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M. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT <br />(a) <br />0) 0,11117 By checking this box, I hereby acknowledge that I am not a pre -qualified bidder <br />with the City of South Bend. the right to <br />By checking this box, I hereby acknowledge that the City reserves <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 reserved 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, I acknowledge that all <br />information provided to the City shall be regarded as public records. <br />By checking this box, I hereby acknowledge that copies of all Applicable <br />Z <br />apprenticeship certificates or standards for training programs applicable to the <br />work performed on the project may be requested at any time and shall be furnished <br />upon request. <br />(iv) <br />By checking this box, I hereby acknowledge and ensure that I and all sub- <br />contractors, from whom I have accepted a bid and/or intend to hire to perform work <br />on the public work project, are properly licensed. Furthermore, I 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 a sub- <br />contractor loses their license at any point, it is the responsibility of that sub- <br />contractor to notify the City. <br />(b) <br />---mnIndiana ofSbub�oon-Hnerecords (�.Bue�omever�cadon)dated within <br />u��a� <br />ohdy (60) days of the submission of said document showing that business is in <br />exietenoe, current with the Indiana Secretary of State's Business Entity Report, <br />and eligible for a certificate of good standing. (Not applicable to individuals, sole <br />proprietors or partnerships). Z, <br />Lost identifying all former business names. <br />����v�� <br />/\nydmherminebonmbyacourtnrgovornrnerta|agencyanyviobtionooffedene| <br />7—� <br />state, or local laws including, but not limited to, violations of contracting or antitrust <br />laws, tax or licensing laws, environmental |axvo. Occupational Safety and Health <br />Act (OSHA), or federal Davis -Bacon andrelated Acts, within the preceding five (5) <br />s. <br />(iv) ' annw�� ��`/�Itaffing capabilities, including labor sources. This uhabamerd <br />--- indicates and ensures | have sufficient employees onstaff tocomplete the work | <br />anmbidding onQRoutlines how | intend tomeet the staffing needs ofthe work. <br />MGtatennentthat individuals who will performwork <br />--- <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) Forewarypo�act,submnbavidenoeofpa�cipationinappnent�nshipandtroining <br />--- applicable to the work to be performed on the project, which are <br />programs, epp . <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor organization. <br />(vii)Copy of a written plan for employee drug testing that covers all of my employees <br />--- who will pedbnn work on the public work project and meats or exceeds the <br />requirements set forth in|C4'13-18-5or|C4-13-1O-G. <br />(viii)Evidence that ! mm utilizing u suretycompanywhich is on the Bureau ofFiscal <br />--' <br />Service "Department of Treasury's Listing of Approved Sureties" as required in the <br />bid specifications orcontract. <br />Version 10/13/2021 General Conditions -13 <br />