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1 <br />09/14/2021 <br />4• <br />City of South Bend <br />Board of Public Works <br />Re: City of South Bend Prequalification Checklist Section II <br />Section II (b) <br />(i) Indiana Secretary of State Business Verification for Michiana Contracting Inc is attached. <br />(ii) Michiana Contracting Inc has no former business names. <br />(iii) Michiana Contracting Inc has no determinations by a court or governmental agency of <br />any violations of federal, state, or local laws including, but not limited to, violations of <br />contracting of antitrust laws, tax or licensing laws, environmental laws, Occupational <br />Safety and Health Act (OSHA), or federal David -Bacon and related Acts, within the <br />preceding five (5) years. <br />(iv) Michiana Contracting Inc has sufficient employees on staff to complete any work we bid <br />on, and also has the appropriate staffing capabilities, including labor sources to meet <br />the staffing needs of the work, if needed. <br />(v) All individuals who will perform work on the Public Works Projects, on behalf of <br />Michiana Contracting Inc will be properly classified as an employee or as an <br />independent contractor under all applicable state and federal laws and local ordinances, <br />(vi) Evidence of participation in apprenticeship and training programs is attached. <br />(vii) Copy of a written plan for employee drug testing is attached. <br />(viii) Evidence of utilizing a surety company listed on the Bureau of Fiscal Services Certified <br />Sureties is attached. <br />(ix) Michiana Contracting Inc has no federal, state, or local tax liens, or tax delinquencies <br />owed to any federal, state, or local taxing body in the preceding three years. <br />(x) List of projects of similar size and scope is attached. <br />G o n trey '•,,f <br />Date: 09/14/21 ;` �� r/rye' <br />n r oRP0�4pt� <br />Signature: ie__ Z. F,� '+ <br />:n <br />Printed Name/Title: Scott KirJatrick, President SEAL <br />Company: Michiana Contracting Inc fJr''�•.'�Lii2lna %0%*1` <br />Address: 7843 Lilac Road PO Bax 929 PI mouth IN 46563 <br />Phone: 574-936-8613 <br />MICHIANA CONTRACTING, INC. <br />7843 Lilac Road, PO Box 929, Plymouth, IN 46563 <br />Ph 574-936-8613 / Fx 574-936-6201 <br />www.michianacontracting.com <br />