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shown in the original contract if accepted by the Cit of South Bend. If the bid is to be awarded on a unit <br />basis, the itemization of the units shall be shown on �,parateachment. <br />w.. <br />By <br />aiasre <br />(Printed la3me of Person _ -._ --`_-._ <br />Signing) <br />ACCEPTANCE <br />The above bid is accepted this day of <br />Subject to the following conditions:. <br />BOARD OF PUBLIC WORKS <br />Gary A. Gilot, President <br />Elizabeth A. Maradik, Membe r <br />James A. Mueller, Member <br />Suzanna M. Fritzberg, Member <br />..................— <br />Therese J. Dorau, Member <br />Attest: Linda M. Martin, Clerk <br />PART II <br />(For projects of $100,000 or more — IC 36-1-12-4) <br />i' • <br />These statements to be submitted under oath by each bidder with and as part of his/her/its bid. <br />Attach additional pages for each section as needed. <br />SECTION I EXPERIENCE QUESTIONNAIRE <br />1. Attach information regarding projects your organization has completed for the period of one <br />(1) year prior to the date of the current bid. <br />2. Attach a listing of public works projects currently in process of construction by your <br />organization. <br />3. Attach information regarding any failure to complete any work awarded to you and the <br />location thereof. <br />4. Attach references from private firms for which you have performed work. <br />SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE <br />" on of • plan or <br />include a narrative of when! you could begin work, complete the project, number of workers, <br />M other informationyou believe would enable the City of • to <br />consider• <br />2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside <br />your own firm who have performed part of the work) that you have used on public works <br />projects during the past five (5) years along with a brief description of the work done by each <br />subcontractor. <br />3. If you intend to sublet any portion of the work, attach the name and address of each <br />subcontractor, equipment to be used by the subcontractor, and whether you will require a <br />Version 7/20/201 S Contractor's Bid for Public Works - 3 <br />