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CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a) <br />0 _Z_ <br />By checking this box | hereby acknowledge that | am not pre -qualified bidder <br />��the C�y�8��8�d. <br />(�) _v` <br />By checking this box, | hereby acknowledge that the City reserves the right to <br />request supplemental infonnmUon, additional vnhfiouUon of any information <br />pnovidwd, and may also conduct random inquiries of my current and prior <br />customers. The City reserved the right to utilize all information provided in this <br />submission and all information obtained in inquiries or requests to determine if a <br />bidder is responsive and responsible. Additionally, | acknowledge that all <br />information provided tothe City shall bwregarded anpublic records. <br />(|iU °/ <br />By checking this box. | hereby acknowledge that copies of all Applicable <br />apprenticeship certificates or standards for training programs applicable to the <br />work performed on the project may be requested at any time and oho|| be <br />furnished upon request. <br />(v/ k/) ___ <br />By checking this box. | hereby acknowledge and ensure that ! and all sub- <br />contractors, from whom | have accepted abid and/or intend to hire toperform <br />work on the public work pnoject, are properly licensed. Furthermore, | <br />acknowledge my understanding that it is my responsibility to ensure that all sub- <br />contractors have the necessary licenses to undertake the work called for in this <br />bid. If sub -contractor loses their license sdany poird, it is the responsibility of <br />that sub -contractor tnnotify the City. <br />(b) Attachments: <br />(U V <br />Indiana Secretary oyGtate'a on-line records (la. Business verification) dated <br />within <br />sixty (60) days of the submission of said document showing that business is in <br />onistenuw, current with the Indiana Secretary of Qtmbo'n Business Entity Report, <br />and eligible for a certificate ofgood standing. (Not applicable to individue|o, sole <br />proprietors orpwrtnamehipa). <br />(ii) V <br />List identifying all former business names. <br />(iii) _V. <br />Any determinations by a court or governmental agency any violations of federal <br />mtmbm. or local |ewm inc|uding, but not limited to, violations of contracting or <br />antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and <br />Health Act (OSHA), or federal Davis -Bacon and related Acts, within the <br />v/ <br />preceding five (S)years. <br />(k0 ___ <br />Statement about staffing capabilities, including labor sources. This statement <br />indicates and ensures I have sufficient employees on staff to complete the work I <br />ambidding onORoutlines how | intend tmmeet the staffing needs cfthe work <br />»/ <br />Statement that ind�kdua�who wiUpa�onmwo�onthe public work pn��project on <br />behalf will be properly classified as an employee or as an independent contractor <br />v/ <br />undoroUappUcob|ewhabsandfadens||awaond|oco|ordinanmma � <br />h�) <br />For every pnoject, submit evidence of participation in apprenticeship and training <br />proQromm, applicable to the work to be performed on the project, which are <br />approved by and registered with the United States Department oyLmbor'oOffice <br />oYApprenticeship, orits successor organization. <br />(oii) v/ <br />Copy ofowritten plan for employee drugtesting that covers all ofmyemployees <br />who will perform work on the public work project and meets or exceeds the <br />requirements set fb�h in |C4-13-18-6or|C4-13-i8-6. <br />v/ <br />(vii0 <br />Evidence that | am utilizing m surety company which is on the Bureau of Fiscal <br />Service "Department of Treasury's Listing of Approved Sureties" an required in <br />the bid specifications orcontract. <br />Version07/1W/2O23 General Conditions '14 <br />