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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br />N OTICE THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - <br />RESPONSIBLE -BIDDERS. ------ <br />U NDER 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 />D ocumentation Submitted with Project No: 1213 <br />P roject Name. Indian River County Public Shooting Range — Skeet and Trap Facility <br />Improvements (Phase I) <br />1. Bidder's Name / Address: A <br />Pe � t-sk S.e.rt. t'cx_S e n c <br />B idder's Telephone & FAX Numbers: 776"--(17.70,2 ?72-7;?SJ,6 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? /-S. <br />b. Bidder's Contractor License No:`vc- txRS 1 [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 />Flan \t' .5 L. 0,,,j Cil/ // 1 t4 L�� „J.-ck Cof-Fro l S''('t✓tjrir> C7 <br />6. Has the firm ever failed to complete work awarded to you? ! —X) <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? - <br />00456 - Qualifications Questionnaire.doc <br />00456 - 1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS11213-IRC Shooting Range -Skeet 8 Trap Improvemnts 8 Hunters Train Bldg\Hdmim\bid documents\Contract <br />Documents\00456 - Qualifications Questionnaire.doc <br />