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U. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE-QUAUF|ED) <br />(a)Acknowledgements: <br />(i) _�_ By checking this box. | hereby acknowledge that | am note pre -qualified bidder <br />with the City ofSouth Bend. <br />By checking this box. | hereby acknowledge that the City reserves the right to <br />request supplemental information, additional verification of any information <br />prmvided, and may Wmm conduct random mqm|r|es of my current and prior <br />customers, The City reserved the right to utilize all information provided in this <br />submission and all information obtained in inquiries or requests to determine if <br />bidder is responsive and responsible. Additionally, | acknowledge that all <br />information provided to the City shall be regarded as public records. <br />(iii) By checking this box. U hereby acknowledge that copies of all Applicable <br />apprenticeship certificates or standards for training programs applicable to the <br />work performed onthe project meyberequeatedotanydmeondshm||befurnimhed <br />upon request. <br />(iv) By checking this box, | hereby acknowledge and ensure that | and all sub- <br />comtmactone.fromwhorn|haveVnceptodab|dand/orimtendtmhinetoper-fnnmvvork <br />onthe public work project, are properly licensed, Furthermore, | acknowledge nmy <br />understanding that it is my responsibility to ensure that all sub -contractors have <br />the necessary licenses to undertake the work oo||ad for in this, bid. If sub- <br />contractor |noem their license at any point, it is the responsibility of that sub- <br />contractor to notify the City. <br />(h) Abmchmont&: <br />(i) ___ <br />Indiana Secretary ofStateson-line records (ie. Business verification) dated within <br />sixty (60) days of the submission of said document showing that business is in <br />existence, current with the Indiana Secretary of States Business Entity Report, <br />and eligible for a certificate of good standing. (Not applicable to ind[vidueXs, sole <br />proprietors orpartmerahipa). <br />List identifying all former business names. <br />Any determinations by a court or governmental agency any violations of federal <br />state, or local laws induding, but not limited to, vio�ationa of contracting or antitrust <br />laws, tax orlicensing laws, environmental laws, Occupational Safety and Hmm|Mh <br />Act (OSH8).mrfederal Davis -Bacon and related Acts, within the preceding five(5) <br />years. <br />(iv) <br />Statement about staffing capabilities, including labor sources, This statement <br />indicates and ensures I have sufficient employees on staff to complete the work I <br />am bidding on DR mmt|imeo how | intend to meet the staffing needs of the work. <br />(v) ___ <br />Statement that individua;s who will perform work on the pubfic work project on my <br />behalf will be properly classified as an employee or as an independent contractor <br />under all applicable state and federal laws and local ordinances. <br />(vN <br />For every project, submit evidence of participation in apprenticeship and training <br />proOnems, applicable to the work to be performed on the project, which are <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor organization. <br />(v[i) <br />Copy of written plan for employee drug testing that covers all of my employees <br />who will perform work on the public vvodK project and meets or exceeds the <br />requirements set forth in |C4-13'18-5or|C4-13-18-6. <br />/viii\ <br />Evidence that | am utilizing a surety company which is on the Bureau of Fiscal <br />Service "Department of Treasury's Listing of Approved Sureties" as required in the <br />bid specifications or contract. <br />VeaionU1/29/2020 Geneqa|Conditiona-Q <br />