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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Cleveland Road and Ameritech Drive Intersection Improvements <br />Project No. 122=049 <br />For Bids Due August 22, 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 />x Proper bid security included. The bidder has the option of providing either a Certified Check <br />or Bid Bond. <br />\! Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />1� executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />x 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 />v Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and <br />WBE-2.1 ]. <br />Acknowledge Receipt of 3 Addendum(s) included with the bid. <br />All required additional information is included with the bid. <br />X Proposal statements and other affidavits all signed by the proper party with name either <br />printed or typed underneath signature. <br />This checklist submitted with the Bid. <br />This checklist is provided for bidder's use in assuring compliance <br />documentation; however, it does not include all specifications requirements <br />relieve the bidder of the need to read and comply with the specifications. <br />Bidder: (REr't2K n CoNCRETC 5FRVZ .E5 Date: 8/-ZZ/� <br />By Authorized Representative: <br />Signature: <br />Print Name &Title: /�%A-X {%A -KEY ��/ rN.VE� <br />with required <br />and does not <br />Version 09/29/2021 Contractor's Bid for Public Works -1 <br />