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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Fellows Street Booster Station Contract B — Station Installation and Site Work <br />Project No. 121-070B <br />For Bids Due April 9, 2024 <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 Bid <br />X Bond. <br />X City of South Bend Responsible Bidder Checklist. <br />X Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, <br />Employment Eligibility Verification, Non -Discrimination Commitment, and Certification of use of United <br />X 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 Faith Efforts <br />X Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and WBE-2.1]. <br />X Acknowledge Receipt of 1 Addendum(s) included with the bid. <br />All required additional information is included with the bid, required SRF Forms (including OEE-1, OEE- <br />X 2, MWE/WBE Good Faith Effort Worksheet, American Iron and Steel Certificate, etc.) <br />Proposal statements and other affidavits all signed by the proper party with name either printed or typed <br />X underneath signature. <br />X 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: Selge Construction Co., Inc. <br />By Authorized Representati <br />Signature: 1 � -- <br />Print Name & Title: Robert Kuhns, Project Engineer <br />Version 09/29/2021 Contractor's Bid for Public Works - 1 <br />Date: April 9, 2024 <br />