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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's: 0803, 0837, 0838 <br />Project Name: <br />17th Lane trom raicon i race rrolect tnirance to zu Hvenue. <br />kA 4t <br />Bidder's Name / Address: a • W • %- e" u"^" 10 <br />:3 34 u✓etpo-4 pis i w• P• B_ FL• 33413 <br />1. Bidder's Telephone & FAX Numbers: (5 41) t'i ? 1 — Li 1 e o <br />�S6I� Lo, 3 3 L 3' <br />2. Licensing and Corporate Status: <br />a. Is Contractor License current? YC 5 <br />b. Bidder's Contractor License No: r K Co 19 4 6 S [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 />LL <br />3. Number of years the firm has performed business as a Contractor in construction work <br />of the type involved in this contract: 3?3 YC4�s <br />4. What is the last project OF THIS NATURE that the firm has completed? <br />GrCCvAy;��✓ 5140 9� 13\.,, •oli j ai-w, �e.,v4 <br />jc�vL4 i✓► to rt.,_y 'IL Pkbl; L woo# ks Ds t <br />5. Has the firm ever failed to complete work awarded to you? A10 <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? AVD <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? !V� <br />00456 - Qualifications Questionnaire - REV 04-07 <br />00456-1 <br />F:\Engineering\Capital Projects\0803 17th Lane SW Roadway Improvements from 27th Ave to approx. 900 LF east of 27th Ave\0603 Contract Documents\00456 - <br />Qualifications Questionnaire - REV 04-07.doc <br />