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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 of all <br /> statements and answers herein contained . Failure to comply with these requirements may be <br /> considered sufficient justification to disqualify a Bidder . Attach additional sheets as required . <br /> Documentation Submitted with Project No : 0923A <br /> Project Name : Trans = Florida Greenway Trail ( North County Park to Sebastian Crossinqs <br /> Blvd . <br /> 1 . Bidder' s Name / Address : <br /> 2 ._ Bidder ' s Telephone & FAX Numbers : r( 17 2 - � (G. -� - �' 0 ( 'Vt 0 k <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? <br /> b . Bidder' s Contractor License No : LC C'_ b `57 z2 !A C10 [Attach a copy of Contractor's <br /> License to the bid] <br /> c . Attach documentation from the State of Florida Division of Corporations that indicates the <br /> business entity's status is active and that lists the names and titles of all officers . <br /> 4 . Number of years the firm has performed business as a Contractor in construction work of the <br /> type involved in this contract : vz_ s <br /> 5 . What is the last projreqt OF THIS NATURE that the firA has comple d ? <br /> C' <br /> 6 . Has the firm ever failed to complete work awarded to you ? >K.) o <br /> [ If your answer is "yes , then attach a separate page to this questionnaire that explains the <br /> circumstances and list the project name , Owner , and the Owner' s telephone number for each <br /> project in which the firm failed to complete the work . ] <br /> 7 . Has the firm ever been assessed liquidated damages ? if )o <br /> [ If your answer is "yes , then attach a separate page to this questionnaire that explains the <br /> circumstances and list the project name , Owner , and the Owner' s telephone number for each <br /> 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 <br /> circumstances and list the project name , Owner , and the Owner' s telephone number for each <br /> project in which OSHA violations were alleged . ] <br /> 00456 - t 00456 - Qualifications Questionnaire . doc <br /> F .\Public Works\ENGINEERING DIVISION PROJECTS\0923A Trans Florida Greenway (At Sebastian River Middle School )\Admiru\Contract Documents\00456 - Qualifications <br /> Queslionnaire . doc <br />