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"SpUT'H AF <br />CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name 2021 Street and Sewer Material Bid <br />Project No. 121-018 <br />For Bids Due April 131 2021,a.m., Local Time <br />From time to time the South Bend Board of Public Works finds it necessary to reject a bid because <br />it does not comply with statutory requirements. In preparing your bid, please use the following <br />checklist in order to make sure that your bid is done in the proper manner. <br />/ Proper bid security included. The bidder has the option of providing either a Certified Check <br />r� or Bid Bond, <br />Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />executed, <br />/Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />Certification of use of United States Steel Products or Foundry Products. <br />Proof of MWBE Utilization Plan [MWBEA,0], If minimum participation goal is not met, also <br />provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MWBE Contacted Form <br />[MWBE-2.1 ], <br />Acknowledge Receipt of Addendum(s) included with the bid. <br />All required additional information is included with the bid, <br />V Proposal statements and other affidavits all signed by the proper party with name either <br />printed or typed underneath signature. <br />This checklist submitted with the Bid, <br />This checklist is provided for bidder's use in assuring compliance with required <br />documentation; however, it does not include all specifications requirements and does not <br />relieve the bidder of the need to read and comply with the specifications. <br />Bidder: rtr9ttS&J WOL tC WZP" Date: 2 <br />r <br />By Authorized <br />Signature: <br />Print Name &Title: j �py�/Ips (yyt <br />Version 01/13l2021 Contractor's Bid for Public Works - 1 <br />