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0 <br />0 <br />}t <br />a <br />0 <br />0 <br />0 <br />0 <br />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 ail 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: 0530B <br />Project Name: 13`" Street S.W. at 58'" Avenue Bridge <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 -phone <br />(772) 429 -4445 -fax <br />3. Licensing and Corporate Status: YES <br />a. is Contractor License current? <br />b. Bidder's Contractor License No: CGCG 6 0 7 9 7 [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 5 7 <br />5. What is the last project OF THiS NATURE that the firm has completed? <br />53rd Street Bridge project <br />6. Has the firm ever failed to complete work awarded to you? <br />no <br />[If your answer is ayes", 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 from failed to complete the work.] <br />7. Has the firm ever been assessed liquidated damages? rio <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 />B. 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 <br />F1PubicWbrblENGiNEERING OINSION PROJECT/310530e 13th Street SW et S81hr <br />Oundanaie.doe &Idpe1idnin1Wd documerdriftster Canlraet Doaaa 100156. Qsdlydbn <br />00456 - Qualifications Questionnalre.doc <br />