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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name WWTP Digester Gas Utilization Design <br />Project No. 116-050 R <br />For Bids Due December 8, 2016 Y <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 />X Proper bid security included. The bidder has the option of providing either a Certified Check <br />or Bid Bond. <br />Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />X executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />X _ Certification of use of United States Steel Products or Foundry Products. <br />Proof of MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not <br />met, also provide Evidence of Good Faith Efforts Form [MWBE-2.01 and MBE/WBE Contacted <br />X Form [MWBE-2.1]. <br />X Acknowledge Receipt of 1 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 />X _ printed or typed underneath signature. <br />X 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: Thieneman Construction, Inc. Date: December 8th, 2016 <br />— -- _ <br />By naturAuthorized Representative: <br />Signature:__�--------- <br />Print Name & Title Vincent J. Rock - Area Manager <br />SB WWPP Digester Gas Utilization Design <br />Project No- 116-050 R 0041 00-1 Version 7/31/2015 <br />