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CHECKLIST FOR BIDDERS <br />Pro'ect Name Berlin Place — Site Concrete, Landscape Plantings, and Bldg. 4 Roof <br />J —Pavers" <br />Project No. 118-067 <br />For Bids Due 6/12118 <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 />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 MBENVBE 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 MBEANBE Contacted <br />X Form [MWBE-2.1], <br />x Acknowledge Receipt of 3 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 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: Ziolkowski Construction, Inc. Date: June 12, 20.1.8._._ <br />By Authorized Representative: <br />Signature- <br />Print Name & Title: Bill Favors, President <br />Version 10/17/2017 Contractor's Bid for Public Works - 1 <br />