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CITY OF SOUTH BEND,INDIANA <br />CONTRACTOR’S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name 2022 Street and Sewer Material Bid <br />Project No.122.028 <br />For Bids Due March 22,2022,9:00 am.,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 />NIA Proper bid security included.The bidder has the option of providing either a Certified Check <br />_____ <br />or Bid Bond.NOT REQUIRED <br />Bid prepared on the City of South Bend Contractor’s Bid for Public Work Form,completely <br />X executed. <br />Contractor’s Non-Collusion and Non-Debarment Affidavit,Certification Regarding <br />Investments with Iran,Employment Eligibility Verification,Non-Discrimination Commitment, <br />X and Certification of use of United States Steel Products or Foundry Products. <br />Proof of MIWBE Utilization Plans [MBE-1 .0 and WBE-1 .0.Also provide Evidence of Good <br />N/A Faith Efforts Forms [MBE-2.0 and WBE-2.0]and M1WBE Contacted Forms [MBE-2.1 and <br />WBE-2.1].NOT REQUIRED BUT STRONGLY ENCOURAGED <br />X Acknowledge Receipt of Addendum(s)included with the bid. <br />x All required additional information is included with the bid. <br />Proposal statements and other affidavits all signed by the proper party with name either <br />X printed or typed undemeath signature. <br />X 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:Smith Ready Mix Date:3/18/22 <br />By Authorized Representative: <br />Signature C s’) <br />Print Name &Title:Jacob Wood,Area Manaqer <br />Version 09/29/2021 Contractors Bid for Public Works.1