977 <br /> 62 <br /> 2 . Bidder ' s Teleph ne & FAX Numbers : 1 '1 5Lpt.rr Co RP'4, ` <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? � <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 : 114 <br /> 5 . What is the IpL t project OF THIS NATURE that the firm has completed ? <br /> y s f 16" J` ICiL " } <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 ? Nfl <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 ? ; t-3 <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 - REV 04-07 . doc <br />