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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 />0N'RE3POM3|BLEB|DOERS. <br />UNDER PENALTY OF PERJURY, the undersigned Bidder Guaiantees 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 -1362 <br />Project Name: OLD OIXIE HIGHWAY AND HEGHLAND DRIVE JNTERSECTION <br />IMPROVEMENTS <br />1. Bidder's Name / Address: Timothy Rose Contracting <br />1360 SW Old Dixie Hwy Suite io6 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: [G[o5294o [Attach a copy of Contractor's <br />Ooense to the bid] <br />� <br />c. Attach documentation from the State of Florida Division of Corporations that <br />indicates the business entity's status is active and that Iists the names and tities 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: 29 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />Sebastian Milling & Paving <br />6. Has the firrn 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 ist the projectnamn.0wner.undthaOwner'ote|ephonenvmber <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. Dwner, and the Owner's telephone number <br />for each pjao in which iquidated darnages have been assessed.] <br />8. Has the firm ever been charged by OSHA for violating any OSHA regulations? No <br />0045Qualifications Questionnaire <br />on*56'/ <br />pAPublic W°m*cwawEExwomvmmw,mucCTm``62m^Dixieu°yi,ghl=omx+*mwomuoc"ne^umest°oontra*oocum=mmo45*'Qu*mcatio° <br />