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WO <br />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 />OMR may be considered sufficient justification to disqualify a Bidder. Attach additional sheets as <br />required. <br />Documentation Submitted with Project No: 0225 <br />Project Name: 20th Avenue & 16th Street Intersection Improvements <br />1. Bidder's Name / Address: IAN! O. - t,{ c.ct <br />2. Bidder's Telephone & FAX Numbers 1Z• S -b t ,�1 QO/1-72_.x%4. -n <br />3. Licensing and Corporate Status: <br />a. !s Contractor License current? <br />b. Bidder's Contractor License No: C-, CC 2_` (1-O [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" <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: 2k.p <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />0 <br />6. Has the firm ever failed to complete work awarded to you? O <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'? NC\ <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? O <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 - <br />F \Public Works\ENGINEEFING DIVISION PROJECTS1522$ 20th .Ave and 16tr 51 Inlerect'en Improveme^t\Ac,im\oid documents1Maste' Conf'act Docu •erlslnn.tEr3 _ <br />Qua! bcahons Questionnaire dac - <br />