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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 MBEIWBE 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: 116-083D MBE/WBE Participation Goal 7.1% <br />Project Name: Randolph Street Basin Emergency Repair <br />Bidder: <br />By: <br />(Signature) (Title) (Date) <br />MBE/WBE Firm <br />Owner or Contact at MBE/WBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />MBE/WBE Firm <br />Owner or Contact at MBEMBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Version 7/2812016 Contractor's Bid for Public Works - 27 <br />