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r <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 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 /> r 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 ProjedsM11-CR 512 Widening\gett CR 512 PHASE PAContmd Dorumenls\00456 - Qualifications Questionnaire - REV O"7.doc <br />