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SECTION UU456 - <br />UALIFICATIONS <br />UESTIONNAIRE <br />NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NOW <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. & 17th St. Intersection Improvements. <br />1. Bidder's Name / Addreenss: �tvytt��.vlt�Se CJCSVLLZEX1✓ <br />o Cw t)`CJC U�`1.1P i 1A;rA <br />2. Bidder's Telephone &FAX Numbers: �"f `r a —�lo �) - r7 �' f�C) <br />�hL <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? LIQ <br />b. Bidder's Contractor License No: Q;5c(ya [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: S�1Yz5 <br />5. What is the last project FTHIS NATURE that the firm has completed? <br />6. Has the firm ever failed to complete work awarded to you? <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 damages? ICU <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? <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.j <br />00456 -Qualifications Question naire.doc <br />00456 - t <br />F:\Pu61ic Works\ENGINEERING DIVISION PROJECTS\1024-17thSlreet and IR Blvd InlerseclionVldmim\Contract Documents\00456 -Qualifications Questionnaire.doc <br />