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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 1 OF 1 <br />Project Number: 116-082A MBEIWBE Participation Goal 7.1% <br />Project Name: Bowen Street Drainage Improvements <br />Bidder: Walsh & Kelly, Inc. <br />By: South Bend Area Manager 8/22/17 <br />(Signature) (Title) (Date) <br />MBEIWBE Firm State Barricading, Inc. <br />Owner or Contact at MBEIWBE Firm Michelle Wolf <br />Telephone: 574-485-8711 Fax: 574-287-1744 Email: mwolfll@outlook.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Traffic Control <br />RESULTS OF CONTACT WITH THE MBEIWBE FIRM: <br />MBE/WBE Firm <br />Owner or Contact at MBEIWBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBEIWBE FIRM: <br />Version 7/28/2016 Contractor's Bid for Public Works - 23 <br />