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ti <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 />9. Has the firm ever been charged with noncompliance of any public policy or rules? <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.] <br />10. Attach to this questionnaire, a notarized financial statement and other information that <br />documents the firm's financial strength and history. <br />11 Has the firm ever defaulted on any of its projects? YN4 <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 a default occurred.] <br />12. Attach a separate page to this questionnaire that summarizes the firm's current <br />workload and that demonstrates its ability to meet the project schedule. <br />13. Name of person who inspected the site of the proposed work for the firm: <br />PIVS.C.. <br />Name: 1 VIM Date of Inspections: i _ 31.1-1 <br />14. Name of on-site Project Foreman: <br />Dovvivi,q03d <br />Number of years of experience with similar projects as a Project Foreman: ZO <br />15. Name of Project Manager: CVWQ <br />Number of years of experience with similar projects as a Project Manager: 3$ <br />16. State your total bonding capacity: to W. LT>G`\ <br />17 State your bonding capacity per job: 5 mitlI is ,i <br />18. Please provide name, address, telephone number, and contact person of your <br />\�9 <br />bonding company: CS ,CL <br />1°0 NA 1a G 0-4-1 <br />[The remainder of this page was left blank intentionally] 44n-1 <br />coo (12 -N <br />00456 - Qualifications Questionnaire <br />00456 - 2 <br />F:1Public Works\ENGINEERING DIVISION PROJECTS11139-CR 512 Wbnd Resurfacing -Roseland Rd to US 1-SCOPlAdmim\bid documents\Master Contract <br />Documents \00456 - Qualifications Questionnaire.doc <br />