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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: 0455 <br />Project Name: 8"' Street Sidewalk Improvements from 18th Court to Old Dixie Hwy. <br />1. Bidder's Name/ Address: S- P S. No-Irac finq T►AC . 11 ejo 15 Ame --(cQha PJ.) <br />Sou 1-,# 1 VLr'o &-n-7C_ o F:L 3Z9(a (o <br />2. Bidder's Telephone & FAX Numbers: -7 7 z -'77 9- 4 8 -7 9 n h t'n e <br />-77-779-28(a..)- f ,,-g <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? S <br />b. Bidder's Contractor License No: CG Oo-7541 [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: I :ki mcs <br />5. What is the last project OF TIS NATURE that the firm has completed? <br />C4,4 I-,( & P f� ( s"-cre V a -v i " -i '(-) rrcz; viae! e <br />6. Has the firm ever failed to complete work awarded to you? N O <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? N o <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? N Q <br />00456 - Qualifications Quwdonnaire.doc <br />00456 -1 <br />F4Publlc Wa k904GINEERING DMSION PROJECTSW455431h Street Sldemlk NrPMVW nts 1®th Ct b Old MIdAdatmWd douffron M5S - Oueilfla UMS <br />Quesuomslm.doc <br />