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I SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE �I I NOTICE : THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - RESPONSIBLE BIDDERS . I 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: 0208 I i Project Name : Bridge Replacement and Roadway Improvements on 82"d Ave . at 0 St . t 1 . Bidder's Name / Address: Lucas Marine Acquisition Company , LLC I 3130 SE Slater St. , Stuart , FL 34997 i2 . Bidder's Telephone & FAX Numbers : 772-286-5094 Fax 772403-2378 3 . Licensing and Corporate Status : a . Is Contractor License current? Yes b . Bidder's Contractor License No : CGC1519919 [Attach a copy of Contractor's License to the bid] Go 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 thLtkckS involved ntshin2sutont�ctii 24 aV alo 'Ak�n � nu�, n� F corlsr�w� � ,J, UI C ris 3104;2411) 5 . What is the last project OF THIS NATURE that the firm has completed ? Juanita Avenue Bridge , Fort Pierce , FL FDOT Design/Build 6 . Has the firm ever failed to complete work awarded to you ? No i ' [ 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 .] SS 7 . Has the firm ever been assessed liquidated damages? Yes I [ if your answer is `des, then attach a separate page to this questionnaire that explains the circumstances and list the project name , Owner, and the Owner's telephone number i for each project in which liquidated damages have been assessed . ] i 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations? Yes [ 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 . ] i 00456 - Qualifications Quesdonnaire.doc 00456 - 1