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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br />NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF RESPONSIBLE BIDDERS* <br />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: 1024 <br />Project Name: Indian River Blvd & 17`h St. Intersection Improvements. <br />1. Bidder's Name /Address: �lwtb`1.�'?� <br />t 3 ►o o <br />2. Bidder's Telephone & FAX Numbers: a S(c �� -" ��> PVLt <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? �1,e <br />b. Bidder's Contractor License No: C6; U� 'G[t o [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: c. 5L1YiS <br />5. What is the last project QF THIS NATURE that the firm has completed? <br />2 o'tie S' ) � � <br />K � <br />6. Has the firm ever failed to complete work awarded to you? <br />[tf 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 damages? K <br />u <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? �y <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- 1 <br />FiPuhlic Works\ENGINEERING DIVISION PROJECTS\1024-17th Street and IR Blvd Intersection\Admim\Contract Documents\00456 -Qualifications Questionnaire.doc <br />