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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 />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: 1427 <br />Project Name: 45th Street Canal Enclosure at 43rd Avenue <br />1. Bidder's Nae (A` Tress:I,1(-) <br />r <br />2. Bidder's Telephone & FAX Numbers: - 72� ' [ t <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? E S , <br />b. Bidder's Contractor License NoOLX7 og30-2 -} [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: C& { - <br />5. What is the last project OF THISctIATURE that the firm has completed? <br />1 A: t. -- <br />f C= � C � fir`-'-s.-c YYvC`i k y--) Cr`sc:k in "-t Li Sc-�" C'4 i lCr Ctt c; i t't21k <br />t <br />6. Has the firm ever failed to complete work awarded to you? 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 the firm failed to complete the work.] <br />7. Has the firm ever been assessed liquidated damages? N 0 <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? [ 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 \1427 -45th St Canal Enclosure at 43rd Ave\Admin\bid documents\Master Contract Documents10O456 - Qualifications <br />Questionnaire.doc <br />