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City of South Bend <br />Lead Hazard Reduction Program Request for Proposals <br />Firm Qualifications Certification Form <br />Company <br />Name: <br />Street <br />Address: <br />City: State: Zip Code: <br />Owner’s <br />Name: Phone: <br />Email: <br />1.The Respondent has experience performing radon mitigation in accordance with the State of Indiana <br />requirements.☐ Yes ☐ No <br />If yes, how many years? ________________________________________________________ <br />2.The Respondent has the knowledge, skills, and experience to install a radon mitigation system in accordance with <br />this RFP and City of South Bend’s LHR Grant Program policy and procedures manual.☐Yes ☐ No <br />3.The Respondent has the capacity to effectively coordinate a radon mitigation system installation as described in <br />this RFP and the City’s LHR Grant Program policy and procedures manual consistently in a timely manner.☐Yes ☐ No <br />4.The Respondent has the capacity to schedule and complete each task listed in the Scope of Service section within <br />the timeframe described in this RFP.☐Yes ☐ No <br />5.The Respondent has the experience and skill to write a summary report of the mitigation efforts and provide the <br />report to the City of South Bend consistently in a timely manner.☐Yes ☐ No <br />6.Is Respondent registered, or willing to register, in the System for Award Management (SAM)?☐Yes, currently registered☐Not currently registered, but willing to complete (the City can provide a registration guide)☐Not registered, and will not complete