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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS 78 <br />Project Name Calvert Street Lift Station Replacement <br />Project No. 116-053 <br />For Bids Due <br />�ecentuer 6, Z V l E <br />From. time to time the South Bend Board of Public Works finds it necessary to reject a bid <br />because it does not comply with statutory requirements. In preparing your bid, please use the <br />following 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 />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/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 />Form [MWBE-2.11. <br />/16 Acknowledge Receipt of 1 82 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 />printed or typed underneath signature. <br />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: Woodruff & Sons, Inc. <br />By Authorized Representative: <br />Signature: <br />Print Name &Title: Todd R. Bell, Vice President <br />Version 10/1812016 Contractor's Sid for Public Works - 1 <br />Date: December 8, 2016 <br />