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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 : 1142 <br /> Project Name : Miscellaneous Drainage Culvert Replacements <br /> 1 , Bidder' s Name / Address : „ <br /> 1J0 Sfi � 4A e <br /> 2 . Bidder's Telephone & FAX Numbers : 17V12z 56 1-1 - "T gnb ke� <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current ? S <br /> b . Bidder's Contractor License No : <br /> License to the bid ] C_ Of: FD [Attach a copy of Contractor' s <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 : cvn rLs=_ <br /> 5 . What is the last project OF THIS NATURE that the firm has completed ? <br /> & Has the firm ever failed to complete work awarded to you ? 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 the firm failed to complete the work . ] <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 /> & 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 . ] <br /> 00456 - 1 00456 - Qualifications Questionnaire . doc <br /> FAPublic Works\ENGINEERING DIVISION PROJECTS\1142-Mist Culvert ReplacementsWdmim\bid documents\00456 - Qualifications Questionnaire.doc <br />