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rr <br /> 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 /> Ctthw+ �+4prl .Arjttt project Nos 0016 X 0236 <br /> Sub iflat s sats s t ) vsr < , <br /> Project Name : 41St Street Roadway Improvements <br /> S? . L � � T, vriLS y ��•C <br /> 1 . <br /> Bidder' s Name / Address : c��M►-- y . • - � d,� <br /> 2 . Bidder' s Telephone & FAX Numbers : 4&4 - 64ss > <br /> b 0155 9 ak <br /> 3 . Licensing and Corporate Status : <br /> a . Is Contractor License current? Yew <br /> �. b . . Bidder' s Contractor License No : cow. M14olto [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 /> ow 4 . Number of years the firm has performed business as a - Contractor in construction . work <br /> of the type involved in this contract: 75 <br /> 5 . What is the last project OF THIS NATURE that the firm has completed ? <br /> 6 . Has the firm ever failed to complete work awarded to you ? 1- e, <br /> [If your answer is "yes , then attach a separate page to this questionnaire that explains <br /> +r 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 /> S. 7 . Has the firm ever been accessed liquidated damages ? MV <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 /> 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations ? 1� y <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 /> ',Ido 1 ` 0016-00456 - Qualifications Questionnaire <br /> +_:; <br /> :+: : 00456 - i <br /> .; <br /> F'.1Englneering\Capital Projects\0016 & 0236- 41st Street tmprovements\0016 & 0236.41st St Contract Docs\0016.00456 - Qualifications Questlonnaire.doc. Rev. <br />05/01 <br />