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0045 - ?(e,'P, ,:, ; ot• s :%UESTIONNAIRE <br />OTICE: THE OWNER RETAINS THE D TO REJECT THE BIDS OF NON- <br />SPONSIBLE BIDDERS. <br />UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees the truth and accuracy <br />all statements and answers herein contained. Failure to comply with these requirements <br />—1,/ be considered sufficient justification to disqualify a Bidder. Attach additional sheets as <br />-_quired. <br />Documentation Submitted with Project No: 0845B <br />Project Name: Old Dixie Highway Sidewalk Improvements <br />(38th Lane to 45th Street) <br />Bidder's Name /. ddress: <br />3'ttO J\ai� w <br />2 Bidder's Telephone & FAX Numbers: -772-54m .11- (�D % 7 �2: j'it, `r , �� <br />Licensing and Corporate Status: <br />a. Is Contractor License current? CS <br />b. Bidder's Contractor License No' (-C.05-291;-6 [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 />j Number of years the firm has performed business as a Contractor in construction work <br />of the type involved in this contract: 2_5- <br />What <br />S <br />What is the last project OF THIS NATURE that the firm has completed? <br />Cita 1)\‘,11,- Awl az f G t 'e <br />3. Has the firm ever failed to complete work awarded to you? K1 0 <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? 140 <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? 3°vO <br />0045 s .; ___,,c;nnaire doc <br />00456 - 1 <br />C:1Documents and Settingslmnixon\Local Seuinr_•,e a—: z- ;rnet Files \OLK21\00456 - Qualifications Questionnaire.dec <br />•-•;v r' :•ems �- �•�-i-.= a..y+�•�:.e tre_ =s: ^via• <br />