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NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - <br />RESPONSIBLE BIDDERS. <br />Documentation Submitted with Project No: IRC -0853 <br />Project (Name: SR 60 and 43fa AVENUE INTERSECTION IMPROVEMENTS <br />1. Bidder's Name / Address: Timothy Rose contracting <br />2. Bidder's Telephone & FAX Numbers: 772-564-7800 F 772-564-7888 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? Yes <br />b. Bidder's Contractor License No: CGC052940 [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 all <br />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: 28 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />49th Street Millina & Resurfacina IRC 1414 <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? 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 liquidated damages have been assessed.] <br />8. ' Has the firm ever been charged by OSHA for violating any OSHA regulations? 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 OSHA violations were alleged.] <br />9. Has the firm implemented a drug-free workplace program in compliance with Florida <br />Statute 287.087? Yes <br />00456 - Qualifications Questionnaire <br />00456 - 1 <br />FAPublic Works\ENGINEERING DIVISION PROJECTS\0853-43rd AVE 18th ST to 26th ST (Arcadis)\t-Admin\Bid Documents\Master Contract Documents\00456 - <br />Qualifications Questionnaire.doc <br />