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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br />aw <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 may <br />be considered sufficient justification to disqualify a Bidder. Attach additional sheets as required. <br />4r Documentation Submitted with Project No: 9611 <br />Project Name: CR 512 PHASE IV ROADWAY IMPROVEMENTS <br />1. Bidder's Name / Address: <br />2. Bidder's Telephone & FAX Numbers: <br />411 3. Licensing and Corporate Status: <br />a. Is Contractor License current? <br />b. Bidder's Contractor License No: [Attach a copy of Contractor's <br />r. 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 all <br />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: <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? <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? <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 - REV 04-07.doc <br />00456-1 <br />F:\Engneering\Capkal Prcieds19811-CR 512 Wdening\gett CR 512 PHASE pAContmd Doruments\00456 - Qualifications Questannalm - REV O"7.doc <br />