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SECTION 00455 - 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 : 9219 <br /> Project Name : EAST GIFFORD STORMWATER IMPROVEMENTS <br /> 1 . Bidder's Name / Address : { a, <br /> t 1, <br /> 2 . Bidder's Telephone & FAX Numbers . 7 get 1 <br /> 3 . Licensing and Corporate Status : `/ S <br /> a . Is Contractor License current? e <br /> b . Bidder's Contractor License No: C_q�-G o t'F o '77 7 [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: � q5MYR5 er <br /> 5 . What ishe last project OFT S TURF that the firm has completed? <br /> n / A )c1 tis <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? 0 <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 liquidated damages have been assessed .] <br /> 8 . Has the firm ever been charged by OSHA for violating any OSHA regulations ? h J40 <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 - Qualifications Questionnaire <br /> ,.. . 00456 - t <br /> FAPublic WarksWetthAA6Stornmeter Projectsafford EsstlCenstrudion ContracMdOng & Contract DoasnentAUNdding & Contract Deaunenb100458 - Quati8a8ons 65 <br /> Questtonnalre doc Rev. 05101 <br />