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III 11*111111rolilk <br />NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NOW <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 cmnnpk/ with these requirements <br />nl8ybeC0nmidered sufficient justification to disqualify Bidder. Attach additional sheets as <br />Documentation Submitted with Project No: IRC -1 305 <br />Project Name: CR 512 RESURFACING & SHOULDER WIDENING FROM MYRTLE <br />STREET TO 125Lh AVENUE <br />1. Bidder's Name / Address: Community Asphalt Corp. <br />2975 Industrial Boulevard Vero Beach. FL 32967 <br />2. Bidder's Telephone & FAX Numbers: -,Ph: (786) 418-3561; Bax: (772)7T0-3707 <br />3. Licensing and Corporate Status: <br />o. IsContractor License current? Yes <br />b. Bidder's Contractor License Nu:CGC1521192 [Attach acopy ofContractor'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: 38 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />Please see attached list of projects 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 nanne,[}vvner,ondthe{}vvner'ste|eohongnunnber <br />for each project in which the firm failed to complete the work.] <br />7. Has the firm ever been assessed liquidated donlaoae? 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 Owners telephone number <br />for each project invvhich|iquidoteddamnogeshavebeenasooGsad] <br />8.' Has the firm ever been charged by OSHA for violating any OSHA regulations? No- <br />oo400'Qualifications ouesmonnai,e <br />uo*na' / <br />,Alo"m=w"m"XEwsINscnINsDIVISION ppoJEcTSxz05-Cnmzpes" (Scop)_". °St*`zwam^"*wmuoctim°ntskM.*"Contract o="men*SX0ow56' <br />Qualifications Quesfionnaire^doc <br />