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.;S yUU7H 8E, <br />o/ UG <br />I T. <br />+Cy x <br />CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Sewer and Manhole Rehabilitation <br />Project No, 122-019 <br />For Bids Due June 27, 2023 <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 or <br />X Bid Bond. <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 Investments <br />with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />X Certification of use of United States Steel Products or Foundry Products. <br />i(���i <br />��QQnT��T_��,__rtO��tS FWAaliv BCE 2.0 and Mrn\AID n 2 IBE Gentaeted Cexw... [MBE 2.4 and <br />�T <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 underneath signature. <br />X This checklist submitted with the Bid. <br />This checklist is provided for bidder's use m <br />documentation; however, it does not include all ecifi <br />relieve the bidder of the need to read and co with the <br />Bidder: National Power Rodding Corp. <br />By Authorized Representative: <br />Signature: lli // <br />Print Name &Title: <br />Version 09/29/2021 Contractor's Bid for Public Works - 1 <br />compliance with required <br />requirements and does not <br />Date: June 27, 2023 <br />