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CITY OF SOUTH BEND, INDIANA <br />CONTRACTOR'S BID FOR PUBLIC WORK <br />CHECKLIST FOR BIDDERS <br />Project Name Brick Pavement Spot Repair 2021 <br />Project No. <br />For Bids Due <br />121-019 <br />July 1311, 2021 by 9:OOam Local Time. Sealed electronic bids are to be <br />submitted by email to bpwbids(a)southbendin.gov. <br />From time to time the South Bend Board of Public Works finds it necessary to reject a bid because <br />it does not comply with statutory requirements. In preparing your bid, please use the following <br />checklist in order to make sure that your bid is done in the proper manner. <br />Proper bid security included. The bidder has the option of providing either a Certified Check <br />x or Bid Bond. <br />Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />X executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />_ x_ Certification of use of United States Steel Products or Foundry Products. <br />Proof of MWBE Utilization Plan [MWBE-1.0]. If minimum participation goal is not met, also <br />provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MWBE Contacted Form <br />X [MWBE-2.1]. <br />X Acknowledge Receipt of 1 Addendum(s) included with the bid. <br />X I All required additional information is included with the bid. <br />Proposal statements and other affidavits all signed by the proper party with name either <br />X printed or typed underneath signature. <br />X This checklist submitted with the Bid. <br />This checklist is provided for bidder's use in assuring compliance with required <br />documentation; however, it does not include all specifications requirements and does not <br />relieve the bidder of the need to read and comply with the specifications. <br />Bidder: Selge Construction Co., Inc. <br />By Authorized Representative: <br />Signature: i <br />Print Name & Title: Robert Kuhns, Project Engineer <br />Version 01/13/2021 Contractor's Bid for Public Works - 1 <br />Date: July 13, 2021 <br />