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CITY OF SOUTH BEND <br />o46ourr[uE4a <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />-e <br />FORM MWBE-1.0 <br />MBEIWBE PARTICIPATION <br />ee6s <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBEIMBE participation. <br />It Is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number: 116-041B Project Name: Fellows Streetsca e <br />Bidder: LaPorte Construction Co., Inc. Total Bid Amount: $ 567,345.00 <br />Page , of <br />Name 8 Address of #NBEMlBB <br />Primary Contact Person <br />(NamefTelephon <br />Scope of Work to be Performed <br />(Attach scvpelschedule if you need additional space) <br />Dollar Amount of <br />MBENVBE Component <br />Percentage <br />of Total <br />Bid/Pro osal <br />'y / t� <br />LAMA*' Grv�s irac�t o1 (f lk, <br />Jo eo% 577 <br />U�4etP D1 6(0352 <br />ye) <br />LQ1�j SG�rgn <br />5V(V�,w5 ay, tqj J(k4t,4VkI r <br />mvlit <br />1001/1 <br />Submitted by: Lori Schrad, President <br />(;��- <br />Print Name <br />Signature <br />Version 10/17/2016 Contractor's Bid for Public Works - 8 Addendum 1 <br />6/27/17 <br />