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CITY OF SOUTH BEND <br />b �eurrie\L?> <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY1, <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBENVBE PARTICIPATION <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Worsts Projects involving MBE 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: 1031-2017 Project Name: Morris Performing Arts Center Morris BistrolPalais Lobby Improvements <br />Bidder: Wilburn Construction Company, LLC Total Bid Amount 22Zlb <br />o"' MBEIWBE Goal: 7 <br />Page of <br />Name & Address of MBEMBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />MBEIWBE Component <br />Percentage <br />of Total <br />Bid/Proposal <br />C. ct_c_r- <br />��� tom. 1�su;i•w Or. <br />222, Boo <br />Submitted by: <br />Michelle Wilburn <br />Print Name <br />Version 1011712016 Contractor's Bid for Public Works - 8 <br />12/21/17 <br />Date <br />