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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: 1705 <br />Project Name: INDIAN RIVER COUNTY ADMINISTRATION COMPLEX BUILDINGS A & B <br />ROOF REPLACEMENT <br />1. Bidder's Name /Address: Advanced Roofing, Inc. <br />1950 NW 22nd Street, Fort Lauderdale, FL 33311 <br />2. Bidder's Telephone & FAX Numbers: (954) 522-6868 phone / (954) 522-2967 fax <br />3. Licensing and Corporate Status: <br />a. Is Contractor license current? Yes <br />b. Bidder's Contractor License No: CCCO24413 [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: 33 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />See attached project list <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 />There have been no violations in the previous three years. See attached OSHA 300 logs. <br />Further information can be provided upon request. <br />00456 - Qualftations Questionnaire.doc <br />00456 -1 <br />FAPublio WorksNENGINEEMNG DIVISION PROJECTSl1705 BulldinBs A& B Roof Noacemenfll-AdminUNd DocunientsWaster ContmdDocuments100456 - QueBOoetlons <br />QuesUannalm.doc <br />