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4 7 <br /> + • SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br /> NOTICE : THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON- <br /> • RESPONSIBLE BIDDERS . <br /> 1 <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 : 0219 <br /> 1 Project Name : KITCHING STATION TRAILHEAD L ��. <br /> 1 . Bidder's Name / Address : �AeTt!- CGktS?� 7to�J� � <br /> 17n ZA 0 44 Rlym bwc> V"o $EJaC14 FL .3ZI &O <br /> ZoZ <br /> 2e, Bidder's Telephone & FAX Numbers : 11 Z - 'Me 30"72. 7e7Z- 7�) 0 • 30i7 <br /> 3 . Licensing and Corporate Status : J <br /> a. Is Contractor License current? <br /> b. Bidder's Contractor License No: 46 CCo [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 enfity'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: Z l UrAg. <br /> 5 . What is the last project OF THIS NATURE that the firm has completed? <br /> Yes <br /> 6. Has the firm ever failed to complete work awarded to you? �_ <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? <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? .0 <br /> k <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 /> 0219-00456 - Quaiiflcations Questionnaire <br /> 00456 - t <br /> FAEnp RWn9lCap1tM Frq)sdsW2194Qtrh1np Ste0an TroilheaM21910tcNn¢Contrad DopW219.W458 - pwlMptlan QunUonneirsAx Rev. 05101 <br />