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CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a) <br />00 ___ By checking this box | hereby acknowledge that | am hut a pre -qualified bidder <br />with the City ofSouth 8end- <br />(ii) ___ By checking this box, | hereby acknowledge that the City reserves the right to <br />request supplemental |nfonnaUon, additional verification of any infomnohon <br />pnw'ided, and may also conduct random inquiries of my current and prior <br />customers. The C|h/ reserved the right to utilize all information provided in this <br />submission and all information obtained in inquiries or requests to determine if a <br />bidder is naoppnoiva and responsible. Additionally, | acknowledge that all <br />information provided buthe City shall baregarded oupublic records. <br />(iii) By checking this box. | hereby acknowledge that copies of all Applicable <br />apprenticeship certificates or standards for training programs applicable to the <br />work performed on the project may be requested at any time and shall be furnished <br />upon request. <br />(iv) By checking this box. | hereby acknowledge and ensure that | and all sub- <br />contractors, from whom I have accepted a bid and/or intend to hire to perform work <br />onthe public work project, are properly licensed. Furthermore, | acknowledge my <br />understanding that itiamy responsibility boensure that all sub -contractors have <br />the necessary licenses to undertake the work called for in this bid. If sub- <br />contractor loses their license at any point, it is the responsibility of that sub- <br />contractor tonotify the City. <br />(b) Attachments: <br />0) __. <br />Indiana Secretary ofSbateoon-line records (ie.Business verifiuoUon)dated within <br />sixty (60) days of the submission of said document showing that business is in <br />exietenme, current with the Indiana Secretary of 8b*te'o Business Entity Report, <br />and eligible for o oecbfioahe of good standing. (Not applicable tu individua/w, sole <br />proprietors nrpednenohips). <br />List identifying all former business names. <br />Any determinations by m court or governmental agency any violations of federal <br />state, or local laws including, but not limited to, violations of contracting or antitrust <br />}ews, tax or licensing |owm. environmental |ovs. Occupational Safety and Health <br />Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) <br />years, <br />(v) ___ <br />Statement about staffing capabilities, including labor sources. This statement <br />indicates and mnounam ! have sufficient employees on staff to nmnp|eb* the work | <br />embidding onC)Routlines how | intend bumeet the staffing needs cf the work. <br />(v) ___ <br />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) <br />For every pnoje±, submit evidence cfparticipation in apprenticeship and training <br />pro0mcme, applicable to the mm/k to be performed on the pnoject, which are <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor organization. <br />NO <br />Copy ofawritten plan for employee drug testing that covers all ofmyemployees <br />who will perform work on the public work project and meets or exceeds the <br />requirements set fodh in |C4-13-1B-5pr|C4-13-1B'8. <br />(viii) <br />Evidence that | am utilizing msurety company which is on the Bureau ofFiscal <br />Service "Department of Treasury's Listing of Approved Sureties" as required in the <br />bid specifications orcontract. <br />VnmionV2/23/2O22 General Conditions -13 <br />