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e�suu r'fa RQ <br />4 <br />CITY OF SOUTH BEND, INDIANA 1� <br />CONTRACTOR'S BID FOR PUBLIC WORK 1865 <br />CHECKLIST FOR BIDDERS <br />Project Name Berlin Place Site Development <br />Project No, 116-089 <br />For Bids Due November 17, 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 />t/ or Bid Bond. <br />✓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 />V Certification of use of United States Steel Products or Foundry Products. <br />Proof of MBEANBE Participation Goal Form [MWBE-1.01. If minimum participation goal is not <br />/ met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBEANBE Contacted <br />Form [MWBE-2.11. <br />I Acknowledge Receipt of I Addendum(s) included with the bid. <br />✓ 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 />V printed or typed underneath signature. <br />L/ This checklist submitted with the Bid. <br />This checklist is provided for bidder's use in assuring compliance with required <br />documentation; however, it does not include all specifications requirements and does not <br />relieve the bidder of the need to read and comply with the specifications. <br />Bidder:r�fgi,�C(� �ytC, Dale: /� <br />By Authorized Representative - <br />Signature: <br />Print Name & Title: MCI ek �7sle � pJ—Si z d <br />Version 10/1812016 Contractoi's Bid for Public Works - 1 <br />