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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 : 0745 <br /> Project Name : Indian River Blvd . Sidewalk Improvements from 12th Street to 17th Street <br /> 1 . Bidder' s Name / Address : �rl vL1,04UL,V c} S <br /> 2 . Bidder' s Telephone & FAX Numbers : 717 2 - 561 - `7 9�b7G <br /> `7 vim— �j6 14 - �s <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? ( eS <br /> b . Bidder's Contractor License No : C & 0,D 3� q Y-U [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: rzS . <br /> 5 . What is the last project OF THIS NATURE that the firm has completed ? <br /> 2 <br /> e, vi <br /> 6 . Has the firm ever failed to complete work awarded to you ? 00 <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 /> 7 . Has the firm ever been assessed liquidated D damages ? <br /> �_ <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? ND <br /> 00456 - Qualifications Questionnaire <br /> 00456 - 1 <br /> F :\Engineering\Capital Projects\0745 IR BLVD SIDEWALK 12th Street to 17th Street\0745 Contract Docs & Specs\00456 - Qualifications Questionnaire.doc <br />