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B!A OF Pt1r WK <br />Gary A. I ilolT'es�iJnl <br />Elizabeth A.Mhradik, Member <br />JaTbs A, Mueller, Member <br />Suzanna M. Fritzberg, Member <br />T re se J. Dorau, Member <br />--Ktt6st: Linda M. Ma in, Cie& <br />PART 11 SEE ATTACHED 96 FORM <br />(For projects of $100,000 or more — IC 36-1-12A) <br />These statements to be submitted under oath by each bidder with and as part of his/her/Its bid. <br />Attach additional pages for each section as needed. <br />SECTION I EXPERIENCE QUESTIONNAIRE <br />1. Attach information regarding projects your organization has completed for the period of one <br />(1) year prior to the date of the current bid. <br />2. Attach a listing of public works projects currently in process of construction by your <br />organization. <br />3. Attach information regarding any failure to complete any work awarded to you and the <br />location thereof. <br />4. Attach references from private firms for which you have performed work. <br />SECTION II, PLAN AND EQUIPMENT QUESTIONNAIRE <br />1. Attach an explanation of your plan, or layout for performing proposed work, (Examples could <br />Include a narrative of when you could begin work, complete the project, number of workers, <br />etc. and any other information which you believe would enable the City of South Bend to <br />consider your bid.) <br />2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside <br />your own firm who have performed part of the work) that you have used on public works <br />projects during the past five (6) years along with a brief description of the work done by each <br />subcontractor. <br />3. If you Intend to sublet any portion of the work, attach the name and address of each <br />subcontractor, equipment to be used by the subcontractor, and whether you will require a <br />bond. However, if you are unable to currenitly provide a, listing, please understand a listing <br />must be provided prior to contract approval. Until the completion of the proposed project, you <br />are under a continuing obligation to Immediately notify the City of South Bend in the event that <br />you subsequently determine that you will use a subcontractor on the proposed project. <br />4. Attach a listing of equipment you have available to use for the proposed project, <br />5. Have you entered into contracts or received offers for all materials which substantiate the <br />prices used In preparing your proposal? If not, attach an explanation for the rationale used <br />which would corroborate the prices listed. <br />Version 1011712017 Contractor's Bid for Public Works - 3 <br />