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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: 1314 <br />Project Name: Vero Lake Estates Asphalt Millings Project (Phase I) <br />1. Bidder's Name / Address: DICKERSON FLORIDA, INC. <br />3122 N. 25TH ST., FT. PIERCE, FL 34946 <br />2. Bidder's Telephone & FAX Numbers: (772) 429-4444, (772) 429 -4445 -FAX <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? YES <br />b. Bidder's Contractor License No: CGCG 60797 [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: 57 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />J.W. Corbett WMA for Florida Fish & Wildlife <br />6. Has the firm ever failed to complete work awarded to you? 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 />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 />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? 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 />for each project in which OSHA violations were alleged.] <br />00456 - Qualifications Questionnaire.doc <br />00456 1 <br />F:1Public WorksIENGINEERING DIVISION PROJECTS\1314107th Ave Milllrg90th St to 94th ShAdminlbid documentslMaster Contract Documents100456 - Qualifications <br />