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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 -2022 <br />Project Name: 4TH STREET CULVERT REPLACEMENT AT 901T—" AVENUE <br />Bidder's Name / Address: Florida Site Contra <br />2. Bidder's Telephone & FAX Numbers: 772 473-1072 Phone 772-778-5196 Fax <br />shaneb u�floridasitecontractinq.com Email <br />Licensing and Corporate Status: <br />a. is Contractor License current? YES <br />b. Bidder's Contractor License No: CLI C1225021 <br />[Attach a copy of 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 <br />of all officers. 51-55c, ATfi A CH E ? <br />4. Number of years the firm has performed business as a Contractor in construction work of <br />the type involved in this contract: 15+ dears <br />5 What is the last project OF THIS NATURE that the firm has completed? <br />Jacobin St @C-51 Canal Culvert Replacement for the City of Palm Bay. <br />6. Has the firm ever failed to complete work awarded to you? NO <br />[If your answer is ''yet", then attach a separate page to this questionnaire that explains <br />the circumstances and list the project name, Owner, and the Owner's telephone <br />number 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 <br />number 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 <br />number 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 />Qualifications Questionnaire - 00456 1 <br />R PublictNorkslENGINEERING DMSION PROJECTS120224th St Culvert Replacement at 00th AWI-AdminlBidslBid Documents101V 0 2 Sidding Douments- <br />20201 Mdocx <br />