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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 : 9701 <br /> Project Name: Oslo Road (CR 606) Phase I Roadway Widening <br /> 1 . Bidder's Name / Address: I 11-� l r nrrz Cc <br /> 2 . Bidder's Telephone & FAX Numbers: 11 �A � S'qL/)w 3- J 3 <br /> 9TI - 541 . H2E� <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? <br /> b . Bidder's Contractor License No . k': 37 [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: JD <br /> 5 . W at, iis� th last roject20F THS NAT `U(R�E� tth�a't the <br /> /firm <br /> /ppas ompleted? <br /> Ill r el 1� 1 � JI 1 I Be#gC ` �. <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 Owners 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? _W <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? Ab <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 /> 9 . Has, the firm ever been charged with noncompliance of any public policy or rules? <br /> [ ifyouranswer 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.] <br /> 00456 - Qualifications Questionnaire <br /> 00456 - i <br /> PAPublic WorkslCaldital Projects%Oslo Road\Oslo Widening, Old Olxie W 27th AveXCONTRACT OOCUMENrOO456 - Quallficetione Queafionnaire.dac Rev. OU01 <br />