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1. BIDDER CHECKLIST <br />(a) <br />N _V_ <br />By checking this box, I hereby acknowledge that I am a pre -qualified bidder with <br />the City ofSouth Bend and that | have met the pre -qualification requirements within <br />the last twelve (12) months. A copy of my Pre -Qualification verification letter <br />is attached. <br />(ii) ^/ <br />By checking this box. | hereby acknowledge that the City namanxas the right to <br />request supplemental infonneUon, additional verification of any information <br />provided byme, and may also conduct random inquiries ofmycurrent and prior <br />customers. <br />(iii) v' <br />By checking this box, | hereby acknowledge that apprenticeship and training <br />programs that | participate inhave graduated etleast five (6)apprentices ineach <br />cfthe past five (5)years. <br />(iv) v^ <br />Bychecking this box. | hereby acknowledge that all subcontractors performing <br />work greater than $250,000 also meet the qualifications of the Responsible Bidder <br />Ordinance. <br />(b) Attachments: <br />00 °/ Indiana Secretary of State's on-line records (ie. Business verification) dated within <br />sixty (GO) days of the submission of said document showing that business is in <br />emmtenna, current with the Indiana Secretary ofGhabs'm Business Entity Report, <br />and e|k])b|e for certificate of good standing. (Not applicable to indixiduals, sole <br />proprietors cvpartnmmuhipm). <br />v/ Statement on staffing capabilities, including labor sources. This statement <br />indicates and ensures | have sufficient employees onstaff tocomplete the work. A <br />outlines how | intend Uomeet the staffing needs ofthe work. <br />v/ List of projects of similar size and scope of work performed in all areas, including <br />the State pf|ndiana.v�thinthe |omtthnom(3)ym�ne <br />v/ � <br />(iv) For every puojeo, submit evidence of participation in apprenticeship and training <br />pnogremn, applicable to the work to be performed on the project, which are <br />approved byand registered with the United States Department mfiahor'mOffioeof <br />Apprenticeship, or its successor organization. This includes, but may not be limited <br />to, letters from apprenticeship coordinators detailing the bidder's association with <br />the program, and the United States Department ofLabor Office mfApprenticeship <br />Certificates of Registration of Apprenticeship Programs for each type of work to be <br />performed onthe project. <br />Version 5/20/2D24 General Conditions '13 <br />