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CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) <br />(a) <br />(V _V� Dychecking this box | hereby acknowledge that | am not pre -qualified bidder <br />with the City ofSouth Bend. <br />U0 V By checking this box, | hereby acknowledge that the City reserves the right to <br />request supplemental information, additional verification of any information <br />provided, and may also conduct random inquiries of my current and prior <br />customers. The City reserved the right to utilize all information provided in this <br />submission and all information obtained in inquiries or requests to determine if <br />bidder is responsive and responsible. Additionally, | acknowledge that all <br />information provided bothe City shall baregarded mmpublic records. <br />(iii) v/ 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 />(k) V By checking this box. | hereby acknowledge and mnuumo 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 it is my responsibility to ensure that all sub -contractors have <br />the necessary |icanawn to undertake the work oo||ed for in this bid. If sub- <br />contractor |ooaa their license at any point, it is the responsibility of that sub- <br />contractor to notify the City. <br />(b) Attachments: <br />W v/ <br />Indiana Secretary ofStatm on-line records (ie. Business verification)dated within <br />mhdy (60) days of the submission of said document showing that business is in <br />existence, current with the Indiana Secretary of State'oBusiness Entity Report, <br />and eligible for a uortifiunby of good standing. (Not applicable to individmala, sole <br />proprietors o,partnamhipo). <br />»/ <br />List identifying all former business names. <br />(ii0 _V' <br />Any determinations bymcourt orgovernmental agency any violations mffederal <br />state, or local laws including, but not limited to, violations of contracting or antitrust <br />|nmvm, tax prlicensing kmwm. environmental laws, Occupational Safety and Health <br />Act (O8HA).orfederal Davis -Bacon and related Acts, withinthepnacadinQfive(5) <br />(iv) v/ <br />years. <br />Statement about staffing capabilities, including labor aounxom. This statement <br />indicates and ensures | have sufficient employees onstaff bocomplete the work I <br />onnbkJdinQonORoudineshow | intend bzmeet the �mffingneeds ofthe work. <br />k� 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 mb�oand federal laws and local ordinances. <br />(vi) *^ <br />For every pnoject, submit evidence of participation in apprenticeship and training <br />pnognamo, applicable to the work to be performed on the project which are <br />approved by and registered with the United States Department of Labor's Office of <br />Apprenticeship, orits successor orgonizotion <br />(vii) »/ <br />Copy cfovvh�enplan for employee dmg--testing that covers all cfmyemployees <br />who will perform work on the public mmdh project and meets or exceeds the <br />naquinen�ontaset fo�h in |C4-1348-6or|��4-13-18-8' <br />(�ii) v^ <br />Evidence that | am utilizing o 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 nrcontract. <br />Version O7/19/3023 General Conditions -1* <br />