Laserfiche WebLink
111. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a)Acknowledgements: <br />U) ___ By checking this box | hereby acknowledge that | am not a pre -qualified bidder <br />with the City ofSouth Bend. <br />(ii) ___ By checking this box. | hereby acknowledge that the City reserves the right to <br />request supplemental information, additional verification of any information <br />provided, and may also conduct random inquiries of my current and prior <br />customers. The City mayen/ed the right to utilize all information provided in this <br />submission and all information obtained in inquiries or requests to determine if a <br />bidder is responsive and responsible. Additionally, | acknowledge that all <br />information provided tothe City shall beregarded aopublic records. <br />(ii|) By checking this box, | hereby acknowledge that copies of all Applicable <br />apprenticeship certificates or standards for training programs applicable 1othe <br />work performed unthe project may berequested atany time and shall befurnished <br />upon request. <br />(iv) By checking this box, | hereby acknowledge and ensure that | and all sub- <br />contractors, from whom I have accepted a bid and/or intend to hire to perform work <br />onthe public work project, are properly licensed. Furthermore, | acknowledge my <br />understanding that it is myresponsibility toensure that all sub -contractors have <br />the necessary |ioonaoo to undertake the work oe||ed for in this bid. If sub- <br />contractor loses their license at any poimd, it is the responsibility ofthat sub- <br />contractor to notify the City. <br />(b) Attachments: <br />0 __ <br />Indiana Secretary of State's on-line records (ie. Business verification) datedwithin <br />sixty (50) days of the submission of said document showing that business is in <br />exiatence, current with the Indiana Secretary ofSt*te'a Business Entity Repod, <br />and eligible for certificate of good standing. (Not applicable to indivkdua!o, sole <br />proprietors orpartnenohipu). <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 including, but not limited to, violations of contracting or antitrust <br />iavvs, tax or licensing laws, environmental |mwe. Occupational Safety and Health <br />Act (O8HA).orfederal Davis -Bacon and related Acts, withinthaprocadingfive(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 <br />ambidding onORoutlines how | intend bomeet the staffing needs ofthe work. <br />(v) ___ <br />Statement that individuals who will perform work on the public 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 />(vi) ___ <br />For every pnoject, submit evidence of participation in apprenticeship and training <br />programs, applicable to the work to be performed on the pro]ect, which are <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor organization. <br />NO ___ <br />Copy of a written plan for employee drug testing that covers all of my employees <br />who will perform work on the public work project and meets or exceeds the <br />requirements set forth in |C4-13-18-5or|C4-13'18-S. <br />(viii) <br />Evidence that | am utilizing surety company which is on the Bureau of Fiscal <br />Service "Department ofTreasury's Listing ofApproved Sureties" aarequired inthe <br />bid specifications orcontract. <br />Vorsion580/2O1S General Conditions -9 <br />