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General Form No. 96-a <br />Prescribed by the State <br />Board of Accounts of Indiana <br />Revised 1949 <br />STANDARD QUESTIONNAIRES AND <br />FINANCIAL STATEMENT FOR BIDDERS <br />Prescribed by <br />THE STATE BOARD OF ACCOUNTS OF INDIANA <br />For use in investigating and determining the qualifications of bidders on public Finance <br />construction when the aggregate cost of any such work or improvement will be <br />Five Thousand Dollars or more. <br />These statements to be submitted under oath by each bidder with and as a part <br />of his bid, as provided by Chapter 306, page 1248, Acts of 1947. <br />OWNER: <br />PROJECT: <br />SUBMITTED BY: <br />City of South Bend, IN <br />227 Jefferson Blvd <br />South Bend, IN <br />Fire Station #8 Replacement — Project #122-034 <br />South Bend, IN <br />GIBSON-LEWIS, LLC <br />1001 W. 11". Street <br />Mishawaka, Ind. 46544 <br />DATE: July 25, 2023 <br />Filed: <br />() A Corporation <br />O A Co -partnership <br />O An Individual <br />(X) A Limited Liability Company <br />