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(i) Indiana Secretary of State's on-line records (ie. Business verification) dated within <br />sixty (60) days of the submission of said document showing that business is in <br />existence, current with the Indiana Secretary of State's Business Entity Report, <br />and eligible for a certificate of good standing. (Not applicable to individuals, sole <br />proprietors or partnerships). <br />List identifying all former business names. <br />Any determinations by a court or governmental agency any violations of federal <br />state, or local laws including, but not limited to, violations of contracting or antitrust <br />laws, tax or licensing laws, environmental laws, Occupational Safety and Health <br />Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) <br />years. <br />(iv) Statement about staffing capabilities, including labor sources. This statement <br />indicates and ensures I have sufficient employees on staff to complete the work I <br />am bidding on OR outlines how I intend to meet the staffing needs of the work. <br />(v) Statement that individuals who will perform work on the public work project on my <br />behalf will be properly classified as an employee or as an independent contractor <br />under all applicable state and federal laws and local ordinances. <br />(vi) Evidence of participation in apprenticeship and training programs, applicable to the <br />work to be performed on the project, which are approved by and registered with <br />the United States Department of Labor's Office of Apprenticeship, or its successor <br />organization. <br />(vii) Copy of a written plan for employee drug testing that covers all of my employees <br />who will perform work on the public work project and meets or exceeds the <br />requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. <br />(viii) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal <br />Service "Department of Treasury's Listing of Approved Sureties" as required in the <br />bid specifications or contract. <br />(ix) Written statement of any federal, state or local tax liens or tax delinquencies owed <br />to any federal, state or local taxing body in the preceding three years. <br />(i) List of projects of similar size and scope of work performed in all areas, including <br />the State of Indiana, within three (3) years prior to the date on which the bid is due. <br />Date: February 12 2019 <br />(Sign Here) <br />Rick Slapl.elV es deiit............ ..... <br />(Print Name Here) <br />Majority Builders, Inc. <br />(Name of Company) <br />62900 US 31 SgLith <br />(Address of Company) <br />South' )Bend <br />(City) <br />Indiana <br />(State) <br />574-291-2091 <br />(Telephone Number) <br />Version 8/16/2018 Special Provisions - 9 <br />