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IM <br />=CTION 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 />In sidered sufficient 'ustification to disqualify a Bidder. Attach additional sheets as <br />I ay a con <br />required. <br />Documentation Submitted with Project No: 9705B <br />Project Name: Oslo Road (CR 606) / Lateral "J" Canal Bridge Replacement <br />1. Bidder's Name / Address: LlArs lw44Qi&1r c'DrlST6LLLC7n-0ti( 00C - <br />3t&o RE <br />2. Bidder's Telephone & FAX Numbers: iii asp-sixr <br />1�4\L hl;g N ea%�V - 113`1 <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? ties <br />b. Bidder's Contractor License No: Cki!.Q9990S [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: 18 <br />5. <br />C09 <br />lr7 <br />Ele <br />What is the last project OF THIS NATURE that the firm has completed? <br />Has the firm ever failed to complete work awarded to you? 1�( <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 />Has the firm ever been assessed liquidated damages? <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 />Has the firm ever been charged by OSHA for violating any OSHA regulations? <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 - t <br />FAPublic Works\Capital Projects\Oslo Road Lateral J\BID DOCUMENTS\00456 - Qualifications Questionnaire.doc Rev, 05/01 <br />00456 - Qualifications Questionnaire <br />