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Bid No. 2018043/IRC-1523 <br />BIDDERS 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 of all <br />statements and answers herein contained. Failure to comply with these requirements may be <br />considered sufficient justification to disqualify a Bidder. Attach additional sheets as required. <br />Documentation Submitted with Project No: IRC -1523 <br />Project Name: 43RD AVENUE BRIDGE OVER IRFWCD SOUTH RELIEF CANAL RAILING <br />REPAIR <br />1. Bidder's Name / Address: Timothy Rose Contracting <br />1360 SW Old Dixie Hwy Suite 106 Vero Beach FL 32962 <br />2. Bidder's Telephone & FAX Numbers: 772.564.7800 / 772.564.7888 <br />3. Licensing and Corporate Status <br />a. Is Contractor License current? Yes <br />b. Bidder's Contractor License No: CGCO52940 [Attach a copy of <br />Contractor's 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 all <br />officers. <br />4. Number of years the firm has performed business as a Contractor in construction work of the <br />type involved in this contract: 27 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />Old Dixie Hwy Phase II <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 for <br />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 for <br />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 />Page 18 of 37 <br />