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Attachment to Bid <br />Pre -Qualification Checklist (for Bidders that are not Pre -qualified) Section II <br />City of South Bend <br />Board of Public Works <br />VPA Restroom Remodeling <br />Project No. 118-043R <br />Bidder: Michiana Contracting, Inc.. <br />7843 Lilac Rd, PO Box 929 <br />Plymouth, Indiana 46563 <br />574-936-8613 <br />Section II (b) <br />(i) Indiana Secretary of State Business verification for Michiana Contracting Inc is attached <br />(ii) Michiana Contracting, Inc has no former business names <br />(iv) Michiana Contracting, Inc has no determinations by a court of governmental agency any <br />violations of federal, state, or local laws including, but not limited to, violations of <br />contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational <br />Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the <br />Preceding five (5) years. <br />(iv) Michiana Contracting, Inc has sufficient employees on staff to complete the work we are <br />bidding on, and also has the appropriate staffing capabilities, including labor sources to <br />meet the staffing needs of the work, if needed. <br />(v) All individuals who will perform work on the public work project on Michiana <br />Contracting, Inc's behalf will be properly classified as an employee or as an independent <br />Contractor under all applicable state and federal laws and local ordinances. <br />(vi) Evidence of participation in apprenticeship and training programs is attached. <br />(vii) Copy of a written plan for employee drug testing is attached <br />(viii) Evidence of utilizing a surety company listed on the Bureau of Fiscal Services certified <br />Sureties is attached <br />(ix) Michiana Contracting, Inc has no federal, state or local tax liens or tax delinquencies <br />owed to any federal, state or local taxing body in the preceding three years <br />(x) List of projects of similar size and scope is attached <br />Date: December 20 2018 <br />Signature: <br />Print Name: Scott Kirk atrick President <br />Company: Michiana Contracting, Inc. <br />Address: 7843 Lilac Rd PO Box 929 PI mouth Indiana 46563 <br />Phone: 574-936-8613 <br />