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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 : 9810 -B <br /> Project Name : 66th Avenue Roadway Improvements - Phase 2 (4th Street to 16th Street) <br /> 1 . Bidder's Name / Address : <br /> `7o/ Wh.`fOe way 'PVLr rY R a Furl- RLeete fL 3t�C 7 <br /> 2 . Bidder's Telephone & FAX Numbers : 712- qtzt - sius- CFAw1 <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? Je5 <br /> b . Bidder's Contractor License No : (, Cr I51 ► So3 [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 /> Cgrcu , K;veo. FAA. 00, 0 <br /> L ,Grl✓1� ✓ c/ �eoA 10> <br /> 6 . Has the firm ever failed to complete work awarded to you ? N` o <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 /> 1 <br /> 7 . 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 <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 ? . 06 _ <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 /> 00456 - Qualifications Questionnaire .doc <br /> 00456 - i <br />