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CITY OF SOUTH BEND, INDIANA <br />SELLER'S PROPOSAL FOR PUBLIC WORK <br />CHECKLIST FOR PROPOSALS <br />Project Name Fellows Street Booster Station Contract A — Procurement <br />Project No. 121-070A <br />For Proposals Due April 9, 2024 <br />From time to time the South Bend Board of Public Works finds it necessary to reject a Proposal because it <br />does not comply with statutory requirements. In preparing your Proposal, please use the following checklist <br />in order to make sure that your Proposal is done in the proper manner. <br />Proper Proposal security included. The Proposer has the option of providing either a Certified Check or <br />X Proposal (Bid) Bond. <br />X City of South Bend Responsible Proposer Checklist. <br />Proposal prepared on the City of South Bend Seller's Proposal for Public Work Form, completely <br />X executed. <br />Seller's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, <br />Employment Eligibility Verification, Non -Discrimination Commitment, and Certification of use of United <br />X States Steel Products or Foundry Products. <br />Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good Faith Efforts <br />X Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and WBE-2.1]. <br />X Acknowledge Receipt of 0 Addendum(s) included with the Proposal. <br />All required additional information is included with the Proposal, required SRF Forms (including OEE-1, <br />X OEE-2, MWE/WBE Good Faith Effort Worksheet, American Iron and Steel Certificate, etc.) <br />X Performance based certified design submittal and quality control certifications. <br />Proposal statements and other affidavits all signed by the proper party with name either printed or typed <br />X underneath signature. <br />X This checklist submitted with the Proposal. <br />This checklist is provided for Proposer's use in assuring compliance with required <br />documentation; however, it does not include all specifications requirements and does not <br />relieve the Proposer of the need to read and comply with the specifications. <br />Proposer: EFI-SOLUTIONS INC <br />By Authorized Representative: <br />Signature: <br />Print Name & Title: DAVE EALY C.B.O. / V a—.- TOWNER <br />Version 09/29/2021 Seller's Proposal for Public Works - 1 <br />Date: 04-08-24 <br />