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i <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 -1324 <br />Project Name: 581H AVENUE RESURFACING/RECLAMATION FROM NORTH OF 26TH <br />STREET TO SOUTH OF 49TH STREET <br />1. Bidder's Name / Address. I %wA" Lie_ a r � <br />2. Bidder's Telephone & FAX Numbers: MZ J A.:: :R C)0 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? "AUS, <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 ofd <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: Z.-1 <br />5. What is the last project OF THIS NATURE that the firm has completed? <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? (),C; <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 />00456 - Qualifications Questionnaire <br />00456 - I <br />F:\Public Works\ENGINEERING DIVISION PROJECTSA1324 581h Ave Resurfacing (N. of 26th St to N. of 57th St)\t-Admin\Bid documents\Master Contract Documents\00456 - <br />Qualifications Questionnaire.doc <br />