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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 -2002 <br />Project Name: 66TTH AVENUE & 8T—" STREET SIGNALIZATION IMPROVEMENTS <br />Bidder's Name / Address: <br />2. Bidder's Telephone & FAX Numbers: —Telephone: (772) 286 -5123 -Fax: (772) 286-5139 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? Yes <br />b. Bidder's Contractor License No: CGC1509418 - EC13006679 <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. <br />4. Number of years the firm has performed business as a Contractor in construction work of <br />the type involved in this contract: 17 years <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />_US1 & 22nd Street Intersection <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 <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 />FAPublic WorWENGINEE RING DIVISION PROJECTSX2002 66th Ave and 8th St Signali7alionll-AdmInTids1Bld DocumenlsVV 0 2 Bidding Documents-20201002.docx <br />