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CITY OF SOUTH BEND cttourxa�t <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM c <br />s <br />FORM MWBE-2.1 '2 <br />MBE/WBE CONTACTED is's <br />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 1 OF 2 <br />Project Number: 116-053 MBE/WBE Participation Goal 7.1 % <br />Project Name: Calvert Street Lift Station Replacement <br />Bidder: John Boettcher Sewer & Excavating Contractor <br />By: President <br />12/08/2016 <br />(Signature) <br />(Title) (Dattee) <br />MBE/WBE Firm State Barricading, Inc. <br />Owner or Contact at MBEANBE Firm JameSMlchalski <br />Telephone: 574-287-2078 Fax 574-287-1744 Email: statebarricadel@aol.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Maintenance of traffic and utility signage <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Received pricing and will use their services if we're the low bidder. <br />MBE/WBE Firm Premium Concrete <br />Owner or Contact at MBE/WBE Firm <br />Telephone: <br />Rob Becker <br />4-264-0196 Fax: 574-266-5392 Email: rbecker@premiumconcreteonline.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: Concrete flat work. <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: No bid received <br />Version 10/18/2016 Contractor's Bid for Public Works - 11 <br />