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CITY OF SOUTH BEND O4 gOUTN q�i <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />s <br />FORM MWBE-2.1 '$ <br />MBE/WBE CONTACTED IN65 <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 2 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) (Date) <br />MBElWBE Firm SlusserS <br />Owner or Contact at MBE/WBE Firm John Williamson <br />Telephone: 574-722-3102 Fax: 574-722-2993 Email: jdw@slussers.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />mulched seeding <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Received quote via fax. We will use their services if we're the low bidder. <br />MBE/WBE Firm Conco Spray Solutions <br />Owner or Contact at MBE/WBE Firm Jennifer Hoop <br />Telephone: 317-428-6543 Fax: 888-791-2220 Email: jhoop@concospray.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: Coatings for exterior and interior of wetwelol and. <br />valve vault. <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Received pricing and will use their services if we're the low bidder. <br />Version 10/18/2016 Contractor's Bid for Public Works - 11 <br />