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Aā€žpā€¢:.. <br />4yOVTH <br />h 9, <br />Vi O <br />CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Chet Waggoner Court <br />Project No. 116-006 <br />For Bids Due August 18, 2016 <br />From time to time the South Bend Board of Public Works finds it necessary to reject a bid because <br />it does not comply with statutory requirements. In preparing your bid, please use the following <br />checklist in order to make sure that your bid is done in the proper manner. <br />Proper bid security included. The bidder has the option of providing either a Certified Check <br />or Bid Bond. <br />āœ“ Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />Certification of use of United States Steel Products or Foundry Products. <br />Proof of MBE/MBE Participation Goal Form [MWBE-1 0] If minimum participation goal is not <br />met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted <br />Form [MWBE-2.1]. <br />Acknowledge Receipt of 1 Addendum(s) included with the bid. <br />1/ All required additional information is included with the bid. <br />Proposal statements and other affidavits all signed by the proper party with name either <br />printed or typed underneath signature. <br />This checklist submitted with the Bid. <br />This checklist Is provided for bidder' se in assuring compliance with required <br />documentation; however, it does not ' cl a all specifications requirements and does not <br />relieve the bidder of the need to rea 4ndoompy with the specifications. <br />Bidder: Walsh & Kell i Inc. Date' August 18, 2016 <br />By Authorized Representati e: āœ“ <br />Signature: / v <br />Print Name & Title: rXl, ri Hilani Araa Mpnnnar <br />Version 7/3112015 Contractor's Bid for Public Works - 1 <br />