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�.J <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 : 0533 <br /> Project Name : Oslo Road (CR 606) Phase II Roadway Widening (43`d Ave to 27"' Ave ) <br /> 1 . Bidder's Name / Ad ress0 <br /> 2 . Bidder's Telephone & FAX Numbers : 7 <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? - S <br /> b . Bidder's Contractor License No: G G C �� ���7 qT_ [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 t e last project OF THIS NATURE that the firm has completed ? <br /> 6 . Has the firm ever failed to complete work awarded to you ? A/Q <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 ? N 0 <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? J_ <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 /> in <br /> 00456 <br /> 00456 - Qualifications Question naire.doc <br /> - I <br /> F :\Public Worcs\ENGINEERING OMSION PROJECTS\0533-0sio Rd Phase 11 (43rd Ave to 27th Ave)\Admlm\bid documents\00456 . Qualifications Questlonnaire.doc <br />