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Project Name <br />Project No. <br />For Bids Due <br />-Lincoln Way West and Charles Martin Sr. Drive Improvements <br />117-072A <br />June 12, 2018 <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-2.0] and MBEfWBE Contacted <br />Form [MWBE-2.1]. <br />Acknowledge Receipt of I 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 bid!d'er'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: HIP CONSTRUCTION INC. Date: June 12, 2018 <br />By Authorized Representative: <br />Signature: <br />Print Name & Title: Matthew D. Cain, President <br />Version 10/17/2016 Contractor's Bid for Public Works - 1 <br />