Laserfiche WebLink
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: IRC -1643 <br />Project Name: 27TH AVENUE AT 21ST STREET SW INTERSECTION/SIGNALIZATION <br />IMPROVEMENTS <br />Bidder's Name/ Address: <br />IrIC. <br />2. Bidder's Telephone & FAX Numbers:y)-1- `mC)q- b93oQ / H 0-1-W �a-Qp7(p <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? L1�� <br />b. Bidder's Contractor License No: E.0-l�)0 �\aCp53 [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: `)S <br />5. <br />What is the last project OF THIS NATURE that the firm has completed? <br />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? .LJ <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? <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 <br />00456-1 <br />F.WubHe Works\ENGINEERING DIVISION PROJECTS\1643 27th Avenue at 21st Street SW Intersection_Signa<zation Improvements\t-Admiri0d DocumentsWaster <br />Contract DocumentsMS6 - Qualifications Quesdonnaire.doc <br />