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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: 1306 <br /> Project Name: Oslo Road Culvert Replacement. <br /> 1. Bidder's Name/Address: _ _ <br /> Cp <br /> 2. Bidder's Telephone & FAX Numbers: ` 1 <br /> 3. Licensing and Corporate Status: <br /> a. Is Contractor License current? <br /> b. Bidder's Contractor License No: - _ ? x [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: _ - <br /> 5. What is the last project OF THIS NATURE that the firm has completed? <br /> 6. Has the firm ever failed to complete work awarded to you? i_A z <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 /> F p.�f<� <br /> 7. Has the firm ever been assessed liquidated damages? s a f <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? i f. <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:\Publlc WorkstENGINEERING DIVISION PROJECTS\1306 Oslo Road(E of 15th Ave SW)Pipe culvert ImprovementWAmimUd documentst00456-Qualifications <br /> Questionnaire.doc <br />