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the prnct <br />Certitic,ac:: ,i i;:�;..,r„ <br />performs c1 ,, Ih� <br />(vi) <br />t/ Copy of a uviitten <br />who will peltnrrrl v,Ic,,, <br />requirem enh-: ,;ei (()W. <br />(vii) <br />V/ Eviden,:w ii,:ri I :-rrr. : <br />SerAlIGF� I1�..'fSr,l!ii�il!-:!�'� <br />bid spef lfc ril(!ril,- <br />(viii) <br />V.// Writteno1.,� <br />/ to any fNdeiai siatr <br />(ix) <br />V_ List of prulec:ts of sit <br />the StatN of Indiana \„,,i <br />Date: <br />(Sign Here) <br />(Print Name Here) <br />taies Department of Labor Office of Apprenticeship <br />Apprenticeship Programs for each type of work to be <br />Hployee drug testing that covers all of my employees <br />io public work project and meets or exceeds the <br />1.� 18 5 or IC 4-13-18-6. <br />surety company which is on the Bureau of Fiscal <br />wy s listing of Approved Sureties" as required in the <br />—,,-ial, state or local tax liens or tax delinquencies owed <br />11 i:Ixrng Body in the preceding three years, <br />ind scope of work performed in all areas, including <br />(3) years prior to the date on which the bid is due. <br />---- <br />(Name of Company; <br />(Address of Company) <br />(City) <br />A <br />(State) <br />(Telephone Nr.imbE:i <br />Version 5/20/2 )24 tF: ,,:(litioris - 15 <br />