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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Marriott Hotel Site Development at Hall of Fame, Phase 3 <br />Project No. <br />For Bids Due <br />117-064 <br />August 22, 2017 <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 />X or Bid Bond. <br />X 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 />X with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />Certification of use of united States Steel Products or Foundry Products. <br />Proof of MBEIWBE Participation Goal Form [MWBE-1.01. If minimum participation goal is not <br />X met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBEIWBE Contacted <br />Form (MWBE-2.1]. <br />X Acknowledge Receipt of 1 , 2. Addendum(s) included with the bid. <br />& 3 <br />X All required additional information is included with the bid. <br />X Proposal statements and other affidavits all signed by the proper party with name either <br />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: Selge Construct ion Co. , Inc. Date: 8/22/17 <br />By Authorized Representative: y <br />Signature: <br />Print Name & Title: uhns project g�n ineer <br />Version 10117/2016 Contractors Bid for Public Works - 3 <br />