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This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify <br />whether any listed minority or woman business meets the qualifications of a Minority or Women's owned <br />business. <br />PAGE OF <br />Project Number: 116-083F MBENVBE Participation Goal <br />Project Name: Chippewa Avenue Emergency Repairs <br />Bidder: Sys F2<;cjce . c��� Inc <br />By tJl2a�i <br />(Signature) (Title) (Date) <br />MBE/WBE Firm <br />Owner or Contact at MBEM/BE Firm �/ C. TL-t��^-� tls <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />-f-'r•�S 7-�- II C✓ <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />rJ •mil vt.:s�" �/ ;�� 7JL JOr� �` � l..iui"(� -}- 7�� <br />MBE/WBE Firm _ _ Alt-1 l f <br />Owner or Contact at MBE/WBE Firm C'c✓O (yam <br />IJV- <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />r(4t ® /7 - <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Version 7/28/16 Page - 25 Public Works Quote <br />)�j,r , CovM <br />