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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br /> + <br /> NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON- <br /> RESPONSIBLE BIDDERS . <br /> + <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 : 0209 & 9321 <br /> Project Names : 4th Street 1 Cooch Ditch Bridge Replacement <br />+ 11th Street SW Paving & Drainage A <br /> 1 . Bidder's Name / Address h m �O �Q - ( 3 (DQ - S l V Old dku ) G <br />+ 2 . Bidder's Telephone & FAX Numbers : CT) -I1 a -�aD4 -1 <br /> 3 . Licensing and Corporate Status: <br />+ a. Is Contractor License current? <br /> b. Bidder's Contractor License No: C GCO 4 [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: O� o1 <br /> 5 . What is the last project OF THIS NATURE that the firm has completed? <br /> iso ` yam' <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 accessed 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 accessed . ] <br /> i 0209-00456 - Qualifications Questionnaire.doc <br /> 00456 - i <br /> F?Engineering\Capital Pmlec \[)209-0th Street Bridge Over Cooch DiichM09ith SUe Bndge Over Coo 07-20-0610203-00456 - Qualifications QuestimnaireAmRev. <br /> i OSlD1 <br />