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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: 1123 <br /> Project Name: 43RD AVENUE SIDEWALK IMPROVEMENTS FROM AVIATION BOULEVARD <br /> TO AIRPORT DRIVE WEST <br /> 1. Bidder's Name 1 Address: —y(-CiJl� <br /> l t t NJ Z <br /> 2. Bidder's Telephone & FAX Numbers:"1-12- . <br /> 3. Licensing and Corporate Status: <br /> a. Is Contractor License current? <br /> b. Bidder's Contractor License No: [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 /> — <br /> 6. Has the firm ever failed to complete work awarded to you? <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? <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 /> 00456-Qualifications Questionnaire <br /> 00456-I <br /> P\Public WorWENGINEERING DIVISION PROJECTS\1123 43rd Ave Sidewalk Improvements 26th St,to Airport Dr West\AdmimUd documents\Master Contract <br /> Documents\00456-Qualifications Questionnaire.doc <br /> i <br />