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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 : 1102 . <br /> Project Name : Old Dixie Hinhway Sidewalk Improvements from 8t' St. to S . R. 609 <br /> 1 . Bidder's Name / Address. <br /> 13 6 s � �5 <br /> 2 . Bidder's Telephone & FAX Numbers : 17 v? ;Z — - '7 A CIU <br /> 1111 a - 56 '4 R 88 <br /> 3 . Licensing and Corporate Status: vl . <br /> a . Is Contractor License current? <br /> b. Bidder's Contractor License No : a4C. 135 ;Z fl 4-b [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: 5 �1 <br /> 5 . What is the last project OF THIS 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? 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 /> r 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 . ] <br /> 00456 - Qualifications Questionnaire. doc <br /> 00456 - 1 <br /> FAPublic Works\ENGINEERING DIVISION PROJECTS\1102-0Id Dixie Hwy Swk 8th St to SR 60-LAP\Admim\bid documentsWlaster Contract Documents\00456 - <br /> Qualifications Questionnaire.doc <br />