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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WOP%K <br />CHECKLIST FOR BIDDERS <br />Project Name Jefferson and Twyckenham Signal Improvements <br />Project No. 116-027 <br />For Bids Due JW�r2W December 19, 2017 at gam <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 laid 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 />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 MBEIWBE Participation Goal Form (MWBE-1.0]. If minimum participation goal Is not <br />met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBEIWBE Contacted <br />X Form [MWBE 2.1]. <br />X Acknowledge Receipt of 1 Addendum(s) included with the bid. <br />X 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 provider) for bidders 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: Pemberton Davis Electric, Inc. <br />By Authorized <br />Signature: <br />Print Name & <br />Date: 12/19/2017 <br />Version 10/17/2017 Contractors Did for Public Works -1 Addendum #1 <br />