Laserfiche WebLink
SECTION 00456 — QUALIFICATIONS QUESTIONNAIRE <br />NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - <br />RESPONSIBLE BIDDERS. <br />UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees 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: 1422 <br />Project Name: Aviation Boulevard/20th Avenue Intersection Improvements <br />1. Bidder's Name / Address: 5.c t s ( iS<+ u cf,' fri LJ c <br />'74/0/ Wh;ftwo..v <br />2. Bidder's Telephone & FAX Numbers: 7? z — /&. (- `✓ 3,4 <br />FAA' 7?Z-<,/(c-(-En39 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? e 7 <br />b. Bidder's Contractor License No: _ 5 15 c• _ [Attach a copy of Contractor's <br />License to the bid] c- c� r <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 <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: C '- <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />1.Q cliv�r' <br />6. Has the firm ever failed to complete work awarded to you? A1u <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? c - <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? A/c <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 />00456 - Qualifications Questionnaire <br />00456 - 1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1422 Aviation Blvd -20th Avenue Intersection Improvements\Admim\bid documents\Master Contract Documents100456 - <br />Qualifications Questionnaire.doc <br />