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PRE -QUALIFICATION CHECKLIST ;t �4 BINDERS THAT ARE NOT PRE -QUALIFIED)
<br />(a) Acknowledgements
<br />(i) V By checking this bco! rt)y ,)(,knowledge that I am not a pre -qualified bidder
<br />with the City of South ! ,,i
<br />By checking this box c:rooy ,,.acknowledge that the City reserves the right to
<br />request supplemeni�:torn ation, additional verification of any information
<br />provided and may unduct random inquiries of my current and prior
<br />customers The Gity red the right to utilize all information provided in this
<br />submission and all ;nit rtion obtained in inquiries or requests to determine if a
<br />bidder is responsive i responsible Additionally, I acknowledge that all
<br />information provided!
<br />;.; ty shall be regarded as public records.
<br />(iii) ✓
<br />By checking this h;
<br />- oreby acknowledge that copies of all Applicable
<br />apprenticeship certiti, .;
<br />. ,r, standards for training programs applicable to the
<br />work performed on the
<br />� - �lect stay be requested at any time and shall be furnished
<br />/
<br />upon request
<br />(iv)
<br />By checking this bc�,
<br />n=ire>.by acknowledge and ensure that I and all sub-
<br />contractor s. from whc r+
<br />we: accepted a bid and/or intend to hire to perform work
<br />on the public work pmjl
<br />taw properly licensed. Furthermore, I acknowledge my
<br />understanding that i+
<br />rr-�sponsibility to ensure that all sub -contractors have
<br />the necessary Been.,,
<br />Wdertake the work called for in this bid. If a sub-
<br />contractor loses the:i,
<br />iise at any point, it is the responsibility of that sub-
<br />contractor to notify the
<br />(v)
<br />By checking this boz
<br />teioby acknowledge that apprenticeship and training
<br />programs that I partif ; .:,
<br />n i,ave graduated at least five (5) apprentices in each
<br />�of
<br />the past five:. (f,) yt,.
<br />(vi) _..
<br />By checkurg this bear
<br />!,f+y acknowledge that all subcontractors performing
<br />work greater than 1'
<br />; i; , ilso meet the qualifications of the Responsible Bidder
<br />Ordinaric:F
<br />(b) Attachments
<br />(i) .! Indiana `;e( rrtary of , )n line records (re. Business verification) dated within
<br />sixty (60) days of ili« of said document showing that business is in
<br />existence curreni viii lmjwnti Secretary of State's Business Entity Report,
<br />and eligible for i cew, ,>i good standing. (Not applicable to individuals, sole
<br />proprietors or partner: i.
<br />(ii) _ List identifying all foino
<br />ismess names.
<br />(iii) ✓ Any determinations i.�,-
<br />ourt or governmental agency any violations of federal
<br />state, or Icx;al laws nu f
<br />ci but not limited to, violations of contracting or antitrust
<br />laws, tax or licensing
<br />; environmental laws. Occupational Safety and Health
<br />Act (OSHA) or feller;-r
<br />i, , Bacon and related Acts, within the preceding five (5)
<br />years
<br />(iv) Statement ahout start r-inabilities, including labor sources. This statement
<br />indicates and ensure.: +ve suffrrient ernployees on staff to complete the work I
<br />am bidding on Off (Wiwi
<br />liow I intend to meet the staffing needs of the work,
<br />(v) Statement that indivifJ
<br />�,h() will work on the public work project on my
<br />behalf will hey [-)io Jc;, ,,
<br />aurci as art ernployee or as an independent contractor
<br />under all applicable si, :
<br />inci federal laws and local ordinances.
<br />(v) " For every project. soil,
<br />-iclerice of participation in apprenticeship and training
<br />programs applic:ablL
<br />i,c, work to be performed on the project, which are
<br />approved by and iegisi:
<br />with fire United States Department of Labors Office, of
<br />Apprenticeship or its
<br />�-!ssor organization. This includes, but may not be limited
<br />to, letters from apprcr
<br />;Fit, coordinators detailing the bidder's association with
<br />Version 5/20/2024 o i, A;uns - 14
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