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City of South Bend Sewer Insurance Program Policy Revision
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City of South Bend Sewer Insurance Program Policy Revision
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3/28/2025 12:49:11 PM
Creation date
11/9/2016 10:16:11 AM
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Board of Public Works
Document Type
Contracts
Document Date
11/8/2016
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Pre -Qualification Category <br />Second Opinion Excavation Special <br />❑ ❑ ❑ <br />Attach copies of the following documents: <br />1. License Number <br />2. Bond letter stating limits for single project and aggregate program <br />3. (Corp. or LLC Only) Corporate authority and/or proof of registry with the Secretary of State to <br />do business in Indiana <br />Principal Place of <br />Business: <br />Mailing Address: <br />Telephone: <br />Cell: Fax: <br />E-Mail: <br />Ownership Information <br />(Identify all owners ifthe <br />Company, ifapplicable) <br />Nature of Company's <br />Business <br />(Briefly describe the type of <br />services yourcompany provides) <br />(Provide references as needed to <br />validate experienceforspecific <br />pre -qualification) <br />OSHA Competent Person <br />Certification <br />(Name ofholder, expiration date) <br />13 <br />
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