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SECTION 00456 — QUALIFICATIONS QUESTIONNAIRE NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - RESPONSIBLE BIDDERS. UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees the truth and accuracy all statements of all and answers herein contained. Failure to comply with these requirements may be considered sufficient justification to disqualify a Bidder. Attach additional sheets as required. Documentation Submitted with Project No: 6381 Project Name: Oslo Road Boat Ramp Repairs l Pe: C" a y (oCT Oi 1, fes: x'1 (661') tife-Co Peel --, 1. Bidder's Name 1 Address:—�ii`�1,� P 2. Bidder's Telephone & FAX Numbers: 77 - Sty - s �` iy 77?- S - ?7 3, Licensing and Corporate Status: a. Is Contractor License current? Attach a copy of Contractor's b. Bidder's Contractor License No: 2 .7 ko License to the bid] c. Attach documentation from the State of Florida Division of Corporations that indicates the business entity's status is active and that lists the names and titles of all officers. 4. Number of years the firm has performed business as a Contractor in construction work of the type involved in this contract: 0 yep:$ r S. What is the last project OF THIS NATURE that the firm has completed? PA [3 } . U orb r 411 Wm, .11 *old Piga tc o Jeri" ihArzifla, A- k/ gero "It It Poc,a 1774ri t.4, 6. Has the firm ever failed to complete work awarded to you? /120 [If your answer is "yes, then attach a separate page to this questionnaire that explains the circumstances and list the project name, Owner, and the Owner's telephone number for each project in which the firm failed to complete the work.] 7. Has the firm ever been assessed liquidated damages? "'O [If your answer is "yes, then attach a separate page to this questionnaire that explains the circumstances and list the project name, Owner, and the Owner's telephone number for each project in which liquidated damages have been assessed.] 8. Has the firm ever been charged by OSHA for violating any OSHA regulations? V) [If your answer is "yes, then attach a separate page to this questionnaire that explains the circumstances and list the project name, Owner, and the Owner's telephone number for each project in which OSHA violations were alleged.] 00456 - Qualifications Questionnaire 00456 -1 ,� ; predar tctftl81 oslo Road Boat Ramp10381 Contract Documents and Spedfications10D456 - Qualifications QuestiOrinalre.doc