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0 1 : I I, i <br />reftl ilk 1111MAT'"01 OMM1111111 ODIUM :44 <br />CHECKLIST FOR BIDDERS <br />Project Name Jefferson and Twyckenham Signal Improvements <br />Project No. 116-027 <br />For Bids Due July.-W—,M-7 December 19, 2017 at gam <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 />X Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely <br />executed. <br />Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments <br />X with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and <br />Certification of use of United States Steel Products or Foundry Products. <br />Proof of MBEMBE Participation Goal Form [MWBE-1.0], If minimum participation goal is not <br />X met, also provide Evidence of Good Faith Efforts Form [MWBE42.0] and MBENVBE Contacted <br />Form [MWBE-2.1 ], <br />X Acknowledge Receipt of 1 Addendum(s) included with the bid, <br />X 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 road and comply with the specifications. <br />Bidder: Michiana Contracting, Inc <br />By Authorized <br />Signature; <br />Print Name & Title: <br />Scott Kirkpatrick, P <br />Date: 12/19/17 <br />Version 10/17/2017 Contractor's Bid for Public Works - 1 Addendurn #1 <br />