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2010-265
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Last modified
2/22/2016 1:21:41 PM
Creation date
10/1/2015 1:26:43 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
10/19/2010
Control Number
2010-265
Agenda Item Number
12.I.1
Entity Name
Dickerson Florida Inc.
Subject
Contract 53rd Street Roadways Improvements
Area
IRFWCD Lateral H Canal to Indian River Boulevard
Project Number
0107
Bid Number
2011011
Supplemental fields
SmeadsoftID
9118
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[ 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 /> 9 . Has <br /> pthe firm ever been charged with noncompliance of any public policy or rules? <br /> N <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. ] <br /> 10 . Attach to this questionnaire , a notarized financial statement an Qther infArmation tht <br /> documents the firm 's financial strength and history . W I t_ L. 5 GW Ly (,cam o N A W A P -t <br /> 11 . Has the firm ever defaulted on any of its projects ? NO <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 a default occurred . ] <br /> 12 . Attach a separate page to this questionnaire that summarizes the firm 's current <br /> workload and that demonstrates its ability to meet the project schedule. <br /> 13 . Name of person who inspected the site of the proposed work for the firm : <br /> Name : 8e, rn I f, Vr 1 I Date of Inspections : <br /> 14 . Name of on-site Project Foreman : f1le C, <br /> Number of years of experience with similar projects as a Project Foreman : <br /> 15 . Name of Project Manager: _(� 0Z / 1/ Lr=l 01P 4 n�c� U11044201 (:" L <br /> Number of years of experience with similar projects as a Project Manager: <br /> 16 . State your total bonding capacity: , DOD i ( ) Q <br /> 17 . State your bonding capacity per job : 0 1 OD b / d w <br /> 18 . Please provide name, address , telephone number, and contact person of your jU&Ty AGS NC/ <br /> bonding company: / akJ Crnelk. kd `� i,-& <br /> d%he vi) /e , Nc age/) : karen d <br /> [The remainder of this page was left blank intentionally] �� � U6D <br /> 00456 - 2 00456 - Qualifications Questionnaire. doc <br /> F:\Engineerjng\Capital Projects\0107-53rd St, 58th Ave-US A1\Contract Documents\00456 - Qualifications Questionnaire.doc <br />
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