Opening of Bids - South Well Field Water Plant Improvement, Bid Package 1 Proj No 117-059A - R Yoder Construction

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11. PRE -QUALIFICATION CHECKLIST (FOR B1D0 ER3 THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) By checking this box, 1 hereby acknowledge that 1 am not apre-qualified bidder with the City of South Bend. (ii) By checking this box, 1 hereby acknowledge [hat the City reserves the right to request supplemental informagon, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. Tha City reserved the right to utilize all information provided in this submission and all Information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowietlge that all information provided to the City shall be regarded as public records. (iii) By checking this box, i hereby acknowietlge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to [he work performed on the project may be requested at any time and shall be furniah¢d upon request. (iv) By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or Intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding [het i[ is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for In this bid. If a sub- contractor loses their license a[ any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) Indiana Secretary of State's on-line recoris (ie. Business verification) dated within sixty (60) days oT the submission of said document showing that business is in existence, current with the Indiana Secretary of Sta[e's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) List identifying all former business names. (lii) Any determinations by a court or governmental agency any violations of federal state, ar Iocai laws including, but no[ limited to, violations of contracting or antitrust laws, tax or licensing Iews, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) Statement about staffing capabilities, Including labor sources. This statement indicet¢s and ensures I have sufficient employees on staff to complete the work 1 am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal Iews and local ordinances. (vl) For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work [o be pertormetl on the project, which are approved by and registered with [he United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) Copy of a written plan for employee drag tasting that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-23-18-5 or IC 4-'13-t8-6. (viii) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. Version W23/2a22 Ganaral Conditions - t3