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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 />Documentation Submitted with Project No: IRC -1727 <br />Project Name: C.R. 512 BRIDGE REPAIRS (FDOT #884078 &#884079) <br />1. Bidder's Name / Address: Proshot Concrete, Inc 4158 Musgrove Drive Florence, AL <br />35630 <br />2. Bidder's Telephone & FAX Numbers: 256-764-5941 Phone 256-764-5946 Fax <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? Yes <br />b. Bidder's Contractor License No: CGCO22040 [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: 14 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />Florida DOT Contract E2V83-RO Count Wide Bridge Repair and Rehab in 18 counties <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? Yes <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 WorkAENGINEERING DIVISION PROJECTS\1727 CR -512 EB & WB Bridge (88407879) Repairs\t-AdminTid DocumenlsV "ter Contract Documents100456- <br />Oualificatlons Questionnaire.doc <br />