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(a) <br />N By checking this box, | hereby acknowledge that | am not a pre -qualified bidder <br />with the City ofSouth Bend. <br />(ii) _V. By checking this box. | hereby acknowledge that the City neoameo the right to <br />request supplemental infomnetknn, additional verification of any information <br />provided, and may also conduct random inquiries 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 tothe City shall beregarded aopublic records. <br />(iii) V By checking this box. | hereby acknowledge that copies of all Applicable <br />apprenticeship certificates or standards for training programs applicable to the <br />work performed onthe project may berequested et any time and shall befurnished <br />upon request. <br />(iv) By checking this box. | hereby acknowledge and ensure that | and all eub- <br />contractons.from whom | have accepted a bid and/or intend tohire toperform work <br />onthe public work project, are properly licensed. Furthermore, | acknowledge my <br />understanding that it is my responsibility to ensure that all sub -contractors have <br />the necessary licenses to undertake the work called for in this bid. If sub- <br />contractor loses their license at any point, it is the responsibility of that sub- <br />contractor to <br />ub'oontraotorto notify the City. <br />(b) Attachments: <br />0) <br />Indiana Secretary of State's on-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 State's Business Entity Report, <br />and eligible fore certificate of good standing. (Not applicable to individua|a, sole <br />proprietors orpartnerah|pa). <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 ino|uding, but not limited to, violations of contracting or antitrust <br />laws, tax orlicensing laws, environmental |awo. Occupational Safety and Health <br />Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) <br />years. <br />(iv) V <br />Statement about staffing capabilities, including labor sources. This statement <br />indicates and ensures | have sufficient employees on staff to complete the work | <br />embidding onORoutlines how | intend tomeet the staffing needs ofthe work. <br />(v) 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 pnojeot, submit evidence of participation in apprenticeship and training <br />prognema, applicable to the work to be performed on the pnojeot, which are <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor organization. <br />(vii) �� <br />Copy of 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 |C 4-13-18-5 or |C 4-13'18-8. <br />(viii) °/ <br />Evidence that | am utilizing e surety company which is on the Bureau of Fiscal <br />Service "Department ofTreasury's Listing of Approved Sureties" as required in the <br />bid specifications orcontract. <br />Version 01/13/2021 General Conditions 9 <br />