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II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a) Acknowledgements: <br />°�By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of <br />South Bend. <br />(ii) V"By checking this box, I hereby acknowledge that the City reserves the right to request <br />supplemental information, additional verification of any information provided, and may also conduct <br />random inquiries of my current and prior customers. The City reserved the right to utilize all information <br />provided in this submission and all information obtained in inquiries or requests to determine if a bidder <br />is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall <br />be regarded as public records. <br />(iii) I�By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship <br />certificates or standards for training programs applicable to the work performed on the project may be <br />requested at any time and shall be furnished upon request. <br />(iv) a By checking this box, I hereby acknowledge and ensure that I and all subcontractors, from whom <br />I have accepted a bid and/or intend to hire to perform work on the public work project, are properly <br />licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all <br />sub -contractors have the necessary licenses to undertake the work called for in this bid. If a <br />subcontractor loses their license at any point, it is the responsibility of that subcontractor to notify the <br />City. <br />NOTE: All T. George Podell & Co., Inc employees are trained in-house. <br />(b) Attachments: <br />(i) ZIndiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days <br />of the submission of said document showing that business is in existence, current with the Indiana <br />Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable <br />to individuals, sale proprietors or partnerships). <br />(ii) �st identifying all former business names. - Company name has always been T. George Podell & <br />Co., %ny <br />(iii) determinations by a court or governmental agency any violations of federal state, or local <br />laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, <br />environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related <br />Acts, with <br />in the preceding five (5) years. — Never have had any violations. <br />(iv) about staffing capabilities, including labor sources. This statement indicates and <br />ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I <br />intendto eet the staffing needs of the work. <br />7 <br />(v) „� Statement that individuals who will perform work on the public work project on my behalf will <br />be properly classified as an employee or as an independent contractor under all applicable state and <br />federal laws and local ordinances. <br />