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CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a) <br />N _Z_ By checking this box, |hereby acknowledge that |am not a pre -qualified bidder <br />w�U�C�y�S��B�d. <br />(ii) _�_ By checking this box, | hereby acknowledge that the City remonxsa the right to <br />request supplemental infonnmtion, additional verification of any information <br />pnovidmd, and may also conduct random inquiries of my current and prior <br />nuaboneny. The City n000med 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 bothe City shall boregarded aepublic records, <br />(iii) «/ 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 shall be furnished <br />upon request, <br />v/ <br />(iv) By checking this box. | hereby acknowledge and anouna that i and all sub- <br />contractors, from whom I have accepted a bid and/or intend to hire to perform work <br />onthe public work project, are properly licensed. Furthermore, | acknowledge my <br />understanding that it is my responsibility to ensure that all sub -contractors have <br />the necessary licenses to undertake the work called for in this bid. If sub- <br />contractor |naeo their license at any point, it is the responsibility of that sub- <br />contractor tonotify the City. <br />8d Attachments: <br />Indiana Secretary ofGtate'oon-line records (ie.Business verification) dated within <br />mhdy (60) days of the submission of said document showing that business is in <br />mxistence, current with the Indiana Secretary ofGtatanBusiness Entity Raport, <br />and eligible for o certificate of good standing. (Not applicable to individua|m, uo|a <br />proprietors or partnerships). <br />v/ <br />List identifying all former business names. <br />v/ <br />Any determinations by a court or governmental agency any violations of federal <br />state, or local laws including, but not limited to, violations of contracting or antitrust <br />laws, tax or licensing laws, environmental |ovms. Occupational Safety and Health <br />Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) <br />(iv) »/ <br />years. <br />Statement about staffing capabilities, including labor uuummm. This statement <br />indicates and ensures I have sufficient employees on staff to complete the work I <br />ambidding onORoutlines how | intend humeet the staffing needs mfthe work. <br />(v) v/ <br />Statement that individuals who will perform work on the public work project on my <br />behalf will be properly classified as an employee or as an independent contractor <br />U <br />under amppUoab(estate and federal laws and local ordinances. <br />(vi) v/ <br />�oreverypnoject.mubmitmvidmnceofpartioipationinappnentineohipondtnmining <br />prognamo, applicable to the work to be performed on the pnoject, which are <br />approved byand registeredwith the United States Department ofLobor'e{ffiueof <br />Apprenticeship, orits successor organization. <br />(vii) "/ <br />Copy ofnwritten plan for employee drug testing that covers all ofmyemployees <br />who will perform work on the public work project and meets or exceeds the <br />requirements set forth in !C4-13-18-5or|C4-13-1B-G. <br />(viii) v' <br />Evidence that i am utilizing a surety company which is on the Bureau of Fiscal <br />Service "Department of Treasury's Listing of Approved Sureties" as required in the <br />bid specifications orcontract. <br />Version07/18/2O23 General Conditions -14 <br />