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SECTION 00456 was 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 Guarantee's the truth and accuracy of <br /> all statements and answers herein contained . Failure to comply with these requirements may be <br /> considered sufficient justification to disqualify a Bidder. Attach additional sheets as required . <br /> Documentation Submitted with Project No: 054 5 &0370 <br /> a <br /> Project Name: 66th Avenue RoadwayImprovements S.R. 60 to North of W Street <br /> 1 . Bidder's Name / Address: Dickerson Florida , Inc . `! <br /> 3122 N . 25th St . , Ft . Pierce , FL 34946 <br /> 2 . Bidder's Telephone & FAX Numbers: ( 772 ) 429 - 44441 ( 772 ) 429 - 4445 ( fax) <br /> 3. Licensing and Corporate Status: <br /> a. Is Contractor License current? Yes <br /> b . Bidder's Contractor License No : CGC 0 6 0 7 9 7 [Attach a copy of Contractor's <br /> License to the bid] <br /> c. Attach documentation from the State of Florida Division of Corporations that indicates <br /> the business entity's status is active and that lists the names and titles of all . officers. <br /> 4. FDOT Prequalified Contractor number: F561327509001. <br /> ( httas ://www3.dot state.fl . us/contractororeQualificabon/public/Pre4ualifiedVendorSearch. asax) <br /> 5. Number of years the firm has performed business as a Contractor in construction work of <br /> the type involved in this contract: + 55 yrs <br /> 6 . What is the last project OF THIS NATURE that the firm has completed? <br /> 25th Street new St . Lucie County <br /> COMMON <br /> I7 . Has the firm ever failed to complete work awarded to you? No <br /> [If your answer is "yes", then attach a separate page to this questionnaire that explains the <br /> circumstances and list the project name , Owner, and the Owner's telephone number for <br /> each project in which the firm failed to complete the work.] <br /> 8 . Has the firm ever been assessed liquidated damages? No <br /> [If your answer is "yes", then attach a separate page to this questionnaire that explains the <br /> circumstances and list the project name, Owner, and the Owner's telephone number for <br /> each project in which liquidated damages have been assessed.] <br /> ® 9. Has the firm ever been charged by OSHA for violating any OSHA regulations? No <br /> 1� [If your answer is "yes" , then attach a separate page to this questionnaire that explains the <br /> circumstances and list the project name, Owner, and the Owner's telephone number for <br /> each project in which OSHA violations were alleged .] <br /> 00456 - Qualifications QuesuonnairsAoc <br /> 00456 - 1 <br /> FAPub is WorksIENGINEERING DIVISION PROJECTS1QP"OTh Ave SR60 10 571h St (Arced1sWrrimH31d 0ocumantSN004456 - QualO{cations Questlonnaire.doc <br />