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NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NOW <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: 0217 <br />' Project Name: Powerline Road from C R 510 North to the Sebastian City Limits <br />1. Bidder's Name/ Ad ress: <br />-7 al Gw CSC <br />2. Bidder's Telephone & FAX Numbers: _�- `l l - I-1 l 0( <br />3. Licensing and Corporate Status: _ <br />a. Is Contractor License current? YeS <br />b. Bidder's Contractor License No: rack 1\ [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: qR VeLLrs <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />2Or'�.o.. *rftr Ph1w,1.2e n rat 11YL Ys neii Ae— rl -'. <br />NNNnAxC Works QC42 . <br />NO <br />6. Has the firm ever failed to complete work awarded to you? <br />t[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? /uD <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? n10 <br />00456 - Qualifications Questionnaire <br />00456 - t <br />F:%Engir»eriny\Capital Projeets\0217-Powerline Road\Bid DocumentsWo456 - Qualifications Queslionnaire.doc <br />