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NOTES: <br />1 <br />2 Financial Statement was reviewed by the City. <br />3 Submitted Pre-Qualification Checklist for Bidders that are not pre-qualified. <br />Certified: <br />Jeffrey L. McKean, PE <br />Date: <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Contractor's Experience <br />Proposed Work Plan Yes Yes <br />Yes <br />Contractor's Affidavit (1)Yes <br />NoneNone <br />Written Plan for Company Drug Testing Policy Yes Yes <br />Miscellaneous/Comments <br />Yes <br />Yes <br />YesForm MBE 1.0 - MBE Utilization Plan <br />Form MBE 2.0 - Evidence of Good Faith Efforts <br />Contractor's Financial Statement (2) <br />Yes <br />Yes <br />Notice to Labor Unions or Other Oragnizations of Works Nondiscrimination in Employment (Form <br />OEE-2) <br />SRF - MBE/WBE Documents / Good Faith Effort Worksheet <br />Yes <br />Yes <br />Form MBE 2.1 - WBE Contacted <br />Yes <br />BID REVIEW <br />CITY OF SOUTH BEND, INDIANA <br />CITY PROJECT NO. 121-070B <br />Bids Received: April 9, 2024 <br />FELLOWS STREET BOOSTER STATION CONTRACT B - STATION INSTALLATION AND SITE WORK <br />Contractor Selge Construction HRP Construction <br />Yes YesOne Addenda Acknowledged <br />April 12, 2024 <br />Yes <br />Yes <br />Yes Yes (3) <br />Yes <br />Yes Yes <br />Contractor's Non-Collusion and Non-Debarment Affidavit, Certification Regarding Investment with Iran, Employment Eligibility Verification, E-Verify Certification, Non-Discrimination Commitment and Certification of Use of <br />United States Steel Products or Foundary Products. <br />Yes <br />Yes <br />Yes <br />Yes <br />City of South Bend - Bidders Checklist <br />City of South Bend - Contractor's Prequalification Certificate <br />Listing of Subcontractors <br />Yes <br />Yes <br />Yes <br />Exceptions None None <br />Yes-5% <br />Yes <br />Yes - 5% <br />Yes <br />Certified Check or Bid Bond equal to 5% of Bid Price <br />Bid Form Signed & Sealed <br />Equipment Listing <br />City of South Bend - Contractor's Bid For Public Works (Incorporates Indiana Form 96) <br />Certification of Nonsegregated Facilities (Form OEE-1) <br />American Iron and Steel Certification (SRF Attachment J) <br />Donohue Associates, Inc. <br />Project No. 13985 <br />Bid Review <br />Page 1 of 1