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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 /> r- required . <br /> Documentation Submitted with Project No : 1136 <br /> Project Name : 61h Avenue S .W . Culvert Replacement North of 23`d Street S .W . <br /> 1 . Bidder' s Name / Address : � vud-ti t � , C� C� yCr - L . k A v c . <br /> 2 . Bidder' s Telephone & FAX Numbers : Y/ %ter — . 1 % �_- <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? e� 5 <br /> b . Bidder' s Contractor License No : LaC=- 6 ;Zcj q- 6 [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 : � L V►2 <br /> 5 . What is the last project OF THIS NATURE that the firm has completed ? <br /> 12420 <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 ? <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 /> assessed . ] <br /> for liquidated damages have been as ] <br /> each project in which Ilq g <br /> 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations ? <br /> 1 � <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 . doc <br /> 00456 - i <br /> R\Public Works\ENGINEERING DIVISION PROJECTS\ 1136-6th Ave SW_Culvert Replacement N of 23rd St SW\Admim\Contract Documents\00456 - Qualifications <br /> Queslionnaire .doc <br />