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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name South Bend Neighborhood Infrastructure Project — Ford Street and <br />Walnut Street Intersection <br />Project No, 121-0480 <br />For Bids Due November 22, 2022 <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 />V or Bid Bond, <br />Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />\1/ executed, <br />Contractors 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 M/WBE Utilization Plans [MBE -1.0 and WBE-1.0]. Also provide Evidence of Good <br />Faith Efforts Forms [MBE -2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE -2.1 and <br />V WBE-2. 1 ]. <br />V Acknowledge Receipt of 1,2 Addendum(s) included with the bid, <br />V 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 />✓ printed or typed underneath signature. <br />V 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: HRP Construction Inc. <br />By Authorized <br />Signature: <br />Date: November 22, 2022 <br />Print Name & Title: Matthew D. Cain, President <br />Version 09/29/2021 Contractor's Bid for Public Works - 1 <br />