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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 : Paving and Drainage Improvements to 17th Lane SW from 27th <br /> Avenue to East approx. 900 ' 20t Avenue from 21 ,5' Street SW to 17'h Lane SW , and <br /> 17th Lane from Falcon Trace Proiect Entrance to 20 Avenue . <br /> Bidder's Name / Address : ""5 • \ev • C % e c. C4~ 10 ALL <br /> :3 3 Z etkjpe ass 4 Pis i w • P • B_ F � • 33413 <br /> 1 . Bidder' s Telephone & FAX Numbers : ( 5 41 ) t'i ? 1 - Li 1 e o <br /> � 5JI L, 71 - 3 L &A <br /> 2 . Licensing and Corporate Status : <br /> a . Is Contractor License current? 5 <br /> b . Bidder's Contractor License No : r K Cc 1 �3 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 /> 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 /> GV'GcAVIcw 5 14 0 9 : j3 \ ., , -:e . pa1cc 40 <br /> vGI ✓► tierr ., y PkbItt wd � ks UcPt <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? N° <br /> [ your our 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 />