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SECTION 00456 — QUALIFICATIONS QUESTIONNAIRE NOTICE : THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - RESPONSIBLE BIDDERS , UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees the truth and accuracy of all statements and answers herein contained . Failure to comply with these requirements may be considered sufficient justification to disqualify a Bidder. Attach additional sheets as required . Documentation Submitted with Project No : 1336 Project Name : Gifford Park Ballfields Gradinglm2rovpmgnL5..RUCTI ® 11 1 . Bidder' s Name / Address : 2837 Flight Safety Drive MEN 1100 FL 32960 )772 ) 7944099 Fax: (772 ) 794 - 2097 2 . Bidder' s Telephone & FAX Numbers : 3 . Licensing and Corporate Status : a . Is Contractor License current ? 42- S b . Bidder's Contractor License No : C. P. l Z5 90 q 5 [Attach a copy of Contractor's License to the bid] c . Attach documentation from the State of Florida Division of Corporations that indicates the business entity' s status is active and that lists the names and titles of all officers . 4 . Number of years the firm has performed business as a Contractor in construction work of the type involved in this contract : / 0 5 . What is the last project OF THIS NATURE that the firm has completed ? SDI ► �� ri �►� c ( dam - wlS � e-�cC � C � (D6l t V�; e, CCUD 6 . Has the firm ever failed to complete work awarded to you ? V'\. [ If your answer is "yes " , then attach a separate page to this questionnaire that explains the circumstances and list the project name , Owner, and the Owner' s telephone number for each project in which the firm failed to complete the work . ] 7 . Has the firm ever been assessed liquidated damages ? n,Q_ [ If your answer is " yes " , then attach a separate page to this questionnaire that explains the circumstances and list the project name , Owner, and the Owner' s telephone number for each project in which liquidated damages have been assessed . ] 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations? YXO [ If your answer is " yes " , then attach a separate page to this questionnaire that explains the circumstances and list the project name , Owner, and the Owner' s telephone number for each project in which OSHA violations were alleged . ] 00456 - Qualifications Questionnaire. doc 00456 - 1 FAPublic Works\ENGINEERING DIVISION PROJECTSN 336-Gifford Senior BallfieldWdmmlbid documents\MasterContract\Contract Documents100456 - Qualifications Questionnaire. doc